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Introducing the "SIMline"-A Simulation Course in the Management of Severe Burns as a Tool in Undergraduate Medical Education. J Pers Med 2023; 13:jpm13020338. [PMID: 36836572 PMCID: PMC9963950 DOI: 10.3390/jpm13020338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Background: Management of burn injuries presents a complex and challenging situation for medical staff, especially for inexperienced young doctors. However, training on how to treat burn victims in the clinical setting is rarely taught in undergraduate medical classes. We have created the "SIMline", a simulation training program explicitly designed for coaching medical students in burn management. Methods: A total of 43 students participated in the "SIMline" course, which took place at the training facility at the Medical University of Graz, between 2018 and 2019. The course provided theoretical classes, practical exercises, and a full-scale care process simulation training. The learning progress of the students was monitored via a formative integrated test. Results: Students showed great progress throughout the course of the "SIMline" program, as their test scores improved by an average of 88%. The passing rate was 0% at the first exam (prior to course) as compared to 87% at the final exam, taken after the training. Conclusions: Comprehensive practical training programs in burn care are underrepresented in medical education. The "SIMline" course presents a novel and effective approach in training medical students in burn management. However, follow-up evaluation is necessary to confirm long-term educational benefits.
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Biswas A, Dalal K, Sawon RA, Mayaboti CA, Mashreky SR. Emergency management for severe burn (EMSB) course for the nurses in Bangladesh: opportunity and way forward. Heliyon 2022; 8:e09156. [PMID: 35846460 PMCID: PMC9280581 DOI: 10.1016/j.heliyon.2022.e09156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 08/03/2021] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Methodology Results Conclusions
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3
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Hendriks TCC, Botman M, de Haas LEM, Mtui GS, Nuwass EQ, Jaspers MEH, Niemeijer AS, Nieuwenhuis MK, Winters HAH, van Zuijlen PPM. Burn scar contracture release surgery effectively improves functional range of motion, disability and quality of life: A pre/post cohort study with long-term follow-up in a Low- and Middle-Income Country. Burns 2021; 47:1285-1294. [PMID: 33485727 DOI: 10.1016/j.burns.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/10/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Burn scar contractures limit range of motion (ROM) of joints and have substantial impact on disability and the quality of life (QoL) of patients, particularly in a Low- and Middle-Income Country (LMIC) setting. Studies on the long-term outcome are lacking globally; this study describes the long-term impact of contracture release surgery performed in an LMIC. METHODS This is a pre-post cohort study, conducted in a referral hospital in Tanzania. Patients who underwent burn scar contracture release surgery in 2017-2018 were eligible. ROM (goniometry), disability (WHODAS 2.0) and QoL (EQ-5D) were assessed. The ROM data were compared to the ROM that is required to perform activities of daily living without compensation, i.e. functional ROM. Assessments were performed preoperatively and at 1, 3, 6 and 12 months postoperatively. RESULTS In total, 44 patients underwent surgery on 115 affected joints. At 12 months, the follow-up rate was 86%. The mean preoperative ROM was 37.3% of functional ROM (SD 31.2). This improved up to 108.7% at 12 months postoperatively (SD 42.0, p < 0.001). Disability-free survival improved from 55% preoperatively to 97% at 12 months (p < 0.001) postoperatively. QoL improved from 0.69 preoperatively, to 0.93 (max 1.0) at 12 months postoperatively (p < 0.001). Patients who regained functional ROM in all affected joints reported significantly less disability (p < 0.001) and higher QoL (p < 0.001) compared to patients without functional ROM. CONCLUSIONS Contracture release surgery performed in an LMIC significantly improved functional ROM, disability and QoL. Results showed that regaining a functional joint is associated with less disability and higher QoL.
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Affiliation(s)
- T C C Hendriks
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Haydom Lutheran Hospital, Haydom, Tanzania; Amsterdam Public Health Research Institute, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands.
| | - M Botman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands
| | - L E M de Haas
- Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands
| | - G S Mtui
- Haydom Lutheran Hospital, Haydom, Tanzania; Global Surgery Amsterdam, The Netherlands
| | - E Q Nuwass
- Haydom Lutheran Hospital, Haydom, Tanzania; Global Surgery Amsterdam, The Netherlands
| | - M E H Jaspers
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands
| | - A S Niemeijer
- Burn Center, Martini Hospital, Groningen, The Netherlands; Association of Dutch Burn Centers, The Netherlands
| | - M K Nieuwenhuis
- Burn Center, Martini Hospital, Groningen, The Netherlands; Association of Dutch Burn Centers, The Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands
| | - P P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Burn Center, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Amsterdam Movement Sciences, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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Baldwin AJ. Volunteering for burns moulage as a medical student. Burns 2019; 45:1488-1489. [PMID: 31174973 DOI: 10.1016/j.burns.2019.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Alexander J Baldwin
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
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D'Asta F, Homsi J, Sforzi I, Wilson D, de Luca M. "SIMBurns": A high-fidelity simulation program in emergency burn management developed through international collaboration. Burns 2018; 45:120-127. [PMID: 30268630 DOI: 10.1016/j.burns.2018.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 12/23/2022]
Abstract
Acute management of a severely burned patient is an infrequent and stressful situation that requires medical knowledge as well as immediate coordinated action. Many adverse events in health care result from issues related to the application of 'non-technical' skills such as communication, teamwork, leadership and decision making rather than lack of medical knowledge. Training in these skills is known as Crisis Resource Management (CRM) training. In order to create well-prepared burn teams, it is critical to teach CRM principles through high-fidelity simulation (HFS). While CRM teaches foundational non-technical skills, HFS incorporates lifelike, whole-body, fully-responsive mannequins in order to provide a realistic emergency situation. The aim of the study is to describe the development of a novel high-fidelity simulation course called "SIMBurns: High Fidelity Simulation Program for Emergency Burn Management" that uses CRM as its foundation and is focused on management of burn injuries. The course was designed by a panel of simulation and burns experts from Meyer Children's Hospital in Italy and Birmingham Children's Hospital in the U.K. Simulation Program experts were certified by Boston Children's Hospital's Simulation Program. In this paper, we describe the course's design, development, structure, and participant's assessment of the course. Since the creation of the SIMBurns course in 2013, 9 courses have been conducted and 101 participants have attended the course. The course was well-received and its "Overall Satisfaction" was rated at 4.8/5. The primary objective in the SIMBurns course - to teach teamwork and CRM skills to medical staff involved in emergency burn care - was also met at 4.8/5. Participants felt that the course developed their ability to interact with other team members, further improved their understanding of how to appropriately use resources, emphasized the importance of role clarity and developed their communication skills. Additional quantitative and qualitative analyses obtained from participants were also reviewed after each course. The SIMBurns course aims to contribute to the education of those in healthcare in order to improve patient safety and to continue advancing the education of our emergency burn care teams.
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Affiliation(s)
- Federica D'Asta
- Burns Centre, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom; AOU Meyer Children Hospital, Florence, Italy. federica.d'
| | | | | | - David Wilson
- Burns Centre, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
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7
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Using "The Burns Suite" as a Novel High Fidelity Simulation Tool for Interprofessional and Teamwork Training. J Burn Care Res 2018; 37:235-42. [PMID: 26056756 DOI: 10.1097/bcr.0000000000000262] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Educational theory highlights the importance of contextualized simulation for effective learning. The authors recently published the concept of "The Burns Suite" (TBS) as a novel tool to advance the delivery of burns education for residents/clinicians. Effectively, TBS represents a low-cost, high-fidelity, portable, immersive simulation environment. Recently, simulation-based team training (SBTT) has been advocated as a means to improve interprofessional practice. The authors aimed to explore the role of TBS in SBTT. A realistic pediatric burn resuscitation scenario was designed based on "advanced trauma and life support" and "emergency management of severe burns" principles, refined utilizing expert opinion through cognitive task analysis. The focus of this analysis was on nontechnical and interpersonal skills of clinicians and nurses within the scenario, mirroring what happens in real life. Five-point Likert-type questionnaires were developed for face and content validity. Cronbach's alpha was calculated for scale reliability. Semistructured interviews captured responses for qualitative thematic analysis allowing for data triangulation. Twenty-two participants completed TBS resuscitation scenario. Mean face and content validity ratings were high (4.4 and 4.7 respectively; range 4-5). The internal consistency of questions was high. Qualitative data analysis revealed two new themes. Participants reported that the experience felt particularly authentic because the simulation had high psychological and social fidelity, and there was a demand for such a facility to be made available to improve nontechnical skills and interprofessional relations. TBS provides a realistic, novel tool for SBTT, addressing both nontechnical and interprofessional team skills. Recreating clinical challenge is crucial to optimize SBTT. With a better understanding of the theories underpinning simulation and interprofessional education, future simulation scenarios can be designed to provide unique educational experiences whereby team members will learn with and from other specialties and professions in a safe, controlled environment.
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Biswas A, Rahman F, Maitz P, Baset KU, Hossain J, Mashreky SR. An evaluation of Emergency Management of Severe Burn (EMSB) course in Bangladesh: a strategic direction. BURNS & TRAUMA 2017; 5:12. [PMID: 28466024 PMCID: PMC5408382 DOI: 10.1186/s41038-017-0078-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 03/29/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Burn is one of the major public health problems in Bangladesh. Specialized personnel and technologies are required, however, in many cases they are not readily available. Taking the situation into account, Interplast Australia and New Zealand, Australia & New Zealand Burn Association (ANZBA), and Centre for Injury Prevention and Research, Bangladesh (CIPRB) initiated Emergency Management of Severe Burn (EMSB) training programme for Bangladeshi physicians in 2008 to help improving their burn management skill. The study was designed to evaluate the effect of EMSB programme in Bangladesh. METHODS Both qualitative and quantitative methods were adopted. A cross-sectional survey was conducted to obtain quantitative information from 38 randomly selected EMSB-trained doctors among 380 trained physicians based on a five year database of EMSB (2008-2012). In-depth interviews (IDIs) and focus group discussion (FGD) were used as data collection techniques to get information. RESULTS A total of 32 participants completed the interview. It was found that 87.5% (n=28) doctors were using their skill in burn management that they learnt from the EMSB course. About 43.8% (n=14) doctors felt that the course largely helped improve their confidence. Majority (56.2%, n=18) of doctors stated EMSB is essential for the Bangladeshi doctors to learn better management of burns. Qualitative findings show that the courses were organized successfully with an excellent coordination, maintaining same quality and standard as running anywhere in the world. For its effectiveness, the course has been recommended to train graduate nurses and junior doctors from the periphery of the country. CONCLUSIONS EMSB has already created a large doctor community who are able to effectively manage burn patients. It also has proven its indispensability for learning burn management skill. The EMSB established a platform to serve the burn victims and reduce the burden of injuries in Bangladesh.
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Affiliation(s)
- Animesh Biswas
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Fazlur Rahman
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.,Department of Epidemiology, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
| | | | - Kamran Ul Baset
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Jahangir Hossain
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Saidur Rahman Mashreky
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.,Department of Epidemiology, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
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Whittam AM, Chow W. An educational board game for learning and teaching burn care: A preliminary evaluation. Scars Burn Heal 2017; 3:2059513117690012. [PMID: 29799570 PMCID: PMC5965322 DOI: 10.1177/2059513117690012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Timely and effective assessment, resuscitation and transfer of patients with
severe burns has been demonstrated to improve outcome. A dedicated one-day
course exists to equip all frontline emergency healthcare workers with the
necessary knowledge and skills to manage severe burn injuries. More recently, a
board game has been developed which aims to act as a learning and practice
development tool for those managing burn injuries. We present the findings of
our preliminary evaluation of this game. We played this game with a
multidisciplinary group of staff including doctors, nurses and therapists. A
proportion of these participants had previously completed the Emergency
Management of Severe Burns (EMSB) course. We obtained subjective results from a
questionnaire, using both Likert-type ratings and open-ended questions. The
styling of the game and ease of instructions was rated from ‘average’ to
‘excellent’. The relevance of questions was rated from ‘good’ to ‘excellent’.
The usefulness of the game to increase knowledge and stimulate discussion was
rated between ‘good’ and ‘excellent’. All participants stated that they would
recommend the game to other healthcare professionals. This is the only burns and
plastic surgery-related educational game in the literature. Educational games
adhere to principles of adult learning but there is insufficient evidence in the
literature to either confirm or refute their utility. Our preliminary evaluation
of this game has shown that it achieves its main aims, namely to increase
knowledge in burn care and to stimulate discussion. Further work is required to
assess the board game. Staff who work in emergency areas should know how to assess, treat and transfer
patients with severe burns. This improves the outcome for these patients. Board
games have been used in other areas of teaching in medicine. This article shows the way we used a board game to teach doctors, nurses and
therapists about how to assess and treat burns. This board game has been made to
increase knowledge and to help players talk about and share how they have
managed these injuries in the past. We asked staff to play the game and tell us what they thought about the design
and the instructions. We also asked whether it helped them increase their
knowledge and if it helped to start a discussion about treating burns. We asked
if they thought other staff should use the game. We found that the staff who played the game rated the style and instructions from
‘average’ to ‘excellent’. They rated the questions and if it helped to start a
discussion as ‘good’ to ‘excellent’. All staff would recommend the game as a way
of teaching about burns. This is the only game which exists to help staff learn about treating burns. We
feel it should be used with all staff who see and manage patients with burns.
More work needs to be done to look at this game in more detail.
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Ziegler B, Hirche C, Horter J, Kiefer J, Grützner PA, Kremer T, Kneser U, Münzberg M. In view of standardization Part 2: Management of challenges in the initial treatment of burn patients in Burn Centers in Germany, Austria and Switzerland. Burns 2016; 43:318-325. [PMID: 27665246 DOI: 10.1016/j.burns.2016.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Initial therapy of severe burns in specialized burn trauma centers is a challenging task faced by the treating multi-professional and interdisciplinary team. A lack of consistent operating procedures and varying structural conditions was recently demonstrated in preliminary data of our group. These results raised the question on how specific treatment measures in acute burn care are met in the absence of standardized guidelines. MATERIAL AND METHODS A specific questionnaire containing 57 multiple-choice questions was sent to all 22 major burn centers in Germany, Austria and Switzerland. The survey included standards of airway management and ventilation, fluid management and circulation, body temperature monitoring and management, topical burn wound treatment and a microbiological surveillance. Additionally, the distribution of standardized course systems was covered. RESULTS 17 out of 22 questionnaires (77%) were returned completed. Regarding volume resuscitation, results showed a similar approach in estimating initial fluid while discrepancies persisted in the use of colloidal fluid and human albumin. Elective tracheostomy and the need for bronchoscopy with suspected inhalation injury were the most controversial issues revealed by the survey. Topical treatment of burned body surface also followed different principles regarding the use of synthetic epidermal skin substitutes or enzymatic wound debridement. Less discrepancy was found in basic diagnostic measures, body temperature management, estimation of the extent of burns and microbiological surveillance. CONCLUSION While many burn-related issues are clearly not questionable and managed in a similar way in most participating facilities, we were able to show that the most contentious issues in burn trauma management involve initial volume resuscitation, management of inhalation trauma and topical burn wound treatment. Further research is required to address these topics and evaluate a potential superiority of a regime in order to increase the level of evidence.
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Affiliation(s)
- Benjamin Ziegler
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Johannes Horter
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Jurij Kiefer
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, Air Rescue Center, BG Trauma Center Ludwigshafen/Rhine, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Thomas Kremer
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopedic Surgery, Air Rescue Center, BG Trauma Center Ludwigshafen/Rhine, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany.
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Sadideen H, Goutos I, Kneebone R. Burns education: The emerging role of simulation for training healthcare professionals. Burns 2016; 43:34-40. [PMID: 27576935 DOI: 10.1016/j.burns.2016.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/10/2016] [Accepted: 07/14/2016] [Indexed: 11/18/2022]
Abstract
Burns education appears to be under-represented in UK undergraduate curricula. However current postgraduate courses in burns education provide formal training in resuscitation and management. Simulation has proven to be a powerful modality to advance surgical training in both technical and non-technical skills. We present a literature review that summarises the format of current burns education, and provides detailed insight into historic, current and novel advances in burns simulation for both technical and non-technical skills, that can be used to augment surgical training. Addressing the economic and practical limitations of current immersive surgical simulation is important, and this review proposes future directions for integration of innovative simulation strategies into training curricula.
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Affiliation(s)
- Hazim Sadideen
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK.
| | - Ioannis Goutos
- Centre for Cutaneous Research, Blizard institute, Queen Mary University of London, 4 Newark Street, London E1 2AT
| | - Roger Kneebone
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK
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Staruch RMT, Beverly A, Lewis D, Wilson Y, Martin N. Should early amputation impact initial fluid therapy algorithms in burns resuscitation? A retrospective analysis using 3D modelling. J ROY ARMY MED CORPS 2016; 163:58-64. [PMID: 27278968 DOI: 10.1136/jramc-2015-000438] [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: 03/09/2015] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 11/04/2022]
Abstract
AIMS While the epidemiology of amputations in patients with burns has been investigated previously, the effect of an amputation on burn size and its impact on fluid management have not been considered in the literature. Fluid resuscitation volumes are based on the percentage of the total body surface area (%TBSA) burned calculated during the primary survey. There is currently no consensus as to whether the fluid volumes should be recalculated after an amputation to compensate for the new body surface area. The aim of this study was to model the impact of an amputation on burn size and predicted fluid requirement. METHODS A retrospective search was performed of the database at the Queen Elizabeth Hospital Birmingham Regional Burns Centre to identify all patients who had required an early amputation as a result of their burn injury. The search identified 10 patients over a 3-year period. Burn injuries were then mapped using 3D modelling software. BurnCase3D is a computer program that allows accurate plotting of burn injuries on a digital mannequin adjusted for height and weight. Theoretical fluid requirements were then calculated using the Parkland formula for the first 24 h, and Herndon formula for the second 24 h, taking into consideration the effects of the amputation on residual burn size. RESULTS AND CONCLUSIONS This study demonstrated that amputation can have an unpredictable effect on burn size that results in a significant deviation from predicted fluid resuscitation volumes. This discrepancy in fluid estimation may cause iatrogenic complications due to over-resuscitation in burn-injured casualties. Combining a more accurate estimation of postamputation burn size with goal-directed fluid therapy during the resuscitation phase should enable burn care teams to optimise patient outcomes.
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Affiliation(s)
- Robert M T Staruch
- School of Engineering & Applied Sciences, Harvard University, USA.,Department of Burns and Plastic Surgery, St Marys Hospital, Imperial College Healthcare, London, UK
| | - A Beverly
- Department of Anaesthetics, Royal Surrey County Hospital, Guildford, UK
| | - D Lewis
- Department of Burns & Plastic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Y Wilson
- Department of Burns & Plastic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - N Martin
- Department of Burns & Plastic Surgery, St Andrews Centre for Burns & Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
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Advanced Burn Life Support for Day-to-Day Burn Injury Management and Disaster Preparedness: Stakeholder Experiences and Student Perceptions Following 56 Advanced Burn Life Support Courses. J Burn Care Res 2016; 36:455-64. [PMID: 25167372 DOI: 10.1097/bcr.0000000000000155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Educational programs for clinicians managing patients with burn injuries represent a critical aspect of burn disaster preparedness. Managing a disaster, which includes a surge of burn-injured patients, remains one of the more challenging aspects of disaster medicine. During a 6-year period that included the development of a burn surge disaster program for one state, a critical gap was recognized as public presentations were conducted across the state. This gap revealed an acute and greater than anticipated need to include burn care education as an integral part of comprehensive burn surge disaster preparedness. Many hospital and prehospital providers expressed concern with managing even a single, burn-injured patient. While multiple programs were considered, Advanced Burn Life Support (ABLS), a national standardized educational program was selected to help address this need. The curriculum includes initial care for the burn-injured patient as well as an overview of the burn centers role in the disaster preparedness community. After 4 years and 56 classes conducted across the state, a survey was developed including a section that measured the perceptions of those who completed the ABLS educational program. The study specifically examines questions including whether clinicians perceived changes in their burn care knowledge, skills and abilities, and burn disaster preparedness following completion of the program? including whether clinicians.
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14
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In view of standardization: Comparison and analysis of initial management of severely burned patients in Germany, Austria and Switzerland. Burns 2015; 41:33-8. [DOI: 10.1016/j.burns.2014.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/29/2014] [Accepted: 08/22/2014] [Indexed: 11/19/2022]
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Proposing "the burns suite" as a novel simulation tool for advancing the delivery of burns education. J Burn Care Res 2014; 35:62-71. [PMID: 23877145 DOI: 10.1097/bcr.0b013e31829b371d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Educational theory highlights the importance of contextualized simulation for effective learning. We explored this concept in a burns scenario in a novel, low-cost, high-fidelity, portable, immersive simulation environment (referred to as distributed simulation). This contextualized simulation/distributed simulation combination was named "The Burns Suite" (TBS). A pediatric burn resuscitation scenario was selected after high trainee demand. It was designed on Advanced Trauma and Life Support and Emergency Management of Severe Burns principles and refined using expert opinion through cognitive task analysis. TBS contained "realism" props, briefed nurses, and a simulated patient. Novices and experts were recruited. Five-point Likert-type questionnaires were developed for face and content validity. Cronbach's α was calculated for scale reliability. Semistructured interviews captured responses for qualitative thematic analysis allowing for data triangulation. Twelve participants completed TBS scenario. Mean face and content validity ratings were high (4.6 and 4.5, respectively; range, 4-5). The internal consistency of questions was high. Qualitative data analysis revealed that participants felt 1) the experience was "real" and they were "able to behave as if in a real resuscitation environment," and 2) TBS "addressed what Advanced Trauma and Life Support and Emergency Management of Severe Burns didn't" (including the efficacy of incorporating nontechnical skills). TBS provides a novel, effective simulation tool to significantly advance the delivery of burns education. Recreating clinical challenge is crucial to optimize simulation training. This low-cost approach also has major implications for surgical education, particularly during increasing financial austerity. Alternative scenarios and/or procedures can be recreated within TBS, providing a diverse educational immersive simulation experience.
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D’Asta F, Homsi J, Clark P, Buffalo M, Melandri D, Carboni A, Pinzauti E, Graziano A, Masellis A, Bussolin L, Messineo A. Introducing the Advanced Burn Life Support (ABLS) course in Italy. Burns 2014; 40:475-9. [DOI: 10.1016/j.burns.2013.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
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van der Wal MBA, Vloemans JFPM, Tuinebreijer WE, van de Ven P, van Unen E, van Zuijlen PPM, Middelkoop E. Outcome after burns: an observational study on burn scar maturation and predictors for severe scarring. Wound Repair Regen 2013; 20:676-87. [PMID: 22985039 DOI: 10.1111/j.1524-475x.2012.00820.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Long-term outcome of burn scars as well as the relation with clinically relevant parameters has not been studied quantitatively. Therefore, we conducted a detailed analysis on the clinical changes of burn scars in a longitudinal setup. In addition, we focused on the differences in scar quality in relation to the depth, etiology of the burn wound and age of the patient. Burn scars of 474 patients were subjected to a scar assessment protocol 3, 6, and 12 months postburn. Three different age groups were defined (≤5, 5-18, and ≥18 years). The observer part of the patient and observer scar assessment scale revealed a significant (p < 0.001) improvement in scar quality at 12 months compared with the 3- and 6-month data. Predictors for severe scarring are depth of the wound (p < 0.001) and total body surface area burned (p < 0.001). Etiology (p = 0.753) and age (p > 0.230) have no significant influence on scar quality when corrected for sex, total body surface area burned, time, and age or etiology, respectively.
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Vloemans A, Dokter J, van Baar M, Nijhuis I, Beerthuizen G, Nieuwenhuis M, Kuijper E, Middelkoop E. Epidemiology of children admitted to the Dutch burn centres. Changes in referral influence admittance rates in burn centres. Burns 2011; 37:1161-7. [DOI: 10.1016/j.burns.2011.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 04/12/2011] [Accepted: 05/02/2011] [Indexed: 11/15/2022]
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Breederveld RS, Nieuwenhuis MK, Tuinebreijer WE, Aardenburg B. Effect of training in the Emergency Management of Severe Burns on the knowledge and performance of emergency care workers as measured by an online simulated burn incident. Burns 2010; 37:281-7. [PMID: 21074330 DOI: 10.1016/j.burns.2010.08.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 07/28/2010] [Accepted: 08/20/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the value of training for the Emergency Management of Severe Burns (EMSB) for medical and nursing staff working in emergency care as measured by their performance in a simulated burn incident online program. METHODS An Internet-based questionnaire, which included a simulated burn incident, was developed. All of the medical and nursing staff in hospital emergency departments and ambulance services in the Netherlands were invited to complete this questionnaire. The effect of EMSB training on the individual's knowledge of and performance in the emergency management of a burn victim was evaluated because some of the respondents had participated in EMSB training, whereas others had not. RESULTS Of the 280 responses received, 198 questionnaires were included in the analysis. The analyzed questionnaires were submitted by nurses (43%), ambulance workers (33%), and physicians (23%). Only 14% of the people in the study had participated in EMSB training, whereas 78% had received other or additional life support training and 22% of respondents had no additional life support training. Medical and nursing staff who had participated in EMSB training performed better in the following subjects: mentioning hypothermia as a focus of attention (70% versus 53%, p=0.085), correct use of hand size (70% versus 36%, p=0.001) and use of the correct hand percentage in the estimation of total body surface area (TBSA, 82% versus 57%, p=0.015), suspicion of no airway obstruction in an outdoor trauma (93% versus 63%, p = 0.002) and referral of functional area burns to a burn center (22% versus 8%, p = 0.04). However, both groups overestimated the TBSA (34% of the total group overestimated ≥ 20%) and did not know the correct formula for fluid resuscitation (87% of the total group). CONCLUSION There is some evidence that medical staff members who have participated in EMSB training have a better knowledge of emergency management and are more effective in the management of a simulated burn case. However, both individuals who had participated in EMSB as well as those who had not participated in EMSB needed additional training in EMSB.
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Affiliation(s)
- Roelf S Breederveld
- Department of Surgery-Burn Center, Red Cross Hospital, 1940 EB Beverwijk, The Netherlands.
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Muehlberger T, Ottomann C, Toman N, Daigeler A, Lehnhardt M. Emergency pre-hospital care of burn patients. Surgeon 2010; 8:101-4. [DOI: 10.1016/j.surge.2009.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
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Al-Benna S, Patani N, Al-Ajam Y. Burns is not in the core curricula of medical schools in the United Kingdom. Burns 2008; 34:902. [DOI: 10.1016/j.burns.2008.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 02/27/2008] [Indexed: 10/22/2022]
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Lindford AJ, Lamyman MJ, Lim P. Review of the emergency management of severe burns (EMSB) course. Burns 2006; 32:391. [PMID: 16527414 DOI: 10.1016/j.burns.2005.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 12/15/2005] [Indexed: 11/22/2022]
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