1
|
Li C, Solish M, Rogers AD. Evaluation of patient-reported outcome measures in burn-specific tools: A systematic review. Burns 2024; 50:1-12. [PMID: 38040617 DOI: 10.1016/j.burns.2023.10.004] [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: 06/30/2022] [Revised: 09/15/2023] [Accepted: 10/17/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) are now well-established tools to evaluate the quality of patient-centred care. Due to the multi-faceted and multi-disciplinary nature of the practice of burn care, as well as the range of significant potential sequelae, PROM's should form a fundamental component of burn quality improvement programs. We aim to 1. Explore biological, psychological, and social considerations that are currently listed in burn-specific PROM tools, as well as their efficacy, 2. Evaluate biological, psychological, and social factors that are considered in new burn-specific PROM tools or those under development, and 3. Identify any opportunities with respect to burn-specific PROM tools, in order to inform future investigation in this area. METHODS A search was performed of MEDLINE (Ovid), EMBASE, CINAHL, and the Cochrane Library databases. Two independent reviewers screened article titles/abstracts and then the full texts using Covidence. All studies were graded independently according to the Quality Rating Scheme for Studies and Other Evidences. RESULTS The initial search yielded 552 references. Based on ab initio inclusion and exclusion criteria, 133 full-text studies were assessed for eligibility, and 21 articles were ultimately included in the systematic review. Due to study heterogeneity, a qualitative synthesis was conducted. Existing burn-specific PROMs covered a range of biological, psychological, and social factors affecting adult and paediatric patients with burn injury, but several studies required additional PROMs for a thorough evaluation. Burn-specific PROM tools under development are poised to fill this deficit. CONCLUSION Major burn injuries are a unique form of trauma, requiring coordinated management that considers numerous factors not relevant to other patient populations. Further research is necessary to validate existing burn-specific PROM tools and to develop more comprehensive burn-specific PROM measures that more comprehensively incorporate the bio-psycho-social model of health.
Collapse
Affiliation(s)
- Calandra Li
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Max Solish
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Alan D Rogers
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Ontario, Canada; Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Ontario, Canada.
| |
Collapse
|
2
|
van de Warenburg MS, Munk EFL, Davies A, McBride CA, Edgar DW, Vehmeijer-Heeman MLAW, Young AE. Working Towards Holistic Scar Assessment and Improved Shared Decision Making in Global Burn Care. J Burn Care Res 2024; 45:112-119. [PMID: 37310702 PMCID: PMC10768758 DOI: 10.1093/jbcr/irad089] [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: 04/20/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous burn scars impact various aspects of life. Scar treatment is mainly evaluated on scar characteristics. Consensus is needed on which other outcomes to capture, ensuring they are relevant to patients, clinicians, and researchers. The aim of this study was to identify, discuss and analyze outcomes related to cutaneous burn scarring, incorporating the voice of patients and views of healthcare professionals. For this, a Delphi process consisting of two survey rounds and a consensus meeting was initiated. Burn scar-related outcomes were identified from an existing comprehensive list of 100 outcomes by an international panel of patients, healthcare professionals and researchers. Fifty-nine outcomes were identified from the Delphi process as related to scarring (≥60% votes). Outcomes less impactful in relation to scar outcomes included psychosocial issues, sense of normality, understanding of treatment, costs and systemic issues. To represent a holistic assessment of outcomes related to cutaneous burn scarring, this Delphi process established a battery of outcomes currently included in scar quality assessment tools, and an expanded set of less frequently considered outcomes. Future work in this area must include the patient voice from developing countries. This is essential to identify globally applicable outcomes related to scarring.
Collapse
Affiliation(s)
- Milly S van de Warenburg
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Elleke F L Munk
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Anna Davies
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Craig A McBride
- Centre for Children’s Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Australia
- Burn Injury Research Node, The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
| | - Mariëlle L A W Vehmeijer-Heeman
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Amber E Young
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, UK
| |
Collapse
|
3
|
Tiongco RFP, Dane JM, Owens MA, Cemaj SL, Puthumana JS, Ross ES, Redett RJ, Hultman CS, Caffrey JA, Lerman SF. A Systematic Review and Meta-analysis of Sleep Disturbances in Pediatric Burn Survivors. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
4
|
Liu H, Shu F, Xu H, Ji C, Wang Y, Lou X, Luo P, Xiao S, Xia Z, Lv K. Ablative fractional carbon dioxide laser improves quality of life in patients with extensive burn scars: A nested case-control study. Lasers Surg Med Suppl 2022; 54:1207-1216. [PMID: 36116066 DOI: 10.1002/lsm.23603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/11/2022] [Accepted: 09/06/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Ablative fractional carbon dioxide laser (CO2 -AFL) for small-area burn scar management shows encouraging outcomes. Few studies, however, focused on comprehensive outcomes following CO2 -AFL treatment for extensive burn scars. This study evaluated whether CO2 -AFL surgery improved the quality of life (QoL) for burn survivors with extensive hypertrophic scars. METHODS A retrospective nested case-control study was initiated to analyze the efficacy of CO2 -AFL treatment for patients with large-area burn scars. Patients with extensive burn scars (≥30% total body surface area [TBSA]) were registered in our hospital from March 2016 to October 2018. Patients undergoing CO2 -AFL surgery were divided into CO2 -AFL group, and patients undergoing conventional surgery were matched in a 1:1 ratio as the conventional surgery group according to the burned area. The questionnaires were collected and followed up. The 36-Item Short Form Health Survey (SF-36) and Burns Specific Health Scale-Brief (BSHS-B) were the primary parameters. Secondary parameters included the Pittsburgh Sleep Quality Index (PSQI), University of North Carolina "4P" Scars Scale (UNC4P), Patient Scars Assessment Scale for Patient (POSAS-P), and Douleur Neuropathique 4 questions (DN4). RESULTS 23 patients (55.96 ± 21.59% TBSA) were included in CO2 -AFL group and 23 patients (57.87 ± 18.21% TBSA) in conventional surgery group. Both the BSHS-B total score (CO2 -AFL vs. conventional surgery: 115.35 ± 29.24 vs. 85.43 ± 33.19, p = 0.002) and the SF-36 total score (CO2 -AFL vs. conventional surgery: 427.79 ± 118.27 vs. 265.65 ± 81.66, p < 0.001) for the CO2 -AFL group were higher than those for the conventional surgery group. Parameters for the CO2 -AFL group were lower than those for the conventional surgery group in all of the following comparisons: PSQI total score (CO2 -AFL vs. conventional surgery: 7.70 ± 3.74 vs. 12.26 ± 4.61, p = 0.001), POSAS-P total score (CO2 -AFL vs. conventional surgery: 26.48 ± 6.60 vs. 33.04 ± 4.56, p < 0.001), UNC4P total score (CO2 -AFL vs. conventional surgery: 5.57 ± 1.97 vs. 7.26 ± 1.81, p = 0.004), and DN4 score (CO2 -AFL vs. conventional surgery: 3 [2-5] vs. 5 [4-8], p = 0.004). CONCLUSIONS Compared to conventional surgery, whole scar CO2 -AFL surgery dramatically improved physical and mental health as well as QoL for people with extensive burn scars. Additionally, CO2 -AFL enhanced the evaluation of scars including their appearance, pain, itching, and a host of other symptoms.
Collapse
Affiliation(s)
- Huazhen Liu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China.,Department of Plastic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Futing Shu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Haiting Xu
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China.,Department of Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chao Ji
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Yuxiang Wang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Xiaozhen Lou
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Pengfei Luo
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Shichu Xiao
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Zhaofan Xia
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Kaiyang Lv
- Department of Plastic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
5
|
Lerman SF, Owens MA, Liu T, Puthumana J, Hultman CS, Caffrey JA, Smith MT. Sleep after burn injuries: A systematic review and meta-analysis. Sleep Med Rev 2022; 65:101662. [DOI: 10.1016/j.smrv.2022.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/09/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
|
6
|
Smolle C, Hutter MF, Kamolz LP. Life after Burn, Part II: Substance Abuse, Relationship and Living Situation of Burn Survivors. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050563. [PMID: 35629980 PMCID: PMC9147374 DOI: 10.3390/medicina58050563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022]
Abstract
Background and Objectives: After burns, social reintegration is a primary long-term objective. At the same time, substance-abuse disorders are more common in burn patients. The aim of this study was to assess prevalence of substance abuse pre- and postburn as well as living situation and relationship status relative to patient-reported health-related quality of life (HRQoL). Patients and Methods: Burn survivors treated as inpatients between 1 January 2012 and 31 December 2019 were retrospectively identified. Collected clinical data included: age, gender, time since injury, burn extent (%TBSA), and substance abuse. Patient-reported living situation, relationship status, smoking habits, alcohol and drug consumption pre- and postburn as well as the SF-36 study were ascertained via telephone survey. Inductive statistical analysis comprised uni- and multivariate testing. A p < 0.05 was considered as statistically significant. Results: A total of 128 patients, 93 (72.7%) men, with a mean age of 40.0 ± 15.7 years were included. Mean TBSA was 9.2 ± 11.0% and significantly lower in women (p = 0.005). General health SF-36 scores were significantly lower in women (67.6 ± 29.8) than men (86.0 ± 20.8, p = 0.002). Smoking decreased from 38.8% pre- to 31.1% postburn. A significant reduction in alcohol consumption was noted over time (p = 0.019). The rate of never-drinkers was 18.0% pre- and 27.3% postburn. Drug abuse was rare both pre- (7.8%) and postburn (5.3%). Living situation remained stable. None of the participants depended on assisted living or lived in a care facility postburn. In total, 75.8% and 67.2% were in a relationship pre- and postburn. Patients with higher alcohol consumption postburn were significantly more often male (p = 0.013) and had higher SF-36 general health scores (p < 0.001). Conclusions: HRQoL is better in men than in women after burn injury. A slight decrease in substance abuse postburn was noted. The connection between HRQoL and substance abuse after burn injuries needs to be investigated further in the future.
Collapse
|
7
|
Hutchinson KA, Amirali Karmali S, Abi-Jaoude J, Edwards T, Homsy C. Sleep Quality Among Burn Survivors And The Importance Of Intervention: A Systematic Review And Meta-Analysis. J Burn Care Res 2022; 43:1358-1379. [PMID: 35349676 DOI: 10.1093/jbcr/irac039] [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: 11/13/2022]
Abstract
Burn survivors undergo a plethora of physiologic disturbances which can greatly affect quality of life (QOL) and healing processes. This review aimed to systematically examine sleep quality among individuals with burns and to explore the effectiveness of interventions using a meta-analytic approach. A systematic review of the literature was conducted by searching for articles using various databases. Titles and abstracts were screened and full texts of retained articles were assessed based on eligibility criteria. Methodological quality was ascertained in all articles using various scales. Overall, 5,323 articles were screened according to titles and abstracts and 25 articles were retained following full-text screening. Of the twenty-five articles, 17 were assessed qualitatively while 8 were included in the meta-analysis. Based on the qualitative analysis, sleep was found to be negatively affected in burn patients. The subsample of 8 articles included in the meta-analysis showed an overall weighted mean effect size (Hedges's g) of 1.04 (SE = 0.4, 95% CI, z = 3.0; p < 0.01), indicating a large, positive effect of intervention on sleep quality for burn patients. This review was able to demonstrate the detrimental effects of burn injury on sleep quality. Several interventions have been examined throughout the literature and have shown to be beneficial for sleep quality. However, there is great heterogeneity between existing interventions. The results from this review suggest that further research is needed before recommendations can be made as to which intervention is most effective at improving sleep in patients suffering from burn injuries.
Collapse
Affiliation(s)
| | | | | | - Thomas Edwards
- University of Ottawa, Faculty of Health Sciences, School of Human Kinetics, Ottawa, Ontario, Canada
| | - Christopher Homsy
- Department of Surgery, Division of Plastic Surgery, Tufts Medical Center, Boston, USA
| |
Collapse
|
8
|
Chen LYA, Wu CY, Lee MB, Lin CH, Kao SC, Tu CC, Chen RC. Predictors for psychological distress of young burn survivors across three years: A cohort study of a burn disaster in Taiwan. J Nurs Scholarsh 2021; 54:56-63. [PMID: 34841644 PMCID: PMC9299193 DOI: 10.1111/jnu.12703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
Purpose The study aims to investigate long‐term psychological distress and its risk factors in the burn survivors. Design A longitudinal study with follow‐up interviews was conducted from November 2015–June 2018. A post‐burn baseline interview was conducted 6 months after the event, followed by annual surveys for three years. Methods The burn survivors received structured assessment through telephone in the four‐wave interviews, including the five‐item Brief Symptom Rating Scale (BSRS‐5); two‐item Patient Health Questionnaire (PHQ‐2); four‐item Startle, Physiological Arousal, Anger, and Numbness Scale (SPAN‐4); and six‐item Impact of Event Scale (IES‐6) alongside demographic data and other health‐related assessment. Findings A total of 180 respondents with the mean age of 23 years old completed the four waves of interview. Using the BSRS‐5 as the outcome, each variable had different input in psychological distress during the follow‐up years. The main finding was that the SPAN‐4 score could predict more than 62% of psychological distress between 6 months and 3 years after the disaster. The generalized estimating equation demonstrated that SPAN‐4, IES‐6, family functioning impairment, hypnotics use, adaptation to the event, and PHQ‐2 could predict psychological distress. However, the variable of follow‐up year did not exemplify significant estimation in the model. Conclusions The results indicated that different factors had various influences on psychological distress across the four follow‐up stages. PTSD‐like symptoms, depression, and anxiety were the most common psychological problems experienced by the young burn cohort in the longitudinal post‐traumatic period. Clinical relevance Healthcare providers should be aware of psychological consequences of traumatic events within up to a 3‐year post‐burn period, particularly post‐traumatic stress, depression, and anxiety symptoms.
Collapse
Affiliation(s)
- Lu-Yen Anny Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Second Degree Bachelor of Science in Nurisng, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Yi Wu
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.,Taiwanese Society of Suicidology & Taiwan Suicide Prevention Center, Taipei, Taiwan
| | - Ming-Been Lee
- Taiwanese Society of Suicidology & Taiwan Suicide Prevention Center, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, Shin-Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chi-Hung Lin
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Chen Kao
- Department of Health, New Taipei City Government, Banqiao, Taiwan
| | - Chung-Chieh Tu
- Department of Health, New Taipei City Government, Banqiao, Taiwan
| | - Ran-Chou Chen
- Department of Health, New Taipei City Government, Banqiao, Taiwan
| |
Collapse
|
9
|
Lv K, Liu H, Xu H, Wang C, Zhu S, Lou X, Luo P, Xiao S, Xia Z. Ablative fractional CO 2 laser surgery improving sleep quality, pain and pruritus in adult hypertrophic scar patients: a prospective cohort study. BURNS & TRAUMA 2021; 9:tkab023. [PMID: 34322556 PMCID: PMC8314205 DOI: 10.1093/burnst/tkab023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/20/2020] [Indexed: 11/28/2022]
Abstract
Background Poor sleep quality is associated with a decrease in quality of life in patients with major burn scars, combined with pruritus and pain. Few interventions have been reported to improve the sleep quality of patients with scars. In the current prospective cohort study, we investigated the efficacy of CO2-ablative fractional laser (AFL) surgery vs conventional surgery in post-burn patients with hypertrophic scars with sleep quality as the primary study outcome. Methods In total 68 consecutive patients undergoing scar surgical treatment were recruited, including a CO2-AFL surgery cohort (n = 35) and a conventional surgery cohort (n = 33). A subgroup from the AFL cohort was selected. Sleep quality, pain and pruritus were evaluated. Multiple linear regression analyses were performed to reveal the effect of CO2-AFL surgery. Results The CO2-AFL surgery cohort had significantly lower Pittsburgh sleep quality index (PSQI) global scores than the conventional surgery cohort after the last surgical treatment. In the subgroup of patients receiving hardware sleep monitoring, CO2-AFL markedly increased deep sleep time, deep sleep efficiency and reduced initial sleep latency. Compared to the conventional surgery cohort, the CO2-AFL cohort presented significantly lower pain and pruritus scores. Correlation analysis showed pain and pruritus were significantly associated with PSQI scores, and there were also significant correlations between pain and pruritus scores. Multiple linear regression analysis showed that surgery method was negatively linearly correlated with visual analog scale (VAS) pain score, brief pain inventory (BPI) total, VAS pruritus score, 5-D itch scale total, four-item itch questionnaire (FIIQ) total and PSQI total. Conclusions CO2-AFL surgery significantly improved sleep quality and reduced pain and pruritus of hypertrophic scar patients. The alleviation of sleep disorder was associated with improvement of deep sleep quality including deep sleep time and deep sleep deficiency. Trial registration The Chinese Clinical Trial Registry (ChiCTR200035268) approved retrospectively registration on 5 Aug 2020.
Collapse
Affiliation(s)
- Kaiyang Lv
- Department of Plastic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092; People's Republic of China.,Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Huazhen Liu
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Haiting Xu
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, People's Republic of China.,Department of Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Caixia Wang
- Shanghai Institute of Laser Technology, Shanghai 200233, People's Republic of China
| | - Shihui Zhu
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Xiaozhen Lou
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Pengfei Luo
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Shichu Xiao
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Zhaofan Xia
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| |
Collapse
|
10
|
Carrougher GJ, McMullen K, Amtmann D, Wolfe AE, Tenney D, Schneider JC, Yeakley J, Holavanahalli RK, Patterson L, Madison C, Gibran NS. "Living Well" After Burn Injury: Using Case Reports to Illustrate Significant Contributions From the Burn Model System Research Program. J Burn Care Res 2021; 42:398-407. [PMID: 32971531 PMCID: PMC10044562 DOI: 10.1093/jbcr/iraa161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The Burn Model System (BMS) program of research has been funded since 1993 by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The overarching aim of this program is to improve outcomes and quality of life for people with burns in the areas of health and function, employment, and community living and participation. This review reports on BMS contributions that have affected the lives of individuals with a significant burn injury using case reports to associate BMS contributions with recovery. In January 2020, current BMS grantee researchers assessed peer-reviewed BMS publications from 1994 to 2020. Using case report methodology, contributions were linked to three individuals treated at one of the four Burn Model System institutions. With over 25 years of NIDILRR funding, unique BMS contributions to patient recovery were identified and categorized into one of several domains: treatment, assessment measures, sequelae, peer support, employment, and long-term functional outcomes. A second review for significant results of BMS research that add to the understanding of burn injury, pathophysiology, and recovery research was identified and categorized as injury recovery research. The case study participants featured in this review identified select NIDILRR research contributions as having direct, personal benefit to their recovery. The knowledge generation and clinical innovation that this research program has contributed to our collective understanding of recovery after burn injury is considerable. Using case study methodology with three adult burn survivors, we highlight the impact and individual significance of program findings and reinforce the recognition that the value of any clinical research must have relevance to the lives of the study population.
Collapse
Affiliation(s)
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Loren Patterson
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Nicole S Gibran
- Department of Surgery, University of Washington, Seattle, Washington
| |
Collapse
|
11
|
Thibaut A, Shie VL, Ryan CM, Zafonte R, Ohrtman EA, Schneider JC, Fregni F. A review of burn symptoms and potential novel neural targets for non-invasive brain stimulation for treatment of burn sequelae. Burns 2021; 47:525-537. [PMID: 33293156 PMCID: PMC8685961 DOI: 10.1016/j.burns.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/30/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
Burn survivors experience myriad associated symptoms such as pain, pruritus, fatigue, impaired motor strength, post-traumatic stress, depression, anxiety, and sleep disturbance. Many of these symptoms are common and remain chronic, despite current standard of care. One potential novel intervention to target these post burn symptoms is transcranial direct current stimulation (tDCS). tDCS is a non-invasive brain stimulation (NIBS) technique that modulates neural excitability of a specific target or neural network. The aim of this work is to review the neural circuits of the aforementioned clinical sequelae associated with burn injuries and to provide a scientific rationale for specific NIBS targets that can potentially treat these conditions. We ran a systematic review, following the PRISMA statement, of tDCS effects on burn symptoms. Only three studies matched our criteria. One was a feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury, one looked at the effects of tDCS to reduce pain anxiety during burn wound care, and one assessed the effects of tDCS to manage pain and pruritus in burn survivors. Current literature on NIBS in burn remains limited, only a few trials have been conducted. Based on our review and results in other populations suffering from similar symptoms as patients with burn injuries, three main areas were selected: the prefrontal region, the parietal area and the motor cortex. Based on the importance of the prefrontal cortex in the emotional component of pain and its implication in various psychosocial symptoms, targeting this region may represent the most promising target. Our review of the neural circuitry involved in post burn symptoms and suggested targeted areas for stimulation provide a spring board for future study initiatives.
Collapse
Affiliation(s)
- Aurore Thibaut
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States; GIGA-Institute and Neurology Department, University of Liège and University Hospital of Liège, Liège, Belgium
| | - Vivian L Shie
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Colleen M Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Shriners Hospitals for Children-Boston, Boston, MA, United States
| | - Ross Zafonte
- Massachusetts General Hospital and Brigham and Women's Hospital, Boston, United States
| | - Emily A Ohrtman
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
12
|
Liang CY, Chen CC, Wang KY, Chung CH, Chang NW, Chien WC. Increased risk for sleep disorders in burn patients: A 14-year nationwide, population-based cohort study. Burns 2020; 47:1408-1415. [PMID: 33941399 DOI: 10.1016/j.burns.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Burn is a major trauma that causes physical and psychosocial impairments, leading to sleep disorders. However, the data about risks for sleep disorders in patients over 3 years following burn injury are limited. AIM To investigate the long-term risks for sleep disorders in patients after burn injury and identify the high-risk population. METHODS A 14-year population-based cohort study was performed using data from the 2000-2013 Taiwan National Health Insurance Research Database (NHIRD) which was a valid representative sample of the total population. All diagnoses of medical records in NHIRD were made by physicians and coded according to the ICD-9-CM. Cases diagnosed with burns (ICD-9 CM: N-code 940-949 and E-code 890-899) were included. The control group (non-burn injury group) was comprised quadruple the number of cases matched by index date, sex and age. RESULTS In 2000-2013, among the 10,289 burn patients included and followed-up after the index year, burn injury significantly increased the risks for sleep disorders (Hazard Ratio; HR = 1.36, p = 0.044), including insomnia (HR = 1.41, p = 0.036), sleep disturbance (HR = 2.39, p = 0.005) and sleep apnoea (HR = 1.38, p = 0.029). Compared with the control group, those who were women (HR = 1.73, p = 0.021), adolescents (HR = 5.45, p < 0.001), aged 19-24 years (HR = 1.36, p = 0.034), aged 25-44 years (HR = 1.67, p = 0.007), had low income (HR = 2.14, p = 0.001), and without a history of mental disorders (HR = 1.41, p = 0.024) had significantly higher risks for developing sleep disorders when suffered burn injury. CONCLUSION Burn had long-term negative effects on sleep during both the first year of burn injury and the subsequent follow-up 14 years. It is important for physicians to long-term assess the sleep quality of burn patients regardless of the number of years after burn injury.
Collapse
Affiliation(s)
- Chun-Yu Liang
- School of Nursing, National Defense Medical Center, 4F., No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan.
| | - Chien-Chang Chen
- Department of Nursing, Tri-Service General Hospital, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, Taiwan.
| | - Kwua-Yun Wang
- School of Nursing, National Defense Medical Center, 4F., No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan; Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan.
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Room 4112, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan.
| | - Nai-Wen Chang
- School of Nursing, National Defense Medical Center, 4F., No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan.
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan; Department of Medical Research, Tri-Service General Hospital, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan.
| |
Collapse
|
13
|
Abstract
Burn-injured patients provide unique challenges to those providing anaesthesia and pain management. This review aims to update both the regular burn anaesthetist and the anaesthetist only occasionally involved with burn patients in emergency settings. It addresses some aspects of care that are perhaps contentious in terms of airway management, fluid resuscitation, transfusion practices and pharmacology. Recognition of pain management failures and the lack of mechanism-specific analgesics are discussed along with the opioid crisis as it relates to burns and nonpharmacological methods in the management of distressed patients.
Collapse
Affiliation(s)
- Francois Stapelberg
- Department of Anaesthesia and Pain Medicine, New Zealand National Burn Centre, Auckland, New Zealand.,Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
14
|
Branding Practices on Four Dairies in Kantale, Sri Lanka. Animals (Basel) 2018; 8:ani8080137. [PMID: 30087245 PMCID: PMC6115924 DOI: 10.3390/ani8080137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/29/2018] [Accepted: 08/04/2018] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Branding cattle with hot irons is a painful procedure, inflicting severe burns that take weeks to heal. Although Sri Lanka prohibits hot-iron branding, the practice is still common in some areas of the country but has not been described. We observed branding practices on four smallholder farms and identified welfare concerns and challenges impeding adoption of alternative methods of identification, such as ear tags. Farmers used multiple irons to mark their initials and, in some cases, their address, with the largest brands extending across the ribs and hip. Farmers did not consider ear tags a viable alternative to hot-iron branding because of issues with security and tag retention. Hot-iron branding raises serious animal welfare concerns and efforts to introduce more welfare-friendly alternatives are needed. Abstract Hot-iron branding is illegal in Sri Lanka, but is still commonly used to identify dairy herds in extensive farming systems, which are primarily located in the country’s Dry Zone. Despite the negative welfare implications of this practice, there is no written documentation of branding in this region. We observed branding on four smallholder farms in Kantale, Eastern Province to understand the welfare implications associated with the procedure and challenges limiting the uptake of more welfare-friendly alternatives, such as ear tagging. Areas of welfare concern included the duration of restraint, the size and location of the brand, and the absence of pain relief. Animals were restrained with rope for an average duration of 12 min (range 8–17 min). Farmers used multiple running irons to mark their initials and, in some cases, their address, with the largest brands extending across the ribs and hip. Three farmers applied coconut or neem oil topically to the brand after performing the procedure. No analgesics were given before or after branding. Farmers reported that poor ear tag retention in extensive systems and theft were the main factors impeding the uptake of alternative forms of identification. Branding is also practiced as part of traditional medicine in some cases. Given the clear evidence that hot-iron branding impairs animal welfare and there is no evidence that this can be improved, alternative identification methods are needed, both in Sri Lanka, as well as in other countries engaging in this practice.
Collapse
|
15
|
Reasons for Distress Among Burn Survivors at 6, 12, and 24 Months Postdischarge: A Burn Injury Model System Investigation. Arch Phys Med Rehabil 2018; 99:1311-1317. [DOI: 10.1016/j.apmr.2017.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/20/2017] [Accepted: 11/07/2017] [Indexed: 11/22/2022]
|
16
|
Grieve B, Shapiro GD, Wibbenmeyer L, Acton A, Lee A, Marino M, Jette A, Schneider JC, Kazis LE, Ryan CM. Long-Term Social Reintegration Outcomes for Burn Survivors With and Without Peer Support Attendance: A Life Impact Burn Recovery Evaluation (LIBRE) Study. Arch Phys Med Rehabil 2017; 101:S92-S98. [PMID: 29097179 DOI: 10.1016/j.apmr.2017.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/20/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine differences in long-term social reintegration outcomes for burn survivors with and without peer support attendance. DESIGN Cross-sectional survey. SETTING Community-dwelling burn survivors. PARTICIPANTS Burn survivors (N=601) aged ≥18 years with injuries to ≥5% total body surface area (TBSA) or burns to critical areas (hands, feet, face, or genitals). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Life Impact Burn Recovery Evaluation Profile was used to examine the following previously validated 6 scale scores of social participation: Family and Friends, Social Interactions, Social Activities, Work and Employment, Romantic Relationships, and Sexual Relationships. RESULTS Burn support group attendance was reported by 330 (55%) of 596 respondents who responded to this item. Attendees had larger burn size (43.4%±23.6% vs 36.8%±23.4% TBSA burned, P<.01) and were more likely to be >10 years from injury (50% vs 42.5%, P<.01). Survivors who attended at least 1 support group scored significantly higher on 3 of the scales: Social Interactions (P=.01), Social Activities (P=.04), and Work and Employment (P=.05). In adjusted analyses, peer support attendance was associated with increased scores on the Social Interactions scale, increasing scores by 17% of an SD (95% confidence interval, 1%-33%; P=.04). CONCLUSIONS Burn survivors who reported peer support attendance had better social interaction scores than those who did not. This is the first reported association between peer support group attendance and improvements in community reintegration in burn survivors. This cross-sectional study prompts further exploration into the potential benefits of peer support groups on burn recovery with future intervention studies.
Collapse
Affiliation(s)
- Brian Grieve
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lucy Wibbenmeyer
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, MI
| | - Austin Lee
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Molly Marino
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Alan Jette
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Lewis E Kazis
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA.
| | | |
Collapse
|