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Evans CK, Hince DA, Tatlow CJ, Pienaar PC, Truter P, Wood FM, Bulsara M, Berghuber A, Gittings PM, Edgar DW. Early ambulation impacts on quality-of-life outcomes positively after lower limb burn injury: A group trajectory analysis. Burns 2024; 50:829-840. [PMID: 38458961 DOI: 10.1016/j.burns.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/04/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Despite the challenges of providing burn care throughout the 2.5MKm2 jurisdiction of Western Australia, early intervention after injury remains a key premise of the multidisciplinary model of care applied by the State Adult Burn Unit (SABU) team. In particular, contemporary guidelines support the facilitation of early ambulation after lower limb burn and skin grafting. Thus, this study aimed to evaluate the association between the timing of ambulation after burn and surgery on quality of life (QoL) outcomes. METHODS Data from 1707 lower limb burn patients aged ≥ 18, admitted to the SABU between February 2011- December 2019, were included. Self-reported QoL longitudinal outcomes were assessed using the Short Form 36 and Burn Specific Health Scale Brief. Three recovery trajectories were defined according to their QoL outcome responses, mapped out to one year. Early ambulation was defined as occurring within 48 h of acute burn or surgery, as per SABU routine practice. RESULTS Early ambulation was shown to have a positive association to the higher QoL trajectory group (>75% of cohort), though not statistically significant for the Physical Component (PCS) and Mental health Component (MCS) summary scores of the SF36; however, ambulation pathway was associated with adjusted long-term BSHS-B QoL outcomes. The least favorable trajectory of long-term recovery of the physical aspects of QoL was seen in those with higher TBSA and complications and increasing age and comorbidities. In contrast, the mental health components of QoL were robust to all those factors, apart from pre-existing comorbidities. CONCLUSION Early ambulation after lower limb burn, and surgery, was positively associated with early and long-term QoL outcomes. Recovery trajectory is strongly indicated by where the patient journey begins after early acute care. The optimal physical QoL recovery trajectory was shared by those who were younger with reduced TBSA; complications; and, comorbidities whereas the mental health QoL trajectories were only impacted by comorbidities.
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Affiliation(s)
- Chelsea K Evans
- School of Health Sciences and Physiotherapy, Faculty of Medicine, Nursing, Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia; State Adult Burn Unit, Level 4, Fiona Stanley Hospital, Murdoch, WA, Australia; Physiotherapy Department, Fiona Stanley Hospital, Murdoch, WA, Australia.
| | - Dana A Hince
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Claudia J Tatlow
- School of Health Sciences and Physiotherapy, Faculty of Medicine, Nursing, Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia; Physiotherapy Department, Royal Perth Hospital, Perth, WA, Western Australia
| | - Pip C Pienaar
- School of Health Sciences and Physiotherapy, Faculty of Medicine, Nursing, Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Piers Truter
- School of Health Sciences and Physiotherapy, Faculty of Medicine, Nursing, Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia; Physiotherapy Department, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Fiona M Wood
- State Adult Burn Unit, Level 4, Fiona Stanley Hospital, Murdoch, WA, Australia; Fiona Wood Foundation of Western Australia, Fiona Stanley Hospital, Murdoch, WA, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, WA, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Aaron Berghuber
- State Adult Burn Unit, Level 4, Fiona Stanley Hospital, Murdoch, WA, Australia; Fiona Wood Foundation of Western Australia, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Paul M Gittings
- State Adult Burn Unit, Level 4, Fiona Stanley Hospital, Murdoch, WA, Australia; Physiotherapy Department, Fiona Stanley Hospital, Murdoch, WA, Australia; Fiona Wood Foundation of Western Australia, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Dale W Edgar
- School of Health Sciences and Physiotherapy, Faculty of Medicine, Nursing, Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia; State Adult Burn Unit, Level 4, Fiona Stanley Hospital, Murdoch, WA, Australia; Physiotherapy Department, Fiona Stanley Hospital, Murdoch, WA, Australia; Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia; Fiona Wood Foundation of Western Australia, Fiona Stanley Hospital, Murdoch, WA, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, WA, Australia.
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Yang X, Li R, Zhai J, Fan Y, Gong S, Li L, Nie X, Li W. Effects of early enteral nutrition in patients with severe burns: A systematic review. Medicine (Baltimore) 2024; 103:e37023. [PMID: 38363893 PMCID: PMC10869067 DOI: 10.1097/md.0000000000037023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/02/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Nutritional problems in the early stages of severe burns are prominent and seriously affect the clinical outcomes of patients. Our aim is to analyze the effects of early enteral nutrition (EEN) in patients with severe burns. METHODS In this study, relevant articles were searched in 8 English and Chinese data, with a time limit from the creation of the database to June 2023. Two researchers independently completed the search, screening and quality assessment of the articles. We conducted a systematic review and meta-analysis of randomized controlled trials that examined EEN therapy in people with severe burns. We compared the effects of EEN and non-EEN therapy in severely burned patients. The outcomes were mortality, gastrointestinal complications, nutritional indicators, gastrointestinal hormones, sepsis, length of hospital stay and wound healing time. Categorical variables were expressed as OR and 95% CI was calculated, and continuous variables were expressed as MD and 95% CI was calculated. The protocol for this systematic review was registered in PROSPERO on May 12, 2023 (identifier CRD42023422895). RESULTS Nineteen studies with a total of 1066 participants met the inclusion criteria. When comparing EEN therapy with non-EEN therapy, the experiment group had significantly lower mortality [OR = 0.39, 95% CI (0.20, 0.74), P = .004], lower wound healing time [MD = -10.77, 95% CI (-13.66,-7.88), P < .00001], fewer gastrointestinal complications [OR = 0.18, 95% CI (0.09, 0.36), P < .00001], lower rates of gastrointestinal hemorrhage [OR = 0.12, 95% CI (0.04, 0.36), P = .0001], lower rates of sepsis [OR = 0.40, 95% CI (0.24, 0.66), P = .0005], shorter length of hospital stay [MD = -12.08, 95% CI (-13.61, 9.19-10.56), P < .00001], and higher prealbumin levels [MD = 29.04, 95% CI (21.98, 36.10), P < .00001], higher total albumin levels [MD = 6.74, 95% CI (4.29, 9.19), P < .00001], and gastrin levels [MD = 15.93, 95% CI (10.12, 21.73), P < .00001]. However, there was no significant difference in albumin between the 2 groups [MD = 2.62, 95% CI (-0.30, 5.55), P = .08] or motilin levels [MD = 12.48, 95% CI (-43.59, 68.56), P = .66]. CONCLUSIONS EEN plays an important role in the rehabilitation of patients with severe burns. EEN is beneficial to reduce complications and the length of hospital stay, maintain organ function, optimize the nutritional status of patients, promote wound healing, and improve the survival rate of patients.
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Affiliation(s)
- Xiaojuan Yang
- Department of Burns, Sichuan Provincial People’s Hospital, Chengdu, Sichuan Province, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Rong Li
- Department of Maternity, Sichuan Provincial People’s Hospital, Chengdu, Sichuan Province, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Jiao Zhai
- Department of Pediatric Surgery, Sichuan Provincial People’s Hospital, Chengdu, Sichuan Province, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Yu Fan
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Shuangying Gong
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Linzhang Li
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
- Department of Respiratory, Wenjiang district people’s Hospital of Chengdu, Sichuan Province, China
| | - Xinyue Nie
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Wei Li
- Department of Burns, Sichuan Provincial People’s Hospital, Chengdu, Sichuan Province, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
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Wang HJ, Feng YP, Tian XX, Wu XH, Hao LZ, Li Y, Mei SJ. Effect of Yak Meat to the Daily Ration of Scalded Rats for Wound Healing. Clin Cosmet Investig Dermatol 2023; 16:751-767. [PMID: 37016603 PMCID: PMC10066901 DOI: 10.2147/ccid.s393066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
Objective Treatment of burn wound healing involves infection, nutrition, psychology and rehabilitation, and proper nutritional support can promote wound healing, enhance immune function and reduce the incidence of complications. This study aimed to investigate the effects of feed containing yak meat on scalded rats' body condition and wound healing. Methods Adopting a two-factor factorial design, the growth performance, food intake, body weight, and Lee's index of rats were measured. The wound conditions of scalded rats with different feeds (basic, basic + yak meat, and basic + yellow beef) were observed at different periods, and their wounds' hematoxylin and eosin (H&E) staining states were detected. The proliferating cell nuclear antigen (PCNA)-positive cells and apoptosis were analyzed to evaluate the effects of feed on the wound healing of scalded rats. Results The feed intake was the highest in the yellow beef feed group and the lowest in the yak meat feed group. The body weight was the highest in the yak meat feed group and the lowest in the yellow beef feed group. Furthermore, 45 days after scalding, the obesity index in the yak beef feed group was the closest to that of the rats before scalding. The wound recovery of the rats in the yak meat feed group was the best at 30 days, and the H&E staining results also proved that the recovery effect of the scalded rats in the yak meat feed group was better than other two groups. According to the results of PCNA and apoptosis, the yak meat feed group had lower positive cell rate and faster wound healing. Conclusion The rats in the yak meat feed group recovered better than those in the other groups, and the yak beef feed had the best effect on the wound healing of the scalded rats.
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Affiliation(s)
- Hong-Jin Wang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai, 810012, People’s Republic of China
| | - Yan-Ping Feng
- Department of Burns and Plastic Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai, 810012, People’s Republic of China
| | - Xiao-Xia Tian
- Qinghai University, Academy of Animal Science and Veterinary Medicine, Key Laboratory of Plateau Grazing Animal Nutrition and Feed Science of Qinghai Province, Xining, Qinghai, 810016, People’s Republic of China
| | - Xiao-Han Wu
- Department of Burns and Plastic Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai, 810012, People’s Republic of China
| | - Li-Zhuang Hao
- Qinghai University, Academy of Animal Science and Veterinary Medicine, Key Laboratory of Plateau Grazing Animal Nutrition and Feed Science of Qinghai Province, Xining, Qinghai, 810016, People’s Republic of China
| | - Yi Li
- Department of Burns and Plastic Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai, 810012, People’s Republic of China
- Correspondence: Yi Li, Department of Burns and Plastic Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Xining, Qinghai province, 810010, People’s Republic of China, Tel +86-13709760887, Email
| | - Shi-Juan Mei
- Department of Oncology, affiliated Hospital of Qinghai University, Xining, Qinghai, 810010, People’s Republic of China
- Shi-Juan Mei, Department of Oncology, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Xining, Qinghai province, 810010, People’s Republic of China, Tel +86-15009715352, Email
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Corish CA. The vital role of nutrition and dietetics in the clinical management of disease and injury. Nutr Diet 2022; 79:552-554. [DOI: 10.1111/1747-0080.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Clare A. Corish
- Clinical Nutrition and Dietetics, School of Public Health, Physiotherapy and Sports Science University College Dublin Ireland
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