A randomized controlled trial of an educational programme with telephone reinforcement to improve perceived health status of Brazilian burn victims at 6-month post discharge

Virtual burn care - Friend or foe? A systematic review

INTRODUCTION

Evidence on the impact of virtual care for patients with burn injuries is variable. This review aims to evaluate its use in remote assessment, rounding, and follow-up through outcomes of efficacy, usability, costs, satisfaction, clinical outcomes, impacts on triage and other benefits/drawbacks.

METHODS

A PRISMA-compliant qualitative systematic review (PROSPERO CRD42021267787) was conducted in four databases and the grey literature for primary research published between 01/01/2010 and 12/31/2020. Study quality was appraised using three established tools. Evidence was graded by the Oxford classification.

RESULTS

The search provided 481 studies, of which 37 were included. Most studies (n = 30, 81%) were Oxford Level 4 (low-level descriptive/observational) designs and had low appraised risk-of-bias (n = 20, 54%). Most applications were for the acute phase (n = 26, 70%). High patient compliance, enhanced specialist access, and new educational/networking opportunities were beneficial. Concerns pertained to IT/connection, virtual communication barriers, privacy/data-security and logistical/language considerations. Low-to-moderate-level (Oxford Grade C) evidence supported virtual burn care's cost-effectiveness, ability to improve patient assessment and triage, and efficiency/effectiveness for remote routine follow-up.

CONCLUSION

We find growing evidence that virtual burn care has a place in acute-phase specialist assistance and routine outpatient follow-up. Low-to-moderate-level evidence supports its effectiveness, cost-effectiveness, usability, satisfactoriness, and capacity to improve triage.

Posttraumatic stress disorder in burn patient: A systematic review

INTRODUCTION

Burns often cause severe physical and mental suffering and can become a trigger for the development of permanent psychological diseases, even after wound healing. Posttraumatic stress disorder (PTSD) is one such disorder, which involves the re-experiencing of many symptoms provoked by a previous traumatic situation.

METHOD

This study is a systematic review of interventions used to reduce or prevent PTSD symptoms in burn victims. We included randomized clinical trials that described therapeutic interventions for the prevention of PTSD in burn patients. The search was conducted in the databases EMBASE and PUBMED/Medline between 2009 and 2020, and the main variables evaluated were%TBSA, age, number of hospitalization days, type of intervention, follow-up time and results. The analysis of the bias risk was carried out according to the guidance in the Cochrane Handbook for Bias Risk Assessment.

RESULTS

Eight clinical trials were selected: three of them were performed in children, and five involved adults. The most common bias risks were related to participant/researcher blinding and loss of follow-up. Two interventions were identified: a pharmacological intervention and a psychological intervention. Medications (sertraline and propanolol) were not effective in reducing stress symptoms. Four studies used cognitive-behavioral therapies, which achieved the best results for PTSD improvement in burn patients. Hypnosis and an informational education program were also evaluated and did not show success in reducing PTSD.

CONCLUSION

Cognitive-behavioral therapies may work to reduce PTSD symptoms in burn patients, and when they are adopted early by burn units, they may improve the psychological condition of burn patients.

The effect of reinforcing an educational programme using telephone follow-up on health-related quality of life of individuals using warfarin: A randomised controlled trial

OBJECTIVES

To evaluate the effect of reinforcing an educational programme through telephone follow-up on health-related quality of life and anxiety and depression symptoms in individuals starting warfarin therapy.

BACKGROUND

Educational interventions have improved quality of life in individuals using warfarin. Few studies have examined the addition of telephone follow-up to enhance educational interventions.

DESIGN

Randomised controlled trial in outpatient setting.

METHODS

Hospitalised adults starting warfarin therapy who agreed to participate received an educational programme about the warfarin treatment. At discharge, they were randomised to receive either five telephone follow-up calls (intervention) or no telephone calls (controls). Both groups were evaluated for health-related quality of life (using Duke Anticoagulation Satisfaction Scale) and symptoms of anxiety and depression (using Hospital Anxiety and Depression Scale) at three and six months post-discharge. Groups were compared at each time by independent-samples t test, and over time by repeated-measures analysis of variance, with time (three and six months), groups (intervention and control) and an interaction between time and group as factors. Level of significance was set at 0.05. The Consolidated Standards of Reporting Trials was used for reporting.

RESULTS

Fifty-two individuals (26 per group) completed the study. There were no statistical differences between groups in health-related quality of life, anxiety and depression symptoms, at both times post-discharge. Participants who received follow-up telephone calls reported better positive psychological impact (a subscale of quality of life) than controls.

CONCLUSIONS

Reinforcing an educational programme with telephone follow-ups did not have an overall effect on health-related quality of life of individuals using warfarin but promoted positive psychological impact.

RELEVANCE TO CLINICAL PRACTICE

The low cost of reinforcing educational programmes with telephone calls and the improvement in positive psychological aspects indicate that this type of intervention is still a promising intervention that could be further investigated and improved.

Effectiveness of person- and family-centred care transition interventions on patient- oriented outcomes: A systematic review

AIM

The aim was to critically analyse the body of evidence regarding the effectiveness of PFCC transition interventions on the quality of care and the experience of patients.

DESIGN

We conducted a systematic review using the Cochrane Handbook's guidelines and adhered to a standardized reporting format: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

METHODS

Four databases and grey literature were searched. Following a two-step screening process, data from the eligible studies were extracted. Risk of bias and quality of the studies were also assessed. Narrative synthesis and vote counting were used for the data analysis.

RESULTS

A total of 28 articles met our inclusion criteria. Interventions varied in regards to the extent of the PFCC focus and the comprehensiveness of the transition of care. Educating patients to promote self-management was the most commonly included component and it was described in all 28 interventions.

The effect of rehabilitation education through social media on the quality of life in burn patients: a randomized, controlled, clinical trial

BACKGROUND

Burn is one of the most brutal harms to the human body and mind and its wide-ranging complications have many adverse effects on the patients' quality of life. The present study was conducted to investigate the effect of rehabilitation education through social media on burn patients' quality of life.

METHODS

The present randomized, controlled, clinical trial was conducted on 60 patients admitted to Imam Reza Hospital Burn Center in the city of Mashhad, Iran, who were randomly assigned to either the intervention or control groups (n = 30 per group). The researcher then created a WhatsApp channel to provide educational content and a WhatsApp group for burns patients to join and get their questions answered. The intervention group patients pursued their post-discharge education through the social media for a month. The control group patients received their discharge education according to the ward's routine procedures through pamphlets and face-to-face training by the personnel. As the study's main variable, the Burn Specific Health Scale-Brief was completed by both groups before and 1 and 2 months after the intervention. Data were analyzed using the ANCOVA and repeated-measures ANOVA.

RESULTS

There was no significant differences between the intervention and control groups in terms of the QOL score and any of the domains at baseline. The results indicated the significant effect of the intervention both 1 and 2 months post-intervention on the QOL score and all the domains (P < 0.05), except for body image (P_model1 = .550 and  P_model2 = .463) and skin sensitivity (P_model1 = .333 and P_model2 = .104).

CONCLUSION

The post-discharge rehabilitation education of burns patients through social media improves their quality of life and can be used as an appropriate educational and follow-up method in different stages of the rehabilitation of burn patients. TRIAL REGISTRATION NO. : IRCT20190622043971N1, 05-10-2019.

Opportunities for Palliative Care in Patients With Burn Injury-A Systematic Review

CONTEXT

Patients with significant burn injuries likely have palliative care needs.

OBJECTIVES

We performed a systematic review of existing evidence concerning the palliative care needs of burn patients.

METHODS

Through November 26, 2018, we systematically searched PubMed, CINAHL, Embase, Web of Science, and Scopus, using terms representing burn injuries and the eight domains of quality palliative care as outlined by the National Consensus Project for Quality Palliative Care. Eligible articles involved burn-injured patients treated with an intervention targeting at least one of the eight domains.

RESULTS

Our searches yielded 7532 unique records, which led to 238 articles for full review and 88 studies that met inclusion criteria. Seventy-five studies addressed the domain physical aspects of care and merit a separate systematic review; 13 studies were included in our final review. Four of the seven domains-processes of care, psychologic symptoms, social aspects, and end of life-were addressed by studies but three domains-spiritual, cultural, or ethics-were unaddressed. Included studies highlight potential benefits from peridischarge self-care education programs, peer support, and group therapy in improving quality of life. In patients with severe injuries, end-of-life decision-making protocols were associated with increased utilization of comfort-focused treatments.

CONCLUSION

Most existing palliative care-related research in burn patients addresses interventions for physical symptoms with minimal literature concerning other domains. Opportunities exist for further research of palliative care in burn populations with emphasis on addressing interventions for all domains and better standardizing the language and outcomes for the palliative care interventions.

Effect of Telenursing and Face-to-Face Training Techniques on Quality of Life in Burn Patients: A Clinical Trial

OBJECTIVE

To compare the effect of telenursing and face-to-face training on the quality of life (QOL) of patients with a burn injury.

DESIGN

This clinical trial with pretest-posttest design on 3 groups was conducted in Kermanshah, Iran, from 2017 to 2018. Convenience sampling was used.

SETTING

A tertiary hospital in Kermanshah, west of Iran.

PARTICIPANTS

A total of 90 patients with burns of grade 2 and 3 after discharge from the hospital were randomly assigned to 3 groups including telenursing (30), face-to-face training (30), and control (30).

INTERVENTIONS

Each intervention group received 1-on-1 telephone training and face-to-face training in 8 sessions (2 sessions of 15 to 20min/wk). The control group received regular care.

MAIN OUTCOME MEASURES

QOL was evaluated by the Burn Specific Health Scale-Brief (BSHS-B).

RESULTS

The mean BSHS-B scores before and after intervention for telenursing, face-to-face, and the control group were 71.43±21.92 and 133.06±11.97; 64.83±26.16 and 124.83±23.05; and 58.63±20.89 and 73.13±33.04, respectively. There was a statistically significant difference among the 3 groups with respect to the training methods after intervention (P<.001). In addition, post hoc test did not show a significant difference between the telenursing and face-to-face groups (P=.244).

CONCLUSIONS

Educational methods in the form of telenursing and face-to-face training were effective and promoted QOL in survivors of burn injuries. Both telenursing and face-to-face training can be used to improve the QOL of survivors of burn injuries during the rehabilitation phase.

Lived experiences of burn survivors regarding the challenges of home care follow-ups: a phenomenological study

Burn victims often require long-term treatments. Patients prefer to be at home while receiving care services but there are some deficiencies in conducting home care. To explore the challenges of nurse-led follow-up, 16 burn survivors who received home care for 6 months were interviewed. The theme, "barriers of care," was extracted. It included two subthemes entitled "Barriers related to implementation of home care and "Barriers of ideality." Providing home care for burn survivors encounters several barriers that were classified into two categories including modifiable and nonmodifiable barriers. Suitable infrastructure and policies are necessary to conduct home care for burn survivors.

Effects of a transtheoretical model-based WeChat health education programme on self-management among haemodialysis patients: A longitudinal experimental intervention study

AIM

To examine the effects of a transtheoretical model-based WeChat health education programme on self-management in haemodialysis patients in China.

DESIGN

A longitudinal experimental intervention study.

METHODS

Patients (N = 120) who underwent haemodialysis from December 2015-November 2017 were recruited and randomly allocated to either group 1 (who received a 3-month WeChat health education immediately after randomization) or group 2 (who was combined with group 1 and received the same intervention at the 5th month after enrolment in the study). Self-management, knowledge and self-efficacy were assessed at baseline (T₀ ), 3 months after enrolment in the study (T₁ ), 21 months after enrolment in the study (T₂ ).

RESULTS

There were significant group effects on self-efficacy; time effects on partnership, self-care, emotion management with total self-management; interaction effects on problem-solving and emotion management within total self-management according to the two-way repeated measures ANCOVA. Further between-group comparisons indicated that patients in group 1 had better self-management than those in group 2 at T₁ . Within-group comparisons demonstrated that, compared with the baseline values, group 1 had significantly improved self-management at T₁ ; however, group 2 had improved self-management at T₂ .

CONCLUSION

The transtheoretical model-based WeChat health education programme had a potentially positive effect on improving the self-management of haemodialysis patients.

IMPACT

Self-management is often difficult yet crucial for haemodialysis patients. This study indicated that the transtheoretical model-based WeChat health education resulted in improved self-management in haemodialysis patients and can be implemented in continuing care during the interdialysis period to improve self-management in patients.

TRIAL REGISTRATION

ChiCTR1800018172.

Confirmatory Factor Analysis and Reliability of the Burn Specific Health Scale-Revised in Brazilian Burned Patients

BACKGROUND AND PURPOSE

The aim of the study was to analyze the factor structure and the reliability of the Brazilian-Portuguese version of the Burn Specific Health Scale-Revised (BSHS-R) in a sample of Brazilian burned adults.

METHODS

This study was a cross-sectional study. The internal consistency was analyzed using Cronbach's α, considering coefficients ≥.70 as appropriate. We conducted confirmatory factor analysis (CFA) to test the hypothesis that the BSHS-R Brazilian-Portuguese version has a factor structure similar to the original. We assessed the factor structure of the BSHS-R Brazilian-Portuguese version by CFA, examining three models: three-factor, six-factor, and seven-factor structure.

RESULTS

The participants were 299 burned adults. The CFA indicated good model fit indices for the seven-factor model (root mean square error of approximation = .062; goodness-of-fit index = .844; adjusted goodness-of-fit index = .809; Akaike information criterion = 1,054.06). The seven-factor BSHS-R Brazilian-Portuguese version showed Cronbach's α of .93.

CONCLUSIONS

The BSHS-R Brazilian-Portuguese version with seven factors is reliable and valid and measures the perceived health status construct.

Health related quality of life in adults after burn injuries: A systematic review

OBJECTIVES

Measurement of health-related quality of life (HRQL) is essential to qualify the subjective burden of burns in survivors. We performed a systematic review of HRQL studies in adult burn patients to evaluate study design, instruments used, methodological quality, and recovery patterns.

METHODS

A systematic review was performed. Relevant databases were searched from the earliest record until October 2016. Studies examining HRQL in adults after burn injuries were included. Risk of bias was scored using the Quality in Prognostic Studies tool.

RESULTS

Twenty different HRQL instruments were used among the 94 included studies. The Burn Specific Health Scale-Brief (BSHS-B) (46%), the Short Form-36 (SF-36) (42%) and the EuroQol questionnaire (EQ-5D) (9%) were most often applied. Most domains, both mentally and physically orientated, were affected shortly after burns but improved over time. The lowest scores were reported for the domains 'work' and 'heat sensitivity' (BSHS-B), 'bodily pain', 'physical role limitations' (SF-36), and 'pain/discomfort' (EQ-5D) in the short-term and for 'work' and 'heat sensitivity', 'emotional functioning' (SF-36), 'physical functioning' and 'pain/discomfort' in the long-term. Risk of bias was generally low in outcome measurement and high in study attrition.

CONCLUSION

Consensus on preferred validated methodologies of HRQL measurement in burn patients would facilitate comparability across studies, resulting in improved insights in recovery patterns and better estimates of HRQL after burns. We recommend to develop a guideline on the measurement of HRQL in burns. Five domains representing a variety of topics had low scores in the long-term and require special attention in the aftermath of burns.