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Kaur D, Sharma N, Samuel AJ. Web-based E-survey in identifying current physiotherapy practices in paediatric burns. Burns 2023; 49:1474-1481. [PMID: 36792471 DOI: 10.1016/j.burns.2023.01.009] [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: 08/19/2022] [Revised: 12/20/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Physiotherapy practices in pediatric burns involves relaxation techniques and exercise training for attaining physical fitness, improving quality of life and, thereby to prevent primary and secondary complications. Physical activity and exercise act as a meaningful and purposeful tool for attaining physical fitness after burn injury. AIM The aim of this e-survey is to identify the current practices of physiotherapy interventions in pediatric burn rehabilitation among physiotherapy students and professionals. METHODS The e-survey was created with validated questionnaire using a Google Forms to gather the information related to current physiotherapy practices in pediatric burns. After the sample size estimation, survey link were sent to identified 144 physiotherapy students and professionals using social networking sites which includes, WhatsApp, Facebook and Instagram for this cross-sectional e-survey. The frequency and percentage of survey responses were analyzed. RESULTS Among 144 identified participants, 62 participants completed the survey, resulting in the response rate of (43.0%). The findings of this study revealed that> 50% of physiotherapy students, and professionals, are performing pain and scar assessment, along with their regular physiotherapy management in children with burns. In addition to these, they also practice physiotherapy for burn conditions in pediatric intensive care units (PICU), pediatric wards, and clinical outpatient department (OPD) settings. CONCLUSION Physiotherapy students and professionals have sufficient knowledge regarding pediatric burns complications, and also, they are well aware regarding recent physiotherapy practices in pediatric burn care management.
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Affiliation(s)
- Daljit Kaur
- Department of Paediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana 133207, Ambala, Haryana, India; Department of Physiotherapy, Narain Hospital & CT Scan Center, Ambala, Haryana
| | - Neha Sharma
- Department of Paediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana 133207, Ambala, Haryana, India
| | - Asir John Samuel
- Department of Paediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana 133207, Ambala, Haryana, India; Yenepoya Physiotherapy College, Yenepoya (Deemed to be University), Naringana, Deralakatte, Mangalore 575018, Karnataka, India.
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2
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Le May S, Genest C, Francoeur M, Hung N, Guingo E, Khadra C, Noel M, Paquette J, Roy A. Virtual reality mobility for burn patients (VR-MOBILE): A within-subject-controlled trial protocol. PAEDIATRIC & NEONATAL PAIN 2022; 4:192-198. [PMID: 36618513 PMCID: PMC9798042 DOI: 10.1002/pne2.12086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/21/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
In the acute phase, burn patients undergo several painful procedures. Pediatric burn care procedures conducted in hydrotherapy have been known to generate severe pain intensity and moderate to high levels of anxiety. Hydrotherapy treatments are done with the use of opioids and benzodiazepines for pain and anxiety. Unfortunately, nonpharmacological methods are rarely combined with pharmacological treatments despite evidence showing that distraction can serve as an effective method for pain management and can potentially decrease analgesic requirements in other painful medical procedures. Virtual reality (VR) is a method that uses distraction to interact within a virtual environment. The use of VR is promising for pain reduction in varying settings. Considering the lack of optimal pain and anxiety management during burn wound care and the positive effect of an immersive distraction for painful procedures, using VR for burn wound care procedures may show promising results. This is a within-subject randomized controlled trial design in which each participant will serve as his/her own control. A minimum of 20 participants, aged 7 to 17 years old undergoing a burn care session, will receive both standard and experimental treatments during the same session in a randomized order. The experimental treatment will consist of combining VR distraction using the video game Dreamland® to the current standard pharmacological care as per unit protocol. The control group will only receive the unit's standard pharmacological care. The mean difference in both pain intensity scores and in anxiety between the two different sequences will be the primary outcomes of this study. This study evaluates the effect of VR on burn wound care. If results from this study show a positive effect of VR compared to standard care, this protocol may provide guidance on how to implement this type of immersive care as part of the tools available for distraction of painful procedures for acute burn victims.
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Affiliation(s)
- Sylvie Le May
- CHU Sainte‐Justine Hospital's Research CentreMontréalQuébecCanada,Faculty of NursingUniversité de MontréalMontréalQuébecCanada,Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CRIUSMM)MontréalQuébecCanada
| | - Christine Genest
- Faculty of NursingUniversité de MontréalMontréalQuébecCanada,Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CRIUSMM)MontréalQuébecCanada
| | - Maxime Francoeur
- CHU Sainte‐Justine Hospital's Research CentreMontréalQuébecCanada
| | - Nicole Hung
- CHU Sainte‐Justine Hospital's Research CentreMontréalQuébecCanada,Faculty of MedicineUniversité de MontréalMontréalQuébecCanada
| | - Estelle Guingo
- Department of Creation and NEW MediaUniversité du Québec en Abitibi‐Témiscamingue (UQAT)Rouyn‐NorandaQuébecCanada
| | | | - Melanie Noel
- Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Julie Paquette
- CHU Sainte‐Justine Hospital's Research CentreMontréalQuébecCanada
| | - Andrée‐Anne Roy
- CHU Sainte‐Justine Hospital's Research CentreMontréalQuébecCanada
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3
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Shiferaw A, Mola S, Gashaw A, Sintayehu A. Evidence-based practical guideline for procedural pain management and sedation for burn pediatrics patients undergoing wound care procedures. Ann Med Surg (Lond) 2022; 83:104756. [DOI: 10.1016/j.amsu.2022.104756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022] Open
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4
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Vest E, Armstrong M, Olbrecht VA, Thakkar RK, Fabia RB, Groner JI, Noffsinger D, Tram NK, Xiang H. Association of Pre-procedural Anxiety with Procedure-related Pain During Outpatient Pediatric Burn Care: A Pilot Study. J Burn Care Res 2022; 44:610-617. [PMID: 35913793 DOI: 10.1093/jbcr/irac108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 11/13/2022]
Abstract
The relationship between preprocedural anxiety and pain is not clear but has the potential to change the way pediatric patients need to be cared for prior to burn procedures. Using results from our recent randomized clinical trial among outpatient burn patients (n=90) age 6-17 years, the objective of this subsequent analysis was to assess whether preprocedural anxiety was associated with self-reported and researcher observed pain scores. Anxiety before the dressing change was assessed using an abbreviated State-Trait Anxiety Inventory for Children (range 6-21) and reported with 95% confidence intervals (CI). Self-reported pain was reported using a Visual Analog Scale (range 0-100) and observed pain was assessed using the Face, Legs, Activity, Cry, and Consolability-revised scale. Over half of patients (58.9%) reported mild anxiety (score <12) and about 5% of patients reported severe anxiety (score >16). Younger children (6-8 years) reported higher anxiety scores than older children (15-17 years), but the difference did not achieve statistical significance (mean=12.7, 95% CI: 11.5-13.9, p=0.09). Nonparametric spearman correlation indicated that anxiety score was significantly correlated with observed pain (p=0.01) and self-reported overall pain neared statistical significance (p=0.06). In the final logistic regression of reporting moderate-to-severe pain (pain score >30), the association between anxiety scores and self-reported overall moderate-to-severe pain was statistically significant (p=0.03) when adjusting for race, healing degree, and pain medication use within 6 hours prior to burn dressing care. This pilot study provides preliminary data showing that anxiety before outpatient pediatric burn dressing changes is significantly associated with self-reported overall moderate-to-severe pain.
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Affiliation(s)
- Eurella Vest
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Ohio University Heritage College of Osteopathic Medicine, Dublin Campus, 6795 Bobcat Way, Dublin, OH 43016, USA
| | - Megan Armstrong
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Vanessa A Olbrecht
- Department of Anesthesiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, USA
| | - Rajan K Thakkar
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, USA
| | - Renata B Fabia
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, USA
| | - Jonathan I Groner
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, USA
| | - Dana Noffsinger
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Nguyen K Tram
- Department of Anesthesiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Henry Xiang
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, USA
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5
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Cook KA, Naguib N, Kirsch J, Hohl K, Colby AH, Sheridan R, Rodriguez EK, Nazarian A, Grinstaff MW. In situ gelling and dissolvable hydrogels for use as on-demand wound dressings for burns. Biomater Sci 2021; 9:6842-6850. [PMID: 34486599 PMCID: PMC8511343 DOI: 10.1039/d1bm00711d] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Currently, no dressings utilized in burn clinics provide adhesion, hydration or mechanical strength on the same order as human skin as well as the ability to be atraumatically removed. We report the synthesis, characterization, and in vivo evaluation of in situ polymerized and subsequent dissolvable hydrogels as burn wound dressings. Hydrogel dressings, from a small library of synthesized materials form in situ, exhibit storage moduli between 100-40 000 Pa, dissolve on-demand within 10 minutes to 90 minutes, swell up to 350%, and adhere to both burned and healthy human skin at 0.2-0.3 N cm-2. Further, results from an in vivo porcine second degree burn model demonstrate functional performance with healing equivalent to conventional treatments with the added benefit of facile, in situ application and subsequent removal via dissolution.
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Affiliation(s)
- Katherine A Cook
- Departments of Chemistry, Biomedical Engineering, and Medicine, Boston University, Boston, MA 02215, USA.
| | - Nada Naguib
- Departments of Chemistry, Biomedical Engineering, and Medicine, Boston University, Boston, MA 02215, USA.
| | - Jack Kirsch
- Departments of Chemistry, Biomedical Engineering, and Medicine, Boston University, Boston, MA 02215, USA.
| | - Katherine Hohl
- Departments of Chemistry, Biomedical Engineering, and Medicine, Boston University, Boston, MA 02215, USA.
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Aaron H Colby
- Departments of Chemistry, Biomedical Engineering, and Medicine, Boston University, Boston, MA 02215, USA.
| | - Robert Sheridan
- Shriners Hospitals for Children and Burns Service, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02214, USA
| | - Edward K Rodriguez
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Ara Nazarian
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Mark W Grinstaff
- Departments of Chemistry, Biomedical Engineering, and Medicine, Boston University, Boston, MA 02215, USA.
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Shahi N, Meier M, Phillips R, Shirek G, Goldsmith A, Recicar J, Zuk J, Bielsky A, Yaster M, Moulton S. Pain Management for Pediatric Burns in the Outpatient Setting: A Changing Paradigm? J Burn Care Res 2021; 41:814-819. [PMID: 32303748 DOI: 10.1093/jbcr/iraa049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Childhood burns are common and distressing for children and their parents. Pain is the most common complaint and often thought to be undertreated, which can negatively influence the child's care and increase the risk of posttraumatic stress disorder. There is limited literature on the role of opioids and multimodal therapy in the treatment of pediatric outpatient burns. We sought to evaluate the current use of opioids (including the use of multimodal therapies), storage, and disposal of opioids in this patient population. Parents of burn-injured children 8 months to 18 years old, who were seen in an outpatient setting within 2 weeks of their burn injury, were queried from April to December 2019 regarding their child's pain control, opioid medication use, over-the-counter pain medication use, opioid storage, and disposal. A total of 142 parents of burn-injured children and their parents were surveyed. The median age of the burn-injured children was 2.7 years old and the majority (54.2%; 77/142) were male. The mean total body surface area (TBSA) was 1.8% and half sustained burn injuries to one or both hands. The most frequently used regimens for constant and/or breakthrough pain control were acetaminophen (62.7%) and nonsteroidal anti-inflammatory drugs (NSAIDs; 68.3%). Less than one fifth (26/142;18%) of patients were prescribed opioids and 88% filled their prescription. The median number of doses of opioids prescribed was eight doses, with a median of four doses of opioids unused. Only three patients used all of their prescribed opioids and no patient ≥12 years old used their entire prescription. Burns greater than 3% TBSA, irrespective of burn injury location, were associated with opioid prescription (P = .003). Approximately 40% (10/26) of parents who filled their child's opioid prescription stored the opioid in a locked area. Fewer than one third (7/26) of patients were educated on how to dispose of excess opioid pain medication. Overall, most pediatric outpatient burn injuries can be successfully managed with over-the-counter medications. Providers, who care for burn-injured children ≤ 12 years old with burns that cover ≥3% TBSA in the outpatient setting, should consider no more than four opioid doses for initial pain control. This guideline, coupled with family and provider-centered education on multimodal therapy at the time of initial presentation and safe use of opioids, are important first steps to minimizing the use of opioids in the management of small area burns in children.
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Affiliation(s)
- Niti Shahi
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado School of Medicine, Aurora, Colorado
| | - Maxene Meier
- The Center for Research in Outcomes for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Ryan Phillips
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado School of Medicine, Aurora, Colorado
| | - Gabrielle Shirek
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Adam Goldsmith
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - John Recicar
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Jeannie Zuk
- University of Colorado School of Medicine, Aurora, Colorado
| | - Alan Bielsky
- University of Colorado School of Medicine, Aurora, Colorado.,Department of Anesthesia, Children's Hospital Colorado, Aurora, Colorado
| | - Myron Yaster
- University of Colorado School of Medicine, Aurora, Colorado.,Department of Anesthesia, Children's Hospital Colorado, Aurora, Colorado
| | - Steven Moulton
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado School of Medicine, Aurora, Colorado
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7
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Cheraghi F, Kalili A, Soltanian A, Eskandarlou M, Sharifian P. A Comparison of the Effect of Visual and Auditory Distractions on Physiological Indicators and Pain of Burn Dressing Change Among 6-12-Year-Oldchildren: A Clinical Trial Study. J Pediatr Nurs 2021; 58:e81-e86. [PMID: 33551193 DOI: 10.1016/j.pedn.2021.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
POURPOSE This study aimed to compare the effect of audiovisual distraction on physiological indicators and pain of burn dressing change among 6-12 year-old children. DESIGN AND METHODS The study was a single-blind clinical trial with a three-group that sample size was 120 children aged 6-12 years admitted to the burn ward of Hamadan Besat Hospital. Data collection tools were the Oucher pain scale, a Cheklist form of the physiological Indicators, and apulse oximetry device. The cartoons were shown for visual group and the melodic poems were played for the auditory group 2 min before the dressing until the end of the procedure (at 2-min intervals). Data were analyzed by SPSS-16 software one-way, variance analysis and post-hoc Bonferroni test. RESULTS Therewere statistically significant differences between visual, auditory and control groups in the mean pain intensity scores at all measurement times, the mean arterial blood oxygen saturation percentage at all measurement times except for the10 min before the dressing and the start of the procedure and the mean heart rate at all measurement times except for 10 min before dressing (p < 0.001). Post-hoc tests showed that the difference in the mean heart rate was related to the difference between the visual and auditory distraction groups during and at the end of the dressing (p < 0.05), the visual and control groups at all measurement times (P < 0.001) and the auditory and control groups at all measurement times (p < 0.05). CONCLUSION Audiovisual distraction is effective in reducing the fluctuations of physiological indicators and the burn dressing pain intensity in children at all times of measurement, especially during changedressing. PRACTICE IMPLICATIONS The findings of this study are relevant to clinical practice because they suggest preparing children before and during a burning procedure situation.
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Affiliation(s)
- Fatemeh Cheraghi
- Associate Professor, Research Center for (Home Care)Chronic Diseases, Department of Pediatric Nursing,School of Nursing and Midwifery, Hamadan University of Medical Sciences, Iran
| | - Arash Kalili
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Iran
| | - Alireza Soltanian
- Professor, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Iran
| | - Mahdi Eskandarlou
- Department of General Surgery, Hamadan University of Medical Sciences, Iran
| | - Pegah Sharifian
- Pediatric Nursing student, Hamadan University of Medical Sciences, Iran.
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Wall SL, Allorto NL, Chetty V. Reaching consensus on an analgesia protocol for paediatric burn patients in a resource-scarce South African community. S Afr Fam Pract (2004) 2021; 63:e1-e7. [PMID: 33764148 PMCID: PMC8378142 DOI: 10.4102/safp.v63i1.5193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite the exceptional burden of burns in low- and middle-income countries (LMIC) and the importance of adequate analgesia in burn care, there is a lack of analgesia protocol developed in resource-scarce settings. This necessitates the development of an analgesia protocol applicable to the resource-scarce setting. This study presents the findings of a modified Delphi study aimed at achieving consensus by a panel of experts in the management of burn injuries from low- and middle-income settings across Africa. METHODS A two-round Delphi survey was conducted to achieve consensus on an analgesia protocol for paediatric burn patients for a resource-limited setting. The Delphi panel consisted of nine experts with experience in management of burn injuries in low-income settings. RESULTS Consensus was determined by an a priori threshold of 80% of agreement for a drug to be included in the analgesia protocol. There was a largely overarching agreement with regard to the background analgesia protocol and strong agreement regarding the use of an initial dose of ketamine and midazolam for procedural sedation. CONCLUSION A modified Delphi method was used to obtain expert consensus for a recently adopted analgesia protocol for burn-injured children in a resource-limited setting, with experts in the management of burn injuries in low- and middle-income settings. The expert consensus leads to the rigour and robustness of the protocol. Delphi methods are exceptionally valuable in healthcare research and the aim of such studies is to find converging expert opinions.
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Affiliation(s)
- Shelley L Wall
- Pietermaritzburg Burn Service, Pietermaritzburg Metropolitan Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; and, Developing Research, Innovation, Localization and Leadership (DRILL), College of Health Sciences, University of KwaZulu-Natal, Durban.
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9
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Le May S, Hupin M, Khadra C, Ballard A, Paquin D, Beaudin M, Bouchard S, Cotes-Turpin C, Noel M, Guingo E, Hoffman HG, Déry J, Hung N, Perreault I. Decreasing Pain and Fear in Medical Procedures with a Pediatric Population (DREAM): A Pilot Randomized Within-Subject Trial. Pain Manag Nurs 2021; 22:191-197. [PMID: 33495093 DOI: 10.1016/j.pmn.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/14/2020] [Accepted: 10/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Many children with injuries, including burns and fractures, experience moderate to severe pain during medical procedures. Recent studies claim that nonpharmacologic pain management using virtual reality (VR) could distract children from procedural pain by engaging multiple senses. AIMS The aims of this pilot randomized clinical trial were to assess the acceptability and feasibility of VR distraction in children with burns or fractures undergoing painful medical procedures, as well as the staff nurses, and assess the preliminary efficacy of VR distraction on pain intensity, pain-related fear, and subsequent recall of both. MATERIALS AND METHOD A within-subject study design, in which participants served as their own control, was used. A total of 20 children from 7 to 17 years old with an injury were recruited at the surgical-trauma outpatient clinics of the Centre hospitalier universitaire Sainte-Justine (CHU Sainte-Justine). Each participant received both standard and experimental treatments through randomized order. Pain (numerical rating scale) and pain-related fear (Children's Fear Scale) measures were taken before the procedure and after each sequence, followed by a measure of children's (graphic rating scale) and nurses' acceptability of the intervention through their satisfaction level. Recall of pain intensity and pain-related fear were assessed 24 hours after the procedure. Wilcoxon signed-rank tests were used, with a significance level at 0.05. RESULTS Results showed that VR distraction was an acceptable and feasible intervention for children and nurses of these outpatient clinics. Preliminary effects showed that, compared to standard of care, children participants reported a significant decrease in pain intensity (p = .023) and pain-related fear (p = .011) during VR as well as less recalled pain-related fear (p = .012) at 24 hours after the procedure. No side effects were reported. CONCLUSION VR is a promising intervention with children undergoing painful procedures because it is immersive and engages multiple senses. It is a low-cost intervention well accepted by children and nursing staff at this clinical site and is easy to implement in daily practice for procedural pain management.
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Affiliation(s)
- Sylvie Le May
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada; CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Quebec, H3T 1C5, Canada.
| | - Mathilde Hupin
- CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Quebec, H3T 1C5, Canada; Department of Surgery, CHU Sainte-Justine, Montreal, QC, Canada
| | - Christelle Khadra
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada; CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Quebec, H3T 1C5, Canada
| | - Ariane Ballard
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada; CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Quebec, H3T 1C5, Canada
| | - David Paquin
- Department of Creation and NEW Media, UQAT Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Myriam Beaudin
- CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Quebec, H3T 1C5, Canada
| | - Stéphane Bouchard
- Department of Psychoeducation and Psychology, UQO Université du Québec en Outaouais, Quebec, Canada
| | - Casey Cotes-Turpin
- Department of Creation and NEW Media, UQAT Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Estelle Guingo
- Department of Creation and NEW Media, UQAT Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Hunter G Hoffman
- Virtual Reality Research Center, University of Washington, Seattle, Washington, USA
| | - Johanne Déry
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada
| | - Nicole Hung
- CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Quebec, H3T 1C5, Canada
| | - Isabelle Perreault
- CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Quebec, H3T 1C5, Canada
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10
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Storey K, Kimble RM, Holbert MD. The Management of Burn Pain in a Pediatric Burns-Specialist Hospital. Paediatr Drugs 2021; 23:1-10. [PMID: 33447938 DOI: 10.1007/s40272-020-00434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
Appropriate pain management for children who have experienced an acute burn injury is critical to improve patient outcomes and reduce potential morbidities. With 60% of our patients being under the age of 4 years, pain management is crucial in reducing pain and anxiety in both patients and parents. It is imperative that appropriate pain relief is commenced from initial contact with healthcare workers as this will affect the success or failure of future wound procedures. Uncontrolled pain can negatively affect a patient, both short and long term. It may cause anticipatory anxiety for future medical procedures, increased pain and anxiety can decrease wound re-epithelialization which can lead to long-term consequences for growth and mobility, and increased pain can also influence the possibility of patients and families displaying signs of post-traumatic stress disorder. Pain management in the form of pharmaceuticals is imperative during burn wound treatment and should incorporate pain relief targeted at both background and procedural pain. It also requires a multimodal, individualized, and targeted approach combining both pharmaceutical and nonpharmaceutical techniques, including cold running water, multimodal distraction devices, hypnotherapy, and bubbles. We discuss the research and knowledge that our center has gained through treating pediatric patients with burns over the last 20 years.
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Affiliation(s)
- Kristen Storey
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia. .,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia. .,Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - Maleea D Holbert
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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11
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Perazzo MF, Serra-Negra JM, Firmino RT, Pordeus IA, Martins-JÚnior PA, Paiva SM. Patient-centered assessments: how can they be used in dental clinical trials? Braz Oral Res 2020; 34 Suppl 2:e075. [PMID: 32785488 DOI: 10.1590/1807-3107bor-2020.vol34.0075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/22/2019] [Indexed: 11/22/2022] Open
Abstract
Recently, there has been greater interest in adopting a more holistic approach to healthcare. However, this trend should not limit itself merely to the notion that a human being lies behind the mouth being treated. Rather, it should embrace the understanding that this human can actively participate in and contribute to the treatment process. Patient Report Outcome Measures (PROMs) and Patient Report Experience Measures (PREMs) provide means for measuring data from the patient's perspective, and enable health-related feelings and functions to be evaluated. Accordingly, this critical review aims to provide definitions, rationales and applications of patient-centered approaches in dental clinical research. Some patient-centered constructs are especially relevant to dental clinical trials, such as oral health-related quality of life, pain/discomfort, aesthetics and satisfaction concerning treatment and services. The selection and application of patient-reported measures can vary according to condition (generic, disease-specific or treatment-specific) and to the specific population evaluated (age and cognitive impairment). These measures can help weigh risks and benefits, as well as assess the cost effectiveness of treatments, thus influencing treatment recommendations and health policies. The incorporation of these measures into a professional's daily life not only represents an improvement in professional performance, but also addresses a humanitarian concern.
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Affiliation(s)
- Matheus França Perazzo
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Júnia Maria Serra-Negra
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ramon Targino Firmino
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Isabela Almeida Pordeus
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Paulo Antônio Martins-JÚnior
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Saul Martins Paiva
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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12
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Wall S, Clarke D, Allorto N. A comparison of analgesia requirements in children with burns: Do delayed referrals require higher procedural analgesia doses? BURNS OPEN 2020; 4:103-109. [PMID: 35634456 PMCID: PMC9141068 DOI: 10.1016/j.burnso.2020.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Our clinical impression is that delayed referrals require more analgesia than children referred to our service acutely. Previous work demonstrated poor uptake of analgesia protocols at district hospitals with probable inadequate background and procedural analgesia, which may account for this. The purpose of this study was to compare analgesia requirements for dressing changes of paediatric patients referred to us acutely versus those children with delayed referral (i.e. more than 21 days post injury). Our hypothesis is that paediatric patients with delayed referral require higher doses of ketamine when taking length of stay and total body surface area (TBSA) of the burn into account. Methods: Data for children under 12 years, admitted to the Pietermaritzburg Burn Service (PBS) from the 1 July 2017 until 30 June 2018 was reviewed. Total ketamine dose during admission, weight, days admitted and TBSA were analysed. The total ketamine use in milligram per kilogram per days admitted per TBSA (mg/kg/days admitted/TBSA) was calculated. Statistical analysis was performed to compare the total ketamine dose between the acute and delayed referral groups. Results: One-hundred-and-ninety-seven patients were included. Patients were divided into two groups, the acute group including those referred to the PBS early (prior to 21 days post-burn) and the delayed referral group (those referred 21 days or more post burn). The acute group consisted of 167 patients and the chronic group 30 patients. There is a statistically significant difference between the total ketamine dose (mg/kg/days admitted/TBSA) for the acute referral and delayed referral groups (p = 0.01). The median total ketamine dose (mg/kg/days admitted/TBSA) of the acute referral group was 0.27 (Range: 0–7.05) and the median total Ketamine dose (mg/kg/days admitted/TBSA) for the delayed referral group was 0.41 (range: 0.1–3.89). Conclusion: Patients with delayed referrals require more ketamine to achieve adequate procedural analgesia than patients referred acutely. Inadequate analgesia in the acute phase of the burn may influence this, underpinning the importance of adequate analgesia right from the time of the injury.
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13
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Ahn HN, Kang HS, Park SJ, Park MH, Chun W, Cho E. Safety and efficacy of basic fibroblast growth factors for deep second-degree burn patients. Burns 2020; 46:1857-1866. [PMID: 33054995 DOI: 10.1016/j.burns.2020.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Burn injuries are common afflictions; however, conservative wound care frequently leads to poor treatment compliance and physical disability in deep burn patients. Therefore, regenerative biologic materials, which are more effective for tissue repair, are required, particularly for deep second-degree burns. A novel spray formulation of basic fibroblast growth factors (bFGF) was produced by synthesizing fibroblast growth factor proteins. In this post-marketing surveillance (PMS) study, we assessed the safety and efficacy of bFGF and indirectly compared this formulation with cultured epidermal autografts (CEAs) for treating deep second-degree burns. MATERIALS AND METHODS A total of 3173 patients treated at 15 hospitals were used for PMS of bFGF in South Korea for six years. In total, 1630 patients with deep second-degree burns were selected for assessing adverse events (AEs) of bFGF treatments. Efficacy was evaluated according to time periods until re-epithelialization, and clinical usefulness of bFGF was indirectly compared with that of CEAs. RESULTS AEs occurred in 37 patients (2.3%) and included application site pain (1.7%) and contact dermatitis (0.6%). All AEs were mild and were evaluated as probably unrelated with bFGF. The average time for re-epithelialization was 8 days; this time span was significantly longer after major burns (9.7 days) than after minor (7.8 days) or moderate burns (7.9 days). Most treated burn wounds (99.8%) were assessed as improved. The indirect comparison included 534 patients using the same inclusion criteria for CEA patients (n = 35). The bFGF treatment demonstrated superior efficacy compared to CEAs by significantly reducing the average day to application (5.4 vs. 8.8 days) and re-epithelialization time (7.1 vs. 13.7 days). CONCLUSION Our study demonstrated that bFGF is a compelling regenerative therapy with competitive clinical efficacy and safety for deep second-degree burns and reduced treatment time, which is expected to reduce medical costs, particularly for deep second-degree burn patients.
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Affiliation(s)
- Hye-Na Ahn
- Daewoong Pharmaceutical Company HQ, Seoul, 06170, Republic of Korea
| | - Hee-Sung Kang
- Daewoong Pharmaceutical Company HQ, Seoul, 06170, Republic of Korea
| | - Su-Jung Park
- Daewoong Pharmaceutical Company HQ, Seoul, 06170, Republic of Korea
| | - Mi-Hee Park
- Daewoong Pharmaceutical Company HQ, Seoul, 06170, Republic of Korea
| | - Wook Chun
- Department of Burn Surgery, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, 07247, Republic of Korea
| | - Eun Cho
- College of Pharmacy, Sookmyung Women's University, Seoul, 04310, Republic of Korea; College of Pharmacy, University of Texas at Austin, Austin, TX, 78712, United States.
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14
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Williams HM, Hunter K, Clapham K, Ryder C, Kimble R, Griffin B. Efficacy and cultural appropriateness of psychosocial interventions for paediatric burn patients and caregivers: a systematic review. BMC Public Health 2020; 20:284. [PMID: 32131784 PMCID: PMC7057463 DOI: 10.1186/s12889-020-8366-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background Paediatric burns are highly painful and traumatising injuries that are overrepresented among Aboriginal and Torres Strait Islander people. Paediatric burn patients’ pain remains poorly managed by pharmacological interventions, leading to increased anxiety, distress, and trauma in patients and their caregivers. Non-pharmacological psychosocial interventions have been suggested as effective in reducing pain and psychological morbidities among paediatric burn patients and their caregivers; however, their degree of effectiveness and appropriateness for Aboriginal and Torres Strait Islander people is unclear. Methods A non-date restricted systematic review was conducted through four databases. Studies published in English assessing psychosocial interventions on paediatric burn patients’ physical pain along with theirs and/or their caregiver’s anxiety, distress, or trauma symptoms were identified and included in this review. Included studies were assessed for their ability to reduce one of the outcomes of interests and for their reflection of Aboriginal and Torres Strait Islander peoples’ perspectives of health. Results Of the 3178 identified references, 17 were eligible. These include distraction based techniques (n = 8), hypnosis/familiar imagery (n = 2), therapeutic approaches (n = 4), and patient preparation/procedural control (n = 3). Distraction techniques incorporating procedural preparation reduced pain, while discharge preparation and increased ‘patient control’ reduced patient and caregiver anxiety; and internet based Cognitive Behaviour Therapy reduced short-term but not long-term post-traumatic stress symptoms. No interventions reflected Aboriginal and Torres Strait Islander peoples’ perspectives of health; and few targeted caregivers or focused on reducing their symptoms. Conclusions The development and assessment of psychosocial interventions to appropriately meet the needs of Aboriginal and Torres Strait Islander paediatric burn patients is required.
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Affiliation(s)
- H M Williams
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Graham Street, South Brisbane, 4101, QLD, Australia. .,Pegg Leditschke Paediatric Burns Centre, Queensland Children's Hospital, Graham Street, South Brisbane, QLD, 4101, Australia.
| | - K Hunter
- Injury Division, The George Institute for Global Health, University of New South Wales, King Street, Sydney, 2042, NSW, Australia
| | - K Clapham
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Australian Health Services Research Institute, The University of Wollongong, Wollongong, 2522, NSW, Australia
| | - C Ryder
- Injury Division, The George Institute for Global Health, University of New South Wales, King Street, Sydney, 2042, NSW, Australia.,College of Medicine & Public Health, Southgate Institute for Health Society and Equity, Flinders University, Registry Road, Bedford Park, 5042, SA, Australia
| | - R Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Graham Street, South Brisbane, 4101, QLD, Australia.,Pegg Leditschke Paediatric Burns Centre, Queensland Children's Hospital, Graham Street, South Brisbane, QLD, 4101, Australia
| | - B Griffin
- Pegg Leditschke Paediatric Burns Centre, Queensland Children's Hospital, Graham Street, South Brisbane, QLD, 4101, Australia.,School of Nursing, Queensland University of Technology, Ring Road, Brisbane, 4059, QLD, Australia
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15
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Qing Y, Yongqiang X, Xiaoming F, Tuo S, Xiaona X, Yiheng H, Pengfei L, Xiaoyan H, Zhaofan X. First-aid knowledge regarding small area burns in children among 5814 caregivers: A questionnaire analysis. Burns 2019; 46:459-464. [PMID: 31481271 DOI: 10.1016/j.burns.2019.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/07/2019] [Accepted: 08/13/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND To assess caregivers'knowledge of first aid for small-area thermal burns in children, and reduce burns-induced morbidity and damage in children. METHODS The multi-stage cluster random sampling method was used to recruit school-age children from different kinds of schools. For each child, we selected only one caregiver as our study participant. First-aid knowledge regarding small area burns in children and choices of medical treatment were investigated in the manner of questionnaires. RESULTS The effective response rate of questionnaire was 99.4% (5814/5850). Folk remedies and daily necessities were chosen by 17.8% (1,036/5814) and 48.9% (2841/5814), respectively. 39.8% (2,312/5814) of caregivers knew all standard burn first aid measures. Moreover, the proportion of knowing all five measures among caregivers with undergraduate education was significantly higher than the figures among those with other educational levels. CONCLUSIONS Child caregivers had poor knowledge of first aid for small area burns in children. Only a few caregivers knew all five standard first aid measures for managing small area burns. Many non-scientific and inappropriate home remedies are still widely applied among Shanghai citizens. Our study results suggest relevant scientific evidence-informed measures should be more widely disseminated to the citizens.
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Affiliation(s)
- Yu Qing
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China
| | - Xiao Yongqiang
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China
| | - Fan Xiaoming
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China
| | - Shen Tuo
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China
| | - Xu Xiaona
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China
| | - Huang Yiheng
- College of Pharmacy, Fudan University, Shanghai, China
| | - Luo Pengfei
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China.
| | - Hu Xiaoyan
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China.
| | - Xia Zhaofan
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China.
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16
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Nelson S, Uhl K, Wright LA, Logan D. Pain is Associated With Increased Physical and Psychosocial Impairment in Youth With a History of Burn Injuries. THE JOURNAL OF PAIN 2019; 21:355-363. [PMID: 31400474 DOI: 10.1016/j.jpain.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/23/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
Burn injuries are significantly painful and associated with physical and psychological impairment. However, little research to-date has examined the potential role of the subjective experience of pain in either physical or psychological impairment in this population. This may be particularly important to examine, given that the pain experience can often be a significant barrier to recovery in other pediatric populations. The current study examined the cross-sectional and predictive relationships between patient-reported experience of pain (operationalized as PROMIS pain interference and self-reported pain intensity) and physical and psychosocial outcomes. Data were gathered as part of the Burn Model System National Database (1994-2018) with the data request inclusive of pediatric self-report PROMIS measures, child PTSD, and post-traumatic growth symptoms assessed at 6- and 12-month postdischarge following initial injury. A total of 65 youth between the ages of 6 and 16 years at the time of their injury were included in the dataset. Correlational and regression analyses indicated that pain interference was cross-sectionally and longitudinally associated with decreased physical functioning, depressive symptoms, and peer relationships. Pain intensity was significantly associated with and predictive of physical functioning and pain interference. Results of the current study are an important first step in understanding the pain experience and associated outcomes in youth with a history of burn injuries. Future research is needed to further examine these relationships. PERSPECTIVE: This study presents preliminary findings from a national database on pain-related outcomes both cross-sectionally and longitudinally in youth with a history of burn injury. To-date, pain-related outcomes are poorly understood in this population and the results of this study serve to inform future research and treatment-related efforts.
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Affiliation(s)
- Sarah Nelson
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - Kristen Uhl
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Laura A Wright
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Deirdre Logan
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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17
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Analgesia protocols for burns dressings: Challenges with implementation. Burns 2019; 45:1680-1684. [PMID: 31230803 DOI: 10.1016/j.burns.2019.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study is to compare doctors' knowledge regarding analgesia in paediatric burns patients in a setting where analgesia protocols are provided but not reinforced to a setting where the same protocols are used but with constant re-enforcement from burns surgeons. METHODS We reviewed questionnaires completed anonymously by doctors managing burns children in the Pietermaritzburg (PMB) Hospital Complex and the referral hospitals. RESULTS The questionnaire was completed by 43 doctors with 53% of the participants working in the referral hospitals. Procedural sedation was given by 98% of doctors. All PMB doctors giving procedural sedation used ketamine compared to 39% in the referral hospitals, which was statistically significant (×2 = 18.237; p < 0.001). Eighty percent of PMB doctors were aware of the correct doses of ketamine and compared to 8% of referral doctors. This was statistically significant (×2 = 21.778; p < 0.001). When assessing the adequacy of analgesia, all of the doctors from PMB used a scoring system or clinical impression. In the referral doctor group, 54% used a scoring system, 38% used the child screaming as an indicator of inadequate analgesia. CONCLUSION We have identified a discrepancy in knowledge between staff in an academic burn centre and those in peripheral referral hospitals. This discrepancy translates into differences in quality of burn analgesia which patients receive. Ongoing efforts must be directed towards changing the culture of district institution and strengthening attempts to standardize care across the region.
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18
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Superiority of silver-foam over porcine xenograft dressings for treatment of scalds in children: A prospective randomised controlled trial. Burns 2019; 45:1401-1409. [PMID: 31230798 DOI: 10.1016/j.burns.2019.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 02/08/2023]
Abstract
AIM Our aim was to compare two different regimens for the treatment of children with partial-thickness scalds. These were treated with either a porcine xenograft (EZderm®, Mölnlycke Health Care, Gothenburg, Sweden) or a silver-foam dressing (Mepilex® Ag, Mölnlycke Health Care, Gothenburg, Sweden). METHODS We organised a prospective randomised clinical trial that included 58 children admitted between May 2015 and May 2018 with partial-thickness scalds to The Burn Centre in Linkoping, Sweden. The primary outcome was time to healing. Secondary outcomes were pain, need for operation, wound infection, duration of hospital stay, changes of dressings, and time taken. RESULTS The patients treated with silver-foam dressing had a significantly shorter healing time. The median time to 97% healing for this group was 9 (7-23) days compared to 15 (9-29) days in the porcine xenograft group (p = 0.004). The median time to complete healing for the silver-foam group was 15 (9-29) days and for the porcine xenograft group 20.5 (11-42) days (p = 0.010). Pain, wound infection, duration of hospital stay, and the proportion of operations were similar between the groups. Number of dressing changes and time for dressing changes were lower in the silver-foam dressing group (p = 0.03 for both variables). CONCLUSIONS We compared two different treatments for children with partial-thickness scalds, and the data indicate that wound healing was faster, fewer dressing changes were needed, and dressing times were shorter in the silver-foam group.
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Yang JO, Kim SJ, Cho H, Lee K. Effects of a conscious sedation dressing on pain and anxiety in pediatric burn patients. Jpn J Nurs Sci 2019; 17:e12273. [PMID: 31216126 DOI: 10.1111/jjns.12273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/10/2019] [Accepted: 02/27/2019] [Indexed: 02/04/2023]
Abstract
AIM This study examined the effects of a conscious sedation dressing on pain and anxiety in pediatric patients with burns. METHODS This was a quasi-experimental study, using a nonequivalent control group. Using convenience sampling, the participants were assigned to two groups, an experimental group (n = 10), which comprised children who received a conscious sedation dressing, and a control group (n = 13), which comprised children who received general dressing care. To minimize the risk of contamination between the two groups, the sampling was sequentially performed. RESULTS The children in the experimental group showed significantly lower levels of pain (U = 3.29, d = 1.00, P = .003) and physiological responses, as evidenced by lower systolic blood pressures, diastolic blood pressures, pulse rates, and respiratory rates than the control group (systolic blood pressures: t = 5. 05, d = 1.22, P < .001; diastolic blood pressures: t = 2.12, d = 0.93, P = .046; pulse rates: t = 2.28, d = 1.00, P = .033; and respiratory rates: t = 2.47, d = 1.09, P = .022). CONCLUSION The application of a conscious sedation dressing may alleviate pain and anxiety for pediatric burn patients.
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Affiliation(s)
- Jung O Yang
- Division of Nursing, Hallym University Hangang Sacred Heart Hospital, Seoul, South Korea
| | - Shin-Jeong Kim
- Department of Nursing, Hallym University, Chuncheon, South Korea
| | - Haeryun Cho
- Department of Nursing, Wonkwang University, Iksan, South Korea
| | - Kyungeun Lee
- Department of Beauty stylist, Yeonsung University, Anyang, South Korea
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20
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Prasad A, Thode HC, Sandoval S, Singer AJ. The association of patient and burn characteristics with itching and pain severity. Burns 2019; 45:348-353. [PMID: 30686696 DOI: 10.1016/j.burns.2018.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/02/2018] [Accepted: 06/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Itch after burn injury causes significant distress to patients and can hamper functional recovery. Itching can persist on a time scale ranging from several weeks to even years after injury. In this study, we sought to determine predictors of itching after burn injury. METHODS We compared itch and pain severity among patients included in a burn registry at a level 1 trauma center. Both itch and pain severity was based on a 5-point scale. ANOVA, chi-squared, and multivariate analyses were performed to determine predictors of itch and pain severity. RESULTS Of the 1159 patients enrolled in the registry, 58% were male and 42% female, with a median age (IQR) of 27 (8-47) years. Most patients were diagnosed with 2nd degree superficial (41%) or deep (43%) burns. Upper extremities were the most common location of burn injury (59%), followed by lower extremities (31%), trunk (22%), and face/neck (20%). More than half (53%) of enrolled patients reported itching, ranging from minimal (19%) to severe (7%) itching. Multivariate analyses revealed age, sex (female), extent of burn injuries, and location (face/neck) to be predictors of itch after burn. Predictors of pain after burn were slightly different: age, extent of burn, and depth of burn. CONCLUSION Pain and itch after burn injuries are predicted by slightly different variables, presumably secondary to different underlying mechanisms. We conclude that age, sex (female), extent of burn injuries (total body surface area %), and injuries to the face/neck predict itching of greater severity. Patients with burn injuries that match these parameters would require greater care and closer follow up to reduce itching after healing.
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Affiliation(s)
- Atulya Prasad
- Department of Emergency Medicine, HSC-L4-080 Stony Brook Medicine, Stony Brook, NY 11794-8350, United States
| | - Henry C Thode
- Department of Emergency Medicine, HSC-L4-080 Stony Brook Medicine, Stony Brook, NY 11794-8350, United States
| | - Steven Sandoval
- Department of Surgery, HSC-L19 Stony Brook Medicine, Stony Brook, NY 11794, United States
| | - Adam J Singer
- Department of Emergency Medicine, HSC-L4-080 Stony Brook Medicine, Stony Brook, NY 11794-8350, United States.
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21
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Holbert MD, Griffin BR, McPhail SM, Ware RS, Foster K, Bertoni DC, Kimble RM. Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric thermal burn injuries: study protocol for a randomised controlled trial. Trials 2019; 20:13. [PMID: 30612585 PMCID: PMC6322255 DOI: 10.1186/s13063-018-3057-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/16/2018] [Indexed: 01/13/2023] Open
Abstract
Background Burns are a painful and traumatic experience, particularly in children. Reduced pain and anxiety positively influences re-epithelialisation rates in paediatric burn patients, however current literature fails to fully explain the effects of pain and anxiety and their links with wound healing. This study will determine if Burnaid® hydrogel dressing is an effective treatment for reducing pain in the acute period of a burn injury. It is hypothesised that a reduction in pain will then improve re-epithelialisation time in comparison to plastic wrap, which is standard practice at our institution — a metropolitan tertiary paediatric hospital located in Brisbane, Australia. Methods/design A randomised controlled trial will be conducted to assess the effectiveness of Burnaid® as an analgesic adjunct to cold running water first aid for the treatment of paediatric burns. Participants will include children aged between 0 and 16 years with an acute thermal burn injury (total burn surface area < 20%) presenting to the Department of Emergency within 24 h of the burn occurring. Participants will be randomised into one of two groups: (1) Burnaid® hydrogel (intervention arm) or (2) plastic wrap (control arm). Participants will also be stratified into one of two groups based on factors that influence pain intensity: (1) high pain risk or (2) low pain risk. High pain risk factors include foot burns, hot coal/ash/fire pit burns, burn area greater than 5%, and circumferential burns. The primary outcome is the intervention’s effect on reducing acute pain. Secondary outcomes include days to re-epithelialisation, pulse rate, temperature, salivary cortisol and α-amylase, anxiety, and cost-effectiveness. Sample size calculations have shown that 36 participants will be recruited into each group. Discussion This study will provide comprehensive data on the analgesic properties of Burnaid® as an adjunct to first aid for the treatment of acute paediatric thermal burns. If the intervention is effective in reducing pain, Burnaid® will be integrated as standard practice within the hospital’s Department of Emergency. This study replicates a real-world scenario in order to identify clinically significant analgesic and wound-healing effects. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12617001274369. Prospectively registered on 5 Sept 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3057-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maleea D Holbert
- Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia. .,Pegg Leditschke Paediatric Burns Centre, Lady Cilento Children's Hospital, South Brisbane, Australia.
| | - Bronwyn R Griffin
- Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia.,Pegg Leditschke Paediatric Burns Centre, Lady Cilento Children's Hospital, South Brisbane, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Buranda, Australia.,School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Kelly Foster
- Paediatric Emergency Research Unit, Children's Health Queensland, South Brisbane, Australia
| | - Demi C Bertoni
- Pegg Leditschke Paediatric Burns Centre, Lady Cilento Children's Hospital, South Brisbane, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia.,Pegg Leditschke Paediatric Burns Centre, Lady Cilento Children's Hospital, South Brisbane, Australia
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Murphy PS, Kleinwachter N, Medina E. Environmental buttocks burns in children and adolescents with spina bifida in the Southwestern United States. J Pediatr Rehabil Med 2019; 12:369-374. [PMID: 31744035 DOI: 10.3233/prm-190607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Spina Bifida (SB) is a congenital defect of the neural tube resulting in motor and sensory defects and frequently includes insensate skin on the buttocks and feet which are innervated by sacral nerves. For those living in hot climates such as the Southwestern United States, environmental surfaces reach temperatures throughout June-September that cause thermal burns. The objective of this novel case series was to evaluate the circumstances associated with environmental buttocks burns in children with SB who attend the District Medical Group Children's Rehabilitative Services Myelomeningocele (MM) Planning clinic in Phoenix, AZ. METHODS Nine children and adolescents with SB and a history of environmental buttocks burns were identified through participation in the National Spina Bifida Patient Registry at District Medical Group Children's Rehabilitative Services Myelomeningocele Planning Clinic. Parents and patients were interviewed about the burn circumstances, charts were reviewed, and information was gathered from the NSBPR including level of function and ambulation status. RESULTS Most of the patients were found to be of emerging independent ages (average age 10 years) and were not with their parents at the time of the burn. All had myelomeningocele (MM), almost all were community ambulators, and all had mid lumbar, low lumbar or sacral level function. There were no non-ambulators. In addition, the majority were wearing incontinence products. CONCLUSIONS Children and adolescents with MM who are community ambulators, of an emerging independent age, and live in hot climates are at risk of environmental buttocks burns. Enhanced education in environmental thermal burn prevention is important. This education should be particularly focused on the child as they spend more time in settings without their parents. In addition, this enhanced education should extend to those who support the child or teen such as teachers, coaches, family and friends.
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Nelson S, Conroy C, Logan D. The biopsychosocial model of pain in the context of pediatric burn injuries. Eur J Pain 2018; 23:421-434. [PMID: 30288844 DOI: 10.1002/ejp.1319] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/20/2018] [Accepted: 09/28/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Burns are a common and traumatic source of childhood injury in the United States. The treatment and recovery from burn injuries can be significantly painful and may lead to chronic or persistent pain for years following the initial incident. Further, burn injuries in youth have been found to increase the potential for significant psychosocial (e.g., anxiety, depression, PTSD) and physical (e.g., decreased mobility) impairment. Relatedly, the general experience and processing of pain in youth can also be associated with greater psychosocial (e.g., anxiety, depression) impairment and functional disability over time. However, the phenomenology and associated characteristics of the pain experience following burn injury and, in particular, the potential for combined impact on physical and psychosocial outcomes in youth with severe and/or prolonged pain and a history of burn injury is poorly understood. METHODS A review of the literature was performed in the areas of burn injuries and outcomes associated with both acute and chronic pain with youth and adult populations. RESULTS The current review highlights current gaps in the literature in important areas of function in youth with a history of burn injuries using the biopsychosocial model of pain. Future research and considerations for practice are also outlined. CONCLUSIONS Gaining a greater understanding of the relationship between pain, physical impairment, and psychosocial functioning in these youth is significantly important in order to provide greater preventative and treatment-related intervention going forward. SIGNIFICANCE Using a biopsychosocial framework, this review highlights the need for a greater understanding of pain processing and the long-term potential for persistent pain and pain-related impairment (e.g., functional disability) in youth with a history of burn injuries.
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Affiliation(s)
- Sarah Nelson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Conroy
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Mayo Clinic Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, Massachusetts
| | - Deirdre Logan
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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24
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Raymond SL, Zecevic A, Larson SD, Ruzic A, Islam S. Delayed Healing Associated with Silver Sulfadiazine Use for Partial Thickness Scald Burns in Children. Am Surg 2018. [DOI: 10.1177/000313481808400628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Burns are a leading cause of injury in children. Management principles vary widely, with no consensus about the best treatment. The purpose of this study was to compare outcomes of three different dressings for pediatric partial-thickness scald burns. A retrospective, single-center study was conducted for patients 0–16 years old with a diagnosis of acute partial-thickness scald burn between July 2007 and December 2012. Data regarding prehospital, inpatient, and outpatient course were collected. Cohort was stratified into topical antimicrobial (TA) ointment, silver sulfadiazine (SS), and biosynthetic dressing (BD) groups for analysis. The primary outcome of interest was time to full healing. One hundred and seventy-seven patients met all study criteria. Overall, mean total body surface area burned was 8.3 per cent. TAwas used in 24 per cent cases, SS in 32 per cent, and BD in 44 per cent. The groups were comparable in terms of presenting burn characteristics and hospital course with the exception of the BD group being associated with greater extent of injury. Patients treated with SS had a significantly longer time to full healing and increased requirement of compression garments for scar therapy. Based on these data, the authors have amended their practice and presently use BD or TA dressings to improve healing.
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Affiliation(s)
- Steven L. Raymond
- From the Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Antonia Zecevic
- From the Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Shawn D. Larson
- From the Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Ana Ruzic
- From the Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Saleem Islam
- From the Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
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26
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Scapin SQ, Echevarría-Guanilo ME, Fuculo Junior PRB, Martins JC, Barbosa MDV, Pereima MJL. Use of virtual reality for treating burned children: case reports. Rev Bras Enferm 2017; 70:1291-1295. [DOI: 10.1590/0034-7167-2016-0575] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/09/2017] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To report the use of virtual reality (VR) in pain intensity during dressing change of two burned children hospitalized in a Burn Treatment Center (BTC) in Southern Brazil. Method: Case report on the use of VR during dressing change of two burned children hospitalized in a BTC, from May to July 2016. For assessing pain, a facial pain rating scale was applied at four times: just before the dressing, during the dressing without the use of VR, during the dressing with the VR, and after the use of VR. Results: The use of goggles was easy to apply and well-accepted by the children, and also had a relevant effect reducing pain. Conclusion: VR can become an important nonpharmacological method for treating pain in burned children.
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27
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Bührer G, Beier JP, Horch RE, Arkudas A. [Surgical treatment of burns : Special aspects of pediatric burns]. Hautarzt 2017; 68:385-392. [PMID: 28314878 DOI: 10.1007/s00105-017-3967-7] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment of pediatric burn patients is very important because of the sheer frequency of burn wounds and the possible long-term ramifications. Extensive burns need special care and are treated in specialized burn centers. OBJECTIVES The goal of this work is to present current standards in burn therapy and important innovations in the treatment of burns in children so that the common and small area burn wounds and scalds in pediatric patients in day-to-day dermatological practice can be adequately treated. MATERIALS AND METHODS Analysis of current literature, discussion of reviews, incorporation of current guidelines. RESULTS Burns in pediatric patients are common. Improvement of survival can be achieved by treatment in burn centers. The assessment of burn depth and area is an important factor for proper treatment. We give an overview for outpatient treatment of partial thickness burns. New methods may result in better long-term outcome. CONCLUSIONS Adequate treatment of burn injuries considering current literature and guidelines improves patient outcome. Rational implementation of new methods is recommended.
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Affiliation(s)
- G Bührer
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - J P Beier
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - R E Horch
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - A Arkudas
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstr. 12, 91054, Erlangen, Deutschland
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Morley J, Holman N, Murray CD. Dressing changes in a burns unit for children under the age of five: A qualitative study of mothers' experiences. Burns 2017; 43:757-765. [PMID: 28069342 DOI: 10.1016/j.burns.2016.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 11/17/2016] [Accepted: 11/29/2016] [Indexed: 01/17/2023]
Abstract
This study aimed to investigate the experiences of mothers who had attended their child's burn dressing changes. Participants were recruited from a burns unit based within a children's hospital. Face-to-face interviews were conducted with five mothers of children under the age of five who had undergone a series of dressing changes taking place on the burns unit. The interview guide explored parents' experience of initial and subsequent dressing changes. Participants were prompted to explore their expectations, thoughts, feelings and behaviours associated with these experiences. The interviews were recorded and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis. The analysis identified four themes: 'needing to fulfil the responsibilities associated with being a mother'; 'emotional synchrony between mother and child'; 'being informed and knowing what to expect'; and 'the importance of establishing rapport with nurses performing dressing changes'. Findings from this research can inform services to help optimise mothers' experiences of dressing changes in this stage of pediatric burn care.
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Affiliation(s)
- Jessica Morley
- Faculty of Health & Medicine, Lancaster University, Lancaster, UK
| | - Natalie Holman
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Craig D Murray
- Faculty of Health & Medicine, Lancaster University, Lancaster, UK.
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30
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Bitter CC, Erickson TB. Management of Burn Injuries in the Wilderness: Lessons from Low-Resource Settings. Wilderness Environ Med 2016; 27:519-525. [DOI: 10.1016/j.wem.2016.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/27/2016] [Accepted: 09/02/2016] [Indexed: 01/22/2023]
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31
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Duran C, Sheridan RL. Current Concepts in the Medical Management of the Pediatric Burn Patient. CURRENT TRAUMA REPORTS 2016. [DOI: 10.1007/s40719-016-0060-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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Konieczynska MD, Villa-Camacho JC, Ghobril C, Perez-Viloria M, Tevis KM, Blessing WA, Nazarian A, Rodriguez EK, Grinstaff MW. On-Demand Dissolution of a Dendritic Hydrogel-based Dressing for Second-Degree Burn Wounds through Thiol-Thioester Exchange Reaction. Angew Chem Int Ed Engl 2016. [DOI: 10.1002/ange.201604827] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Marlena D. Konieczynska
- Departments of Chemistry and Biomedical Engineering; Boston University; 590 Commonwealth Ave Boston MA 02215 USA
| | - Juan C. Villa-Camacho
- Center for Advanced Orthopaedic Studies; Beth Israel Deaconess Medical Center; 330 Brookline Ave Boston MA 02215 USA
| | - Cynthia Ghobril
- Departments of Chemistry and Biomedical Engineering; Boston University; 590 Commonwealth Ave Boston MA 02215 USA
| | - Miguel Perez-Viloria
- Center for Advanced Orthopaedic Studies; Beth Israel Deaconess Medical Center; 330 Brookline Ave Boston MA 02215 USA
| | - Kristie M. Tevis
- Departments of Chemistry and Biomedical Engineering; Boston University; 590 Commonwealth Ave Boston MA 02215 USA
| | - William A. Blessing
- Departments of Chemistry and Biomedical Engineering; Boston University; 590 Commonwealth Ave Boston MA 02215 USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies; Beth Israel Deaconess Medical Center; 330 Brookline Ave Boston MA 02215 USA
| | - Edward K. Rodriguez
- Center for Advanced Orthopaedic Studies; Beth Israel Deaconess Medical Center; 330 Brookline Ave Boston MA 02215 USA
| | - Mark W. Grinstaff
- Departments of Chemistry and Biomedical Engineering; Boston University; 590 Commonwealth Ave Boston MA 02215 USA
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Konieczynska MD, Villa-Camacho JC, Ghobril C, Perez-Viloria M, Tevis KM, Blessing WA, Nazarian A, Rodriguez EK, Grinstaff MW. On-Demand Dissolution of a Dendritic Hydrogel-based Dressing for Second-Degree Burn Wounds through Thiol-Thioester Exchange Reaction. Angew Chem Int Ed Engl 2016; 55:9984-7. [PMID: 27410669 DOI: 10.1002/anie.201604827] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/23/2016] [Indexed: 12/20/2022]
Abstract
An adhesive yet easily removable burn wound dressing represents a breakthrough in second-degree burn wound care. Current second-degree burn wound dressings absorb wound exudate, reduce bacterial infections, and maintain a moist environment for healing, but are surgically or mechanically debrided from the wound, causing additional trauma to the newly formed tissues. We have developed an on-demand dissolvable dendritic thioester hydrogel burn dressing for second-degree burn care. The hydrogel is composed of a lysine-based dendron and a PEG-based crosslinker, which are synthesized in high yields. The hydrogel burn dressing covers the wound and acts as a barrier to bacterial infection in an in vivo second-degree burn wound model. A unique feature of the hydrogel is its capability to be dissolved on-demand, via a thiol-thioester exchange reaction, allowing for a facile burn dressing removal.
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Affiliation(s)
- Marlena D Konieczynska
- Departments of Chemistry and Biomedical Engineering, Boston University, 590 Commonwealth Ave, Boston, MA, 02215, USA
| | - Juan C Villa-Camacho
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Cynthia Ghobril
- Departments of Chemistry and Biomedical Engineering, Boston University, 590 Commonwealth Ave, Boston, MA, 02215, USA
| | - Miguel Perez-Viloria
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Kristie M Tevis
- Departments of Chemistry and Biomedical Engineering, Boston University, 590 Commonwealth Ave, Boston, MA, 02215, USA
| | - William A Blessing
- Departments of Chemistry and Biomedical Engineering, Boston University, 590 Commonwealth Ave, Boston, MA, 02215, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Edward K Rodriguez
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Mark W Grinstaff
- Departments of Chemistry and Biomedical Engineering, Boston University, 590 Commonwealth Ave, Boston, MA, 02215, USA.
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An assessment of early Child Life Therapy pain and anxiety management: A prospective randomised controlled trial. Burns 2015; 41:1642-1652. [DOI: 10.1016/j.burns.2015.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/05/2015] [Accepted: 05/26/2015] [Indexed: 11/18/2022]
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Singer AJ, Beto L, Singer DD, Williams J, Thode HC, Sandoval S. Association between burn characteristics and pain severity. Am J Emerg Med 2015; 33:1229-31. [PMID: 26168699 DOI: 10.1016/j.ajem.2015.05.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/27/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Traditionally, full thickness burns have been thought to be painless due to destruction of underlying nerves. We explored the association between patient and burn characteristics and pain severity in burn patients and determined whether full thickness burns were less likely to be painful than more superficial burns. METHODS We performed a structured review of medical records of patients presenting to a burn center between 2010 and 2013. Data abstracted included baseline patient and burn characteristics. The primary end point was pain severity on patient arrival to the emergency department using a verbal numeric score of 0 to 10. Univariate and multivariate analyses were used to explore the association between patient and burn characteristics and pain severity. RESULTS There were 507 patients. Mean (SD) age was 29.9 (23.6); 38% were ages younger than 18, and 68% were males. The median (interquartile ranges) pain score was 5 (2-8). Of all patients, 7% had isolated full thickness burns. Median (interquartile ranges) pain scores in isolated full thickness burns were slightly lower than in more superficial burns: 4 (1-8) vs 6 (2-8), respectively, P = .09. Twenty-five percent of patients with isolated full thickness burns had pain scores of 0 compared with 18% of all others (P = .28). There was no correlation between total body surface area and pain severity, however, pain scores increased with the number of burns (P = .007). CONCLUSIONS Pain severity is slightly less with full thickness burns; however, most patients have pain. The presence of pain should not be used to exclude full thickness burns.
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Affiliation(s)
- Adam J Singer
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY; Department of Surgery, Stony Brook University, Stony Brook, NY.
| | - Lionelle Beto
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY; Department of Surgery, Stony Brook University, Stony Brook, NY
| | - Daniel D Singer
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY; Department of Surgery, Stony Brook University, Stony Brook, NY
| | - Justin Williams
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY; Department of Surgery, Stony Brook University, Stony Brook, NY
| | - Henry C Thode
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY; Department of Surgery, Stony Brook University, Stony Brook, NY
| | - Steven Sandoval
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY; Department of Surgery, Stony Brook University, Stony Brook, NY
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Dunpath T, Chetty V, Van Der Reyden D. The experience of acute burns of the hand – patients perspectives. Disabil Rehabil 2014; 37:892-8. [PMID: 25109499 DOI: 10.3109/09638288.2014.948129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eich C, Sinnig M, Guericke H. Akutversorgung des brandverletzten Kindes. Notf Rett Med 2014. [DOI: 10.1007/s10049-013-1809-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abedipour M, Tavasouli A, Sobouti B, Mansourimanesh M, Saeedi Eslami N, Bodaghy Alny M. Frequency and causes of seizure among hospitalized burned children. Burns 2013; 40:737-43. [PMID: 24184286 DOI: 10.1016/j.burns.2013.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 09/23/2013] [Accepted: 09/25/2013] [Indexed: 12/14/2022]
Abstract
METHODS In this cross-sectional retrospective study, frequency, type, time of occurrence and atiology of seizures in children with burn was investigated. All cases were under 18 years and were hospitalized in Shahid Motahari Burns Hospital during 2006-2011. Extracted data from patients' medical records was reviewed and statistically analyzed. RESULTS Among 1103 patients, 69 (6.2%) had seizures, more frequently in the first 24 h following burn. Thermal burn, especially with boiling water was the cause of burn in most of the children. Seizures occurred more commonly in children less than 3 years old and was generalized (tonic-clonic). Seizure was found to be primarily associated with febrile seizure, while hyponatremia was diagnosed as the second cause. Previous seizure history and seizure with unknown cause were identified as other etiologies. This paper summarizes the key information about seizure following burn, which health professionals, especially those in burn centers, should be aware. However, since this study was single-center more investigations in other centers are needed.
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Affiliation(s)
| | - Azita Tavasouli
- Department of Pediatrics, Ali Asghar Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Sobouti
- Burn Research Center (BRC), Shahid Motahari Burns Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Burn injuries are a huge public health issue for children throughout the world, with the majority occurring in developing countries. Burn injuries can leave a pediatric patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. Rehabilitation is an essential and integral part of pediatric burn treatment. The aim of this article was to review the literature on pediatric burn rehabilitation from the Medline, CINAHL, and Web of Science databases. An attempt has been made to present the basic aspects of burn rehabilitation, provide practical information, and discuss the goals and conceptualization of rehabilitation as well as the development of rehabilitation philosophy and strategies.
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Affiliation(s)
- Shohei Ohgi
- School of Rehabilitation Sciences, Seirei Christopher University, Shizuoka, Japan
| | - Shouzhi Gu
- School of Rehabilitation Sciences, Seirei Christopher University, Shizuoka, Japan
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