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Wang C, Deng Y, Yao Y, Tan H. Demoralization syndrome in burn patients: A cross-sectional study. Burns 2024; 50:1640-1651. [PMID: 38555238 DOI: 10.1016/j.burns.2024.02.016] [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: 10/12/2023] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 04/02/2024]
Abstract
AIMS To investigate the status of demoralization syndrome and the factors affecting demoralization in burn patients. METHODS This study employed a cross-sectional research design and utilized a face-to-face questionnaire to gather data from adult burn patients with burn depths classified as second-degree or higher. The Demoralization Scale Mandarin Version, the Perceived Social Support Scale, the Herth Hope Index, and the Medical Coping Method Questionnaire were used to assess the level of demoralization, perceived social support, sense of hope, and coping strategies, respectively. General information, including socio-demographic data and disease characteristics, were collected. The patients' level of demoralization was categorized as the mean ± 1 standard deviation of the DS-MV scores. The data was analyzed using IBM SPSS 26.0 software to explore the relationship between the variables. RESULTS This study included 381 burn patients with a mean DS-MV score of 34.62 ± 18.319. Of these, 66 (17.3%) had mild demoralization, 241 (63.3%) had moderate demoralization, and 74 (19.4%) had severe demoralization. Cause of burn, total burn area, average monthly income of the individual, occupation, sense of hope, perceived social support, and medical coping strategies were the important factors associated with the severity of demoralization in burn patients. CONCLUSIONS Patients with burn injuries exhibit a notable prevalence and severity of demoralization indicating focused attention. By considering associated risk factors, healthcare professionals can devise and execute tailored intervention strategies aimed at mitigating the occurrence and intensity of demoralization in burn patients.
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Affiliation(s)
- Chang Wang
- School of Nursing, Guizhou Medical University, No. 9 Beijing Road, Yunyan District, Guiyang, China
| | - YunYun Deng
- School of Nursing, Guizhou Medical University, No. 9 Beijing Road, Yunyan District, Guiyang, China
| | - YiMing Yao
- Department of Nursing, Guangzhou Red Cross Hospital, Jinan University, No. 396, Tongfu Middle Road, Haizhu District, Guangzhou, China
| | - HuiYi Tan
- School of Nursing, Guizhou Medical University, No. 9 Beijing Road, Yunyan District, Guiyang, China; Department of Nursing, Guangzhou Red Cross Hospital, Jinan University, No. 396, Tongfu Middle Road, Haizhu District, Guangzhou, China.
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Koly KN, Saba J, Rao M, Rasheed S, Reidpath DD, Armstrong S, Gnani S. Stakeholder perspectives of mental healthcare services in Bangladesh, its challenges and opportunities: a qualitative study. Glob Ment Health (Camb) 2024; 11:e37. [PMID: 38572252 PMCID: PMC10988148 DOI: 10.1017/gmh.2024.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/20/2024] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
This study explores Bangladesh's mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it's mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.
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Affiliation(s)
- Kamrun Nahar Koly
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jobaida Saba
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mala Rao
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Sabrina Rasheed
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel D. Reidpath
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Stephanie Armstrong
- School of Health and Social Care, College of Health and Science, University of Lincoln, Lincoln, UK
| | - Shamini Gnani
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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Optimal timing and effect of music therapy in patients with burn injuries: Systematic review and meta-analysis of randomized controlled trials. Burns 2022; 48:1069-1078. [PMID: 34426015 DOI: 10.1016/j.burns.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/06/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Burn injuries may have both physiological and psychological consequences. Numerous studies have reported the use of music therapy during burn injury treatment, but the optimal timing for music therapy remains unclear. Therefore, we performed a systematic review and meta-analysis of randomized controlled trials on patients with burn injuries to analyze the effects of music intervention on them at different timings: background (T0) and time before (T1), during (T2), and after (T3) change dressing (CD). METHOD The PubMed and EMBASE databases were searched for articles published before Novenber 2020 based on predetermined criteria. Our search focused on two keywords: music and burn. Reviewers extracted data from all eligible studies independently. The I2 statistic was used to determine statistical heterogeneity. The endpoints included standardized mean differences (SMDs) and 95% confidence intervals (CIs). Relevant Forest plots were also created. RESULT This study finally included seven trials recruiting a total of 524 patients. The results indicated that compared with non-music intervention, music intervention significantly reduced anxiety at T0 (SMD = -1.32, 95% CI [-2.61, -0.02], T1 (SMD = -2.15, 95% CI [-4.30, -0.00]) and T2 (SMD = -0.39, 95% CI [-0.74, -0.04]). Moreover, they also significantly reduced the pain levels at T0 (SMD = -1.59, 95% CI [-2.00, -1.17]) and T2 (SMD = -0.47, 95% CI [-0.82, -0.12]), improved the mental condition, and reduced the amount of opioid analgesics used at T0. CONCLUSION Music therapy seems to have some effects at T0 and T1 in patients with burn injuries. Music therapy was more effective in improving psychological outcomes than physiological outcomes. However, additional high-quality studies related to music therapy for patients with burn injuries are warranted.
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Drugs Interfering with Insulin Resistance and Their Influence on the Associated Hypermetabolic State in Severe Burns: A Narrative Review. Int J Mol Sci 2021; 22:ijms22189782. [PMID: 34575946 PMCID: PMC8466307 DOI: 10.3390/ijms22189782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 12/31/2022] Open
Abstract
It has become widely accepted that insulin resistance and glucose hypermetabolism can be linked to acute pathologies, such as burn injury, severe trauma, or sepsis. Severe burns can determine a significant increase in catabolism, having an important effect on glucose metabolism and on muscle protein metabolism. It is imperative to acknowledge that these alterations can lead to increased mortality through organ failure, even when the patients survive the initial trauma caused by the burn. By limiting the peripheral use of glucose with consequent hyperglycemia, insulin resistance determines compensatory increased levels of insulin in plasma. However, the significant alterations in cellular metabolism lead to a lack of response to insulin's anabolic functions, as well as to a decrease in its cytoprotective role. In the end, via pathological insulin signaling associated with increased liver gluconeogenesis, elevated levels of glucose are detected in the blood. Several cellular mechanisms have been incriminated in the development of insulin resistance in burns. In this context, the main aim of this review article is to summarize some of the drugs that might interfere with insulin resistance in burns, taking into consideration that such an approach can significantly improve the prognosis of the burned patient.
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Sheng Q, Zhang X, Cai C, Shi Y. Parents' Experiences of Caring for Their Only Child With Mental Illness in China: A Qualitative Study. J Psychosoc Nurs Ment Health Serv 2020; 59:29-37. [PMID: 33095263 DOI: 10.3928/02793695-20201001-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/28/2020] [Indexed: 11/20/2022]
Abstract
The current study explored Chinese parents' experiences of caring for their only child with mental illness. Face-to-face interviews with semi-structured questions were conducted to learn about the care experiences of parents whose only child had mental illness. Purposeful sampling was used to recruit parents (n = 14) and thematic analysis was used. Five themes were identified: (1) Having Responsibility to Care for Children, (2) Feeling Guilt and Self-Blame, (3) Experiencing Loneliness and Helplessness, (4) Drained by Caregiving, and (5) Worrying About the Future. Parents who cared for their only child with mental illness experienced considerable emotional and physical challenges. Professionals and health care providers should recognize and understand the experiences of these parents to identity their needs and provide adequate support. Targeted support services and appropriate professional information should be developed and provided for parents to relieve them of negative caregiving experiences and improve their psychological and physical well-being. [Journal of Psychosocial Nursing and Mental Health Services, 59(1), 29-37.].
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Zhang XH, Cui CL, Lee KK, Chen XX, Yu JA, Wu WW. A specially designed medical screen for children suffering from burns: A randomized trial of a distraction-type therapy. Burns 2020; 47:1137-1145. [PMID: 34030910 PMCID: PMC7261105 DOI: 10.1016/j.burns.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 05/09/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Abstract
The current study is the first to explore the medical screen as a treatment to control the pain and its related psychological symptoms on children suffering from burns;. Compared with conventional dressing methods, the medical screen can be used as a novel way to decrease the negative experience of burn patients -ages 1–3 who require dressing changes. The medical screen is likely a feasible, acceptable and potentially efficacious treatment option for burns medical workers.
Objective To evaluate the impact of the specially designed medical dressing screen during wound dressing changes of children who suffered burns to their hand or foot. Design Randomized controlled trial. Setting Burns and Plastic Reconstruction Unit. Participants Children (NN = 120) with burns on up to 1%-–5% of the total body surface area. Interventions The patients were selected and randomly allocated to 3 equal-sized groups as follows:control group (N control group (N = 40): the children received only regular dressing changes; computer group (NN = 40): a touch-screen computer was used for children during dressing changes; medical screen group (NN = 40): a medical screen combined with the touch-screen computer were used for children during dressing changes. All patients underwent a dressing change once per day for four days. Data were distributed four times: immediately after the initial dressing change (T1); and immediately after each times at next three consecutive days (T2-T4).Main Outcome M–T4). Main outcome measures The Pain level of the children evaluated by medical staffs was the primary outcome, the Pain level of the children evaluated by children's parents and the satisfaction of wound therapist were used as second outcomes. Results The mean scores related to pain level at the medical screen group displayed significantly better results than those of control group and those of the computer group. Additionally, the results of the pain evaluated by parents and satisfaction score of the wound therapist at the medical screen group was also better than other groups. Conclusions This study demonstrated “that the” application of the medical screen for burns can relieve the pain of 1-–3 years old children suffering from a burns during dressing changes. Additionally, the application of the medical screen also increased the satisfaction of the parents and the wound therapist performing the dressing changes.
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Affiliation(s)
- Xiu-Hang Zhang
- Department of Burn Surgery, The First Hospital of Jilin University, Chaoyang District, Xinmin Street, Street 71, Changchun City, Jilin Province 130021, China.
| | - Chang-Lei Cui
- Department of Anesthesiology, The First Hospital of Jilin University, Chaoyang District, Xinmin Street, Street 71, Changchun City, Jilin Province 130021, China.
| | - Kai-Ki Lee
- The Chinese University of Hong Kong, School of Preclinical Medicine, Beijing University of Chinese Medicine, Beijing 100000, China.
| | - Xin-Xin Chen
- Department of Burn Surgery, The First Hospital of Jilin University, Chaoyang District, Xinmin Street, Street 78, Changchun City, Jilin Province 130021, China.
| | - Jia-Ao Yu
- Department of Burn Surgery, The First Hospital of Jilin University, Chaoyang District, Xinmin Street, Street 78, Changchun City, Jilin Province 130021, China.
| | - Wei-Wei Wu
- Department of Burn Surgery, The First Hospital of Jilin University, Chaoyang District, Xinmin Street, Street 71, Changchun City, Jilin Province 130021, China.
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Subrata SA. A concept analysis of burn care in nursing. Scand J Caring Sci 2020; 35:75-85. [PMID: 32319697 DOI: 10.1111/scs.12847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/04/2020] [Accepted: 03/11/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Burn is a life-threatening injury that requires long-term treatment and concomitant hospital stay. Relevant clinical studies in burns have been accomplished and published in the literature. However, none of these studies reported the concept analysis of burn care in nursing. Therefore, analysing the concept of burn care acts as an imperative strategy to provide comprehensive management of burn injury. OBJECTIVE The study aims to describe the concept of burn care in nursing. METHOD Walker and Avant's method (2013) was used to achieve the objective of the study. FINDINGS A model of burn care in nursing was generated that consists of assessment and diagnosis, intervention and evaluation. In addition, the biopsychosocial model developed by George L. Engel (1977) was also integrated to examine how these aspects play a significant role in burn care. CONCLUSION Implementing the concept of burn care will improve the quality of nursing care, cosmetic outcomes and vice versa, reduce the comorbidities on burn injury.
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Affiliation(s)
- Sumarno A Subrata
- Philosophy Program in Nursing, International and Collaborative Program with Foreign University Program, Mahidol University, Phaya Thai, Thailand.,Department of Nursing and Wound Research Center, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Magelang, Indonesia
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Zhang XH, Gao XX, Wu WW, Yu JA. Impact of orally administered tramadol combined with self-selected music on adult outpatients with burns undergoing dressing change: A randomized controlled trial. Burns 2019; 46:850-859. [PMID: 31672469 DOI: 10.1016/j.burns.2019.10.010] [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: 07/17/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the effects of music and/or tramadol on pain and anxiety in burn outpatients undergoing dressing changes. DESIGN Randomized controlled trial. SETTING Burns and Plastic Reconstruction Unit. PARTICIPANTS Patients (N=180) with burns on up to 10%-30% of the total body surface area (TBSA). INTERVENTIONS The patients were randomly allocated to 4 equal-sized groups as follows: (1) tramadol group (TG), patients received 100mg of tramadol orally 20min before the dressing change; (2) music group (MG), patients listened to self-selected music during the dressing change; (3) music-plus-tramadol group (MTG), patients received tramadol and listened to self-selected music; and (4) control group (CG), patients received a routine dressing change only. All patients underwent the interventions once per day for 2days. MAIN OUTCOME MEASURES McGill Pain Questionnaire Short Form (MPQ-SF) (primary outcome), McGill Pain Persian version of Burn Specific Pain Anxiety Scale (BSPAS) (primary outcome), and heart rate (HR) and overall patient satisfaction (secondary outcomes). RESULTS The results showed that music-plus-tramadol group (MTG) had better outcomes with respect to pain and anxiety management during dressing changes. CONCLUSIONS In comparison with music or tramadol alone, the integration of music and tramadol offers a secure and favorable treatment choice to relieve pain and anxiety, ultimately improving the satisfaction levels of burn outpatients during dressing changes.
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Affiliation(s)
- Xiu-Hang Zhang
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun 130021, China.
| | - Xin-Xin Gao
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun 130021, China.
| | - Wei-Wei Wu
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun 130021, China.
| | - Jia-Ao Yu
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun 130021, China.
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