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Starosta AJ, Bombardier CH, Kahlia F, Barber J, Accardi-Ravid MC, Wiechman SA, Crane DA, Jensen MP. Feasibility of Brief, Hypnotic Enhanced Cognitive Therapy for SCI-related Pain During Inpatient Rehabilitation. Arch Phys Med Rehabil 2024; 105:1-9. [PMID: 37364685 DOI: 10.1016/j.apmr.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/05/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES (1) Adapt evidence-based hypnosis-enhanced cognitive therapy (HYP-CT) for inpatient rehabilitation setting; and (2) determine feasibility of a clinical trial evaluating the effectiveness of HYP-CT intervention for pain after spinal cord injury (SCI). STUDY DESIGN Pilot non-randomized controlled trial. SETTING Inpatient rehabilitation unit. PARTICIPANTS English-speaking patients admitted to inpatient rehabilitation after SCI reporting current pain of at least 3 on a 0-10 scale. Persons with severe psychiatric illness, recent suicide attempt or elevated risk, or significant cognitive impairment were excluded. Consecutive sample of 53 patients with SCI-related pain enrolled, representing 82% of eligible patients. INTERVENTION Up to 4 sessions of HYP-CT Intervention, each 30-60 minutes long. METHODS Participants were assessed at baseline and given the choice to receive HYP-CT or Usual Care. MAIN OUTCOME MEASURES Participant enrollment and participation and acceptability of intervention. Exploratory analyses examined the effect of intervention on pain and cognitive appraisals of pain. RESULTS In the HYP-CT group, 71% completed at least 3 treatment sessions and reported treatment benefit and satisfaction with the treatment; no adverse events were reported. Exploratory analyses of effectiveness found pre-post treatment pain reductions after HYP-CT with large effect (P<.001; β=-1.64). While the study was not powered to detect significant between-group differences at discharge, effect sizes revealed decreases in average pain (Cohen's d=-0.13), pain interference (d=-0.10), and pain catastrophizing (d=-0.20) in the HYP-CT group relative to control and increases in self-efficacy (d=0.27) and pain acceptance (d=0.15). CONCLUSIONS It is feasible to provide HYP-CT to inpatients with SCI, and HYP-CT results in substantial reductions in SCI pain. The study is the first to show a psychological-based nonpharmacologic intervention that may reduce SCI pain during inpatient rehabilitation. A definitive efficacy trial is warranted.
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Affiliation(s)
- Amy J Starosta
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
| | | | - Faran Kahlia
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, WA
| | | | - Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Deborah A Crane
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Wiechman SA, Amtmann D, Bocell FD, McMullen KA, Schneider JC, Rosenberg L, Rosenberg M, Carrougher GJ, Kowalske K, Ryan CM, Stewart BT, Gibran NS. Trajectories of physical health-related quality of life among adults living with burn injuries: A burn model system national database investigation to improve early intervention and rehabilitation service delivery. Rehabil Psychol 2023; 68:313-323. [PMID: 37347905 PMCID: PMC10527858 DOI: 10.1037/rep0000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Understanding trajectories of recovery in key domains can be used to guide patients, families, and caregivers. The purpose of this study was to describe common trajectories of physical health over time and to examine predictors of these trajectories. METHOD Adults with burn injuries completed self-reported assessments of their health-related quality of life (HRQOL) as measured by the SF-12® Physical Component Summary (PCS) score at distinct time points (preinjury via recall, index hospital discharge, and at 6-, 12-, and 24 months after injury). Growth mixture modeling (GMM) was used to model PCS scores over time. Covariables included burn size, participant characteristics, and scores from the Community Integration Questionnaire (CIQ)/Social Integration portion, Satisfaction With Life Scale (SWLS), and Satisfaction With Appearance Scale (SWAP). RESULTS Data from 939 participants were used for complete-case analysis. Participants were 72% male, 64% non-Hispanic White, with an average age of 44 years and an average burn size of 20% of total body surface area (TBSA). The best fitting model suggested three distinct trajectories (Class 1 through 3) for HRQOL. We titled each Class according to the characteristics of their trajectory. Class 1 (recovering; n = 632), Class 2 (static; n = 77), and Class 3 (weakened; n = 205) reported near average HRQOL preinjury, then reported lower scores at discharge, with Class 1 subsequently improving to preinjury levels and Class 3 improving but not reaching their preinjury quality of life. Class 3 experienced the largest decrease in HRQOL. Class 2 reported the lowest preinjury HRQOL and remained low for the next 2 years, showing minimal change in their HRQOL. CONCLUSIONS These findings emphasize the importance of early universal screening and sustained intervention for those most at risk for low HRQOL following injury. For Class 2 (static), lower than average HRQOL before their injury is a warning. For Class 3 (weakened), if the scores at 6 months show a large decline, then the person is at risk for not regaining their HRQOL by 24 months and thus needs all available interventions to optimize their outcomes. Results of this study provide guidance for how to identify people with burn injury who would benefit from more intensive rehabilitation to help them achieve or regain better HRQOL. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, Burn Model System National Data and Statistical Center, University of Washington
| | - Fraser D. Bocell
- Department of Rehabilitation Medicine, Burn Model System National Data and Statistical Center, University of Washington
| | - Kara A. McMullen
- Department of Rehabilitation Medicine, Burn Model System National Data and Statistical Center, University of Washington
| | - Jeffrey C. Schneider
- Department of Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School
| | - Laura Rosenberg
- Shriners Children’s Texas, University of Texas Medical Branch
| | - Marta Rosenberg
- Shriners Children’s Texas, University of Texas Medical Branch
| | | | | | - Colleen M. Ryan
- Department of Surgery, Mass General Surgery, Harvard Medical School
| | - Barclay T. Stewart
- Department of Surgery, Harborview Medical Center, University of Washington
| | - Nicole S. Gibran
- Department of Surgery, Harborview Medical Center, University of Washington
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Starosta AJ, Wright KS, Bombardier CH, Kahlia F, Barber J, Accardi-Ravid MC, Wiechman SA, Crane DA, Jensen MP. A Case Study of Hypnosis Enhanced Cognitive Therapy for Pain in a Ventilator Dependent Patient during Inpatient Rehabilitation for Spinal Cord Injury. J Clin Med 2023; 12:4539. [PMID: 37445573 DOI: 10.3390/jcm12134539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Early, acute pain following spinal cord injury (SCI) is common, can negatively impact SCI rehabilitation, and is frequently not responsive to biomedical treatment. Nonpharmacological interventions show promise in reducing pain for individuals with SCI. However, most psychological interventions rely heavily on verbal interaction between the individual being treated and the clinician, making them inaccessible for individuals with impaired verbal output due to mechanical ventilation. This case study aims to describe the adaptation and implementation of hypnotic cognitive therapy (HYP-CT) intervention for early SCI pain in the context of mechanical ventilation dependence and weaning. The participant was a 54-year-old male with C2 AIS A SCI requiring mechanical ventilation. Four sessions of HYP-CT were provided during inpatient rehabilitation with assessment prior to intervention, after the intervention sessions, and prior to discharge. The participant reported immediate reductions in pain intensity following each intervention session. Overall, he reported increases in self-efficacy and pain acceptance. He did not report any negative treatment effects and thought the intervention provided support during mechanical ventilation weaning. During treatment, he discontinued opioid pain medications and reported actively using intervention strategies. Our results support the potential for early, hypnotic cognitive therapy for individuals with SCI experiencing pain or distress while dependent on mechanical ventilation.
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Affiliation(s)
- Amy J Starosta
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Katherine S Wright
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Faran Kahlia
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195, USA
| | - Michelle C Accardi-Ravid
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT 84132, USA
| | - Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Deborah A Crane
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
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Bhalla A, Bamer AM, Temes C, Roaten K, Carrougher GJ, Schneider JC, Stoddard FJ, Stewart B, Gibran NS, Wiechman SA. Posttraumatic Stress Disorder Symptom Clusters as Predictors of Pain Interference in Burn Survivors: A Burn Model System National Database Study. J Burn Care Res 2023; 44:27-34. [PMID: 35866527 PMCID: PMC9990905 DOI: 10.1093/jbcr/irac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Individuals who experience burns are at higher risk of developing posttraumatic stress disorder and chronic pain. A synergistic relationship exists between posttraumatic stress disorder and chronic pain. We sought to evaluate the role of individual posttraumatic stress disorder symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two posttraumatic stress disorder symptom clusters, pain intensity, and other covariates. Multivariate linear regression analyses were completed using data from the Burn Model System National Database. A total of 439 adult participants had complete responses on self-report measures assessing posttraumatic stress disorder symptoms, pain intensity, and pain interference at 6-month after discharge and were included in analyses. Results indicate hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) posttraumatic stress disorder symptom clusters were each significantly associated with pain interference, even when accounting for pain intensity (B = .64, p < .001). Results highlight the importance of the emotional numbing and hyperarousal posttraumatic stress disorder symptom clusters in explaining pain interference. Findings suggest that when posttraumatic stress disorder symptoms or chronic pain are present, screening for and treating either condition may be warranted to reduce pain interference. Further, psychological interventions that target emotional numbing and hyperarousal posttraumatic stress disorder symptoms may be fruitful for promoting better coping with chronic pain and reducing pain interference.
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Affiliation(s)
- Arjun Bhalla
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Alyssa M. Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Christina Temes
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Roaten
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Frederick J. Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Nicole S. Gibran
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Shelley A. Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Shupp JW, Holmes JH, Moffatt LT, Phelan HA, Sousse L, Romanowski KS, Jeschke M, Kowalske KJ, Badger K, Allely R, Cartotto R, Burmeister DM, Kubasiak JC, Wolf SE, Wallace KF, Gillenwater J, Schneider DM, Hultman CS, Wiechman SA, Bailey JK, Powell HM, Travis TE, Supp DM, Carney BC, Johnson LS, Johnson LS, Chung KK, Chung KK, Kahn SA, Gibson ALF, Christy RJ, Carter JE, Carson JS, Palmieri TL, Kopari NM, Blome-Eberwein SA, Hickerson WL, Parry I, Cancio JM, Suman O, Schulman CI, Lamendella R, Hill DM, Wibbenmeyer LA, Nygaard RM, Wagner AL, Carter ADW, Greenhalgh DG, Lawless MB, Carlson DL, Harrington DT. Proceedings of the 2021 American Burn Association State and Future of Burn Science Meeting. J Burn Care Res 2022; 43:1241-1259. [PMID: 35988021 DOI: 10.1093/jbcr/irac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Periodically, the American Burn Association (ABA) has convened a State of the Science meeting on various topics representing multiple disciplines within burn care and research. In 2021 at the request of the ABA President, meeting development was guided by the ABA's Burn Science Advisory Panel (BSAP) and a subgroup of meeting chairs. The goal of the meeting was to produce both an evaluation of the current literature and ongoing studies, and to produce a research agenda and/or define subject matter-relevant next steps to advance the field(s). Members of the BSAP defined the topics to be addressed and subsequently solicited for nominations of expert speakers and topic leaders from the ABA's Research Committee. Current background literature for each topic was compiled by the meeting chairs and the library then enhanced by the invited topic and breakout discussion leaders. The meeting was held in New Orleans, LA on November 2nd and 3rd and was formatted to allow for 12 different topics, each with two subtopics, to be addressed. Topic leaders provided a brief overview of each topic to approximately 100 attendees, followed by expert-lead breakout sessions for each topic that allowed for focused discussion among subject matter experts and interested participants. The breakout and topic group leaders worked with the participants to determine research needs and associated next steps including white papers, reviews and in some cases collaborative grant proposals. Here, summaries from each topic area will be presented to highlight the main foci of discussion and associated conclusions.
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Wiechman SA, Jensen MP, Sharar SR, Barber JK, Soltani M, Patterson DR. The Impact of Virtual Reality Hypnosis on Pain and Anxiety Caused by Trauma: Lessons Learned from a Clinical Trial. Int J Clin Exp Hypn 2022; 70:156-173. [PMID: 35348435 PMCID: PMC9248347 DOI: 10.1080/00207144.2022.2052296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This randomized, controlled trial tested the impact that hypnosis delivered through immersive virtual reality technology on background pain, anxiety, opioid use, and hospital length of stay in a sample of patients hospitalized for trauma. Participants were randomly assigned to receive either virtual-reality-induced hypnosis, virtual reality for distraction, or usual care during the course of their hospitalization. Mean number of treatment sessions was 3. A total of 153 patients participated in the study. Results indicated no significant differences between the experimental and control conditions on any outcome measures. This study used an early version of virtual reality technology to induce hypnosis and highlighted several important lessons about the challenges of implementation of this technology and how to improve its use in clinical settings.
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Affiliation(s)
- Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Sam R Sharar
- Department of Anesthesiology, University of Washington, Seattle, USA
| | - Jason K Barber
- Department of Neurosurgery, University of Washington, Seattle, USA
| | - Maryam Soltani
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - David R Patterson
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
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Wiechman SA, Bhalla A, Bamer AM, Carrougher GJ, Stewart BT, Gibran NS, Schneider JC, Temes C, Stoddard FJJ, Roaten K. 122 PTSD Symptom Clusters as Predictors of Pain Interference in Burn Survivors. Journal of Burn Care & Research 2022. [PMCID: PMC8945520 DOI: 10.1093/jbcr/irac012.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Individuals who experience burns are at higher risk of developing post-traumatic stress disorder (PTSD) and chronic pain. There exists a synergistic relationship between PTSD and chronic pain in burn survivors. Theories exist about how aspects of each condition may perpetuate one another, or share underlying mechanisms. Both of these conditions are of relevance to pain-related disability. We sought to examine the role of individual PTSD symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two PTSD symptom clusters, pain intensity, and other covariates (burn size, hospital length of stay, age and gender). Methods Data were analyzed from the Burn Model System National Database. Inclusion criteria required participants to have a moderate to severe burn injury that required surgery for wound closure. Patient-reported outcome data: PTSD Checklist - Civilian, PROMIS-Pain Interference Short Form 4a, and a 0-10 average Pain Intensity item were analyzed at 6-months after injury. Hierarchical linear regression models were fit to examine the impact of PTSD symptom clusters on pain interference over and above that of pain intensity, and standardized betas were calculated (B). Results A total of 439 adult participants had complete responses on the measures of interest (e.g. PTSD symptoms, PROMIS-Pain Interference, and Pain Intensity) and were included in the analysis. Mean age, percent total body surface area burned, and hospital length of stay were 47 years, 18%, and 27 days, respectively. 69% were male and 82% were Caucasian. Results of a linear regression found that hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) PTSD symptom clusters were each significant predictors of pain-related disability, even when accounting for pain intensity (B = .64, p < .001). The covariates age, gender, days until discharge, and TBSA were all nonsignificant. The model accounted for 61% of the variance associated with pain-related disability. Conclusions Results highlight the importance of the emotional numbing and hyperarousal PTSD symptom clusters in explaining pain interference. Future evaluations parsing out the longitudinal relationships (i.e., beyond 6-months postburn) between PTSD symptom clusters, pain intensity, and pain interference, as well as evaluating other underlying mechanisms, are warranted.
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Affiliation(s)
- Shelley A Wiechman
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Arjun Bhalla
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Alyssa M Bamer
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Gretchen J Carrougher
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Barclay T Stewart
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Nicole S Gibran
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Jeffrey C Schneider
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Christina Temes
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Frederick J J Stoddard
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Kimberly Roaten
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
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Bissoon Z, Gause EL, Carrougher GJ, Baker C, Wiechman SA, Pham TN, Gibran NS, Stewart BT. 78 Classification and Regression Tree Model for Predicting Satisfaction with Life Scale Scores After Burn Injury. J Burn Care Res 2022. [PMCID: PMC8946063 DOI: 10.1093/jbcr/irac012.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction Current early burn care prognostication models predict in-hospital mortality (e.g., revised Baux Score). However, patients, families and clinicians need more holistic tools in the hours and days after injury to identify specific factors that might affect their quality of life and indicate a need for more intensive services. This project aims to predict Satisfaction with Life (SWL) in survivors of burn injury using patient, injury, and care factors available within 24 hours of admission. Methods Two hundred and fourteen participants were identified from a multicenter national longitudinal database and merged with clinical data from a single institution's trauma registry. Patients were randomized into a training dataset (80%) and a testing dataset (20%). A CART algorithm was used to examine the relative contributions of individual predictor variables in classifying low SWL at six-month follow up (SWL ≤ 20). Seventeen covariables obtained within 24 hours of index hospital admission were analyzed from five domains: demographics, comorbidities, injury, care, and host response to injury. Lab values were those closest to but not greater than 24 hours after index hospital admission. Results Multiple covariables contributed to the SWL score. CART analysis selected a pre-injury SWL score < 31 as the first node and strongest indicator of low SWL. CART then selected the following subgroups at risk for SWL ≤ 20 at 6 months: (1) hematocrit >55%; (2) lactate >4 mmol/L, age > 59; (3) total body surface area (TBSA) burned >30%, presence of a hand, neck, and/or face burn. The cross-validated predictive accuracy of the CART model was 69.4% with a cross-validated relative error of 0.379. In the validation data set, sensitivity and specificity were 62.5% and 72.0%, respectively. Conclusions The findings demonstrate the potential feasibility of creating a model that can predict a clinically meaningful quality of life outcome using covariables gathered within hours of hospital admission after burn injury. Predictive measures suggest that while some of the included covariables may be associated with SWL, they are not consistently and reliably predictive of low SWL alone. With more data and additional refined inputs, a similar model could be used to identify those in need of more intensive services earlier on in the hospitalization.
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Affiliation(s)
| | - Emma L Gause
- Johns Hopkins University, Baltimore, Maryland; Harborview Medical Center, Seattle, Washington; Department of Surgery, The University of Washington, Seattle, Washington; Harborview Medical Center, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, W
| | - Gretchen J Carrougher
- Johns Hopkins University, Baltimore, Maryland; Harborview Medical Center, Seattle, Washington; Department of Surgery, The University of Washington, Seattle, Washington; Harborview Medical Center, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, W
| | - Claudia Baker
- Johns Hopkins University, Baltimore, Maryland; Harborview Medical Center, Seattle, Washington; Department of Surgery, The University of Washington, Seattle, Washington; Harborview Medical Center, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, W
| | - Shelley A Wiechman
- Johns Hopkins University, Baltimore, Maryland; Harborview Medical Center, Seattle, Washington; Department of Surgery, The University of Washington, Seattle, Washington; Harborview Medical Center, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, W
| | - Tam N Pham
- Johns Hopkins University, Baltimore, Maryland; Harborview Medical Center, Seattle, Washington; Department of Surgery, The University of Washington, Seattle, Washington; Harborview Medical Center, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, W
| | - Nicole S Gibran
- Johns Hopkins University, Baltimore, Maryland; Harborview Medical Center, Seattle, Washington; Department of Surgery, The University of Washington, Seattle, Washington; Harborview Medical Center, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, W
| | - Barclay T Stewart
- Johns Hopkins University, Baltimore, Maryland; Harborview Medical Center, Seattle, Washington; Department of Surgery, The University of Washington, Seattle, Washington; Harborview Medical Center, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, W
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Mata-Greve F, Wiechman SA, McMullen K, Roaten K, Carrougher GJ, Gibran NS. The relation between satisfaction with appearance and race and ethnicity: A National Institute on Disability, Independent Living, and Rehabilitation Research burn model system study. Burns 2022; 48:345-354. [PMID: 34903410 PMCID: PMC9007822 DOI: 10.1016/j.burns.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022]
Abstract
Research supports that people of color in the U.S. have poorer outcomes after burn injury compared to White individuals. The current study sought to explore burn health disparities by testing the relationship between racial and ethnic minority status, a proxy for systemic discrimination due to race and ethnicity, with two key constructs linked to functional outcomes, satisfaction with appearance and social community integration. Participants included 1318 burn survivors from the Burn Model System National Database (mean age = 40.2, SD = 12.7). Participants completed measures of satisfaction with appearance and social community integration at baseline, 6-, 12-, and 24-months after burn injury. Linear regressions revealed that racial and ethnic minority status significantly related to lower satisfaction with appearance and social community integration compared to White individuals at all time points. In addition, satisfaction with appearance continued to significantly relate to greater social community integration even while accounting for race and ethnicity, age, sex, burn size, and physical disability at 6-, 12-, and 24-month time points. Overall, the study supports that racial and ethnic minority burn survivors report greater dissatisfaction with their appearance and lower social community reintegration after burn injury.
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Affiliation(s)
- Felicia Mata-Greve
- VA Puget Sound Health Care System Mental Health, 1660 S Columbian Way, Seattle, WA 98108, USA
| | - Shelley A Wiechman
- University of Washington, Department of Rehabilitation Medicine, 9th Avenue Box 359612, Seattle, WA 98104, USA.
| | - Kara McMullen
- University of Washington, Department of Rehabilitation Medicine, 9th Avenue Box 359612, Seattle, WA 98104, USA
| | - Kimberly Roaten
- University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Gretchen J Carrougher
- University of Washington Department of Surgery, 325 9th Avenue; Box 359796, Seattle, WA 98104, USA
| | - Nicole S Gibran
- University of Washington Department of Surgery, 325 9th Avenue; Box 359796, Seattle, WA 98104, USA
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10
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Patterson DR, Hoffman HG, Chambers G, Bennetts D, Hunner HH, Wiechman SA, Garcia-Palacios A, Jensen MP. Hypnotic Enhancement of Virtual Reality Distraction Analgesia during Thermal Pain: A Randomized Trial. Int J Clin Exp Hypn 2021; 69:225-245. [PMID: 33724890 PMCID: PMC8141382 DOI: 10.1080/00207144.2021.1882259] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Excessive pain during medical procedures is a pervasive health challenge. This study tested the (additive) analgesic efficacy of combining hypnotic analgesia and virtual reality (VR) pain distraction. A single blind, randomized, and controlled trial was used to study 205 undergraduate volunteers aged 18 to 20. The individual and combined effects of hypnotic analgesia (H) and VR distraction on experimentally induced acute thermal pain were examined using a 2 X 2, between-groups parallel design (4 groups total). Participants in groups that received hypnosis remained hypnotized during the test phase pain stimulus. The main outcome measure was "worst pain" ratings. Hypnosis reduced acute pain even for people who scored low on hypnotizability. As predicted, H+ VR was significantly more effective than VR distraction alone. However, H+ VR was not significantly more effective than hypnotic analgesia alone. Being hypnotized during thermal pain enhanced VR distraction analgesia.
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Affiliation(s)
- David R Patterson
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA
| | - Hunter G Hoffman
- Human Photonics Lab, Department of Mechanical Engineering, University of Washington, Seattle, USA
| | - Gloria Chambers
- Human Photonics Lab, Department of Mechanical Engineering, University of Washington, Seattle, USA
| | - Devon Bennetts
- Human Photonics Lab, Department of Mechanical Engineering, University of Washington, Seattle, USA
| | - Harley H Hunner
- Human Photonics Lab, Department of Mechanical Engineering, University of Washington, Seattle, USA
| | - Shelley A Wiechman
- University of Washington School of Medicine, Harborview Medical Center, Seattle, USA
| | - Azucena Garcia-Palacios
- Human Photonics Lab, Department of Mechanical Engineering, University of Washington, Seattle, USA.,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain.,Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA.,University of Washington School of Medicine, Harborview Medical Center, Seattle, USA
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11
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Abstract
Abstract
Introduction
In 2015, the Burn Quality Improvement Program (BQUIP) guidelines recommended systematic screening of Major Depressive Disorder at all verified burn centers. Our level one trauma center rolled out a program to screen all patients entering the burn service starting in June 2018. This project evaluates the program after the first year of implementation.
Methods
All patients over age 12 admitted to the burn service were screened by bedside nurses using the 2-item Patient Health Questionnaire (PHQ-2). Exclusion for screening included those who were intubated and sedated and/or not alert or oriented. A reminder for the PHQ-2 screener automatically popped up in the nursing task list in the electronic medical record until it was given or patient was coded as not appropriate for screening.
Results
A total of 509 patients were admitted to the Burn Service between June 2018 and May 2019. Of those, 40 were identified as not being appropriate for screening due to prolonged mental impairment (e.g. not able to regain consciousness), and 116 (24%) were not screened for unknown reasons. The remaining patients (n=353, 77%) were screened with the PHQ-2 and 94% of these patients were screened on the same day of admit. Of the patients screened, 28 (8%) scored above the clinical cut-off for probable depression (PHQ-2 ³ 3) and 265 (75.1%) did not endorse any symptoms on the PHQ-2 (PHQ-2 = 0). Of the 28 that screened positive on the PHQ-2, 16 (57.1%) received psychological services. Of those that did not receive psychology services, the majority were admitted for less than 3 days (n=10, 76.9%).
Conclusions
In the first year of the program the vast majority of eligible patients were able to be screened by nursing staff with a 2-item measure within one day of admit to the burn service. This success is likely due to the automation of the task in the electronic medical record, the ease of use of the PHQ-2 and the dedication of the nursing staff. The 8% rate of a positive screen is higher than the general population. Given that most patients were screened within 24 hours of admission, we are capturing depressive symptoms that predate the injury. We know that depression can impair burn recovery (e.g. affect participation in therapy, impede wound healing) and lead to poorer long term outcomes. Systematic screening of depressive symptoms upon admission will allow us to intervene earlier and potentially reduce barriers to optimal recovery. Despite high screening rates, about 40% of patients did not receive psychological intervention. We will be discussing utilization of resources for providing inpatient services to patients with a positive screen.
Applicability of Research to Practice
The PHQ-2 is an effective screening tool for depressive symptoms for patients on an inpatient burn unit. These findings are important for hospital systems looking to screen for and treat the mental health needs of burn patients. Depression screening will be required for BQUIP starting in 2020.
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Affiliation(s)
- Shelley A Wiechman
- University of Washington/Harborview Burn Center, Seattle, Washington; Johns Hopkins Medicine, Baltimore, Maryland; Harborview Medical Center, Sammamish, Washington
| | - Eva Keatley
- University of Washington/Harborview Burn Center, Seattle, Washington; Johns Hopkins Medicine, Baltimore, Maryland; Harborview Medical Center, Sammamish, Washington
| | - Carolyn B Blayney
- University of Washington/Harborview Burn Center, Seattle, Washington; Johns Hopkins Medicine, Baltimore, Maryland; Harborview Medical Center, Sammamish, Washington
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12
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Romanowski KS, Carson JS, Pape K, Bernal E, Wiechman SA, Carter DW, Nitzschke S, Bhalla PI, Litt J, Friedman B, Jeng JC, Sharar S, Liu Y, Ryan CM, Joe VC. 125 Management of Acute Pain in the Burn Patient: Reaching a New Guideline. J Burn Care Res 2020. [DOI: 10.1093/jbcr/iraa024.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
The most recent ABA pain guidelines were developed over 13 years ago and have not been revised despite the changing practice of burn care. Coupled with the nationwide opioid epidemic there is a need to examine the available literature and revise the ABA practice guidelines for pain management.
Methods
A committee of a professional association was created to revise the previously published pain guidelines and consisted of a wide range of burn care providers including burn surgeons, burn nurses, anesthesiologists, a pharmacist, and a psychologist. A MEDLINE search of English-language publications from 1968 to 2018 was conducted using the keywords “burn pain,” “treatment,” and “assessment”. Selected other references were also used based on our evaluation of the greater pain literature. Studies were graded by 2 members of the committee using Oxford Centre for Evidence-based Medicine – Levels of Evidence (level 1 being the highest and level 5 the lowest). When there was a disagreement, a third member of the committee was used to resolve the disagreement. Our next step was to meet as a group and determine what our expert consensus was on a variety of topics related to treating pain in burn-injured patients. Finally, we assessed gaps in the knowledge that was available and determined research questions that would aid us in providing better recommendations for the care of the burn-injured patient.
Results
The literature search produced 189 papers, of which 95 were found to be relevant to the assessment and treatment of burn pain. From the greater pain literature, 115 references were included so a total of 210 papers were analyzed. The greatest number of papers were level 5 evidence (62, 29.5%) while only 30 (14.3%) were level 1. Following the review of the literature and meeting to establish consensus, 18 guidelines were established in the areas of pain assessment, opioid pain medications, non-opioid pain medications, regional anesthesia, and non-pharmacologic treatments.
Conclusions
While there is increasing research on various pain management modalities, the available studies are inadequate to create a true standard of care. Despite this, our committee reached a consensus using available literature from burn or other areas, expert experience and knowledge of pain physiology. Moving forward we call for more burn specific research into all modalities for burn pain control as well as research on multimodal pain control.
Applicability of Research to Practice
Burn pain is particularly difficult to manage and further study is needed to develop a standard of care for burn pain management.
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Affiliation(s)
- Kathleen S Romanowski
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Joshua S Carson
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Kate Pape
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Eileen Bernal
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Shelley A Wiechman
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Damien W Carter
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Stephanie Nitzschke
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Paul I Bhalla
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Jeffrey Litt
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Bruce Friedman
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - James C Jeng
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Sam Sharar
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Yuk Liu
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Colleen M Ryan
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
| | - Victor C Joe
- UC Davis, Sacramento, CA; University of Florida Health System, Gainesville, Florida; University of Iowa Hospitals and Clinics, Iowa City, Iowa; Kendall Regional Medical Center, Miami, Florida; University of Washington/Harborview Burn Center, Seattle, Washington; Maine Medical Center, Portland, Maine; Brigham and Women’s Hospital, Boston, Massachusetts; University of Washington, Seattle, Washingto
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13
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Grant GG, Wolfe AE, Thorpe CR, Gibran NS, Carrougher GJ, Wiechman SA, Holavanahalli R, Stoddard FJ, Sheridan RL, Kazis LE, Schneider JC, Ryan CM. Exploring the Burn Model System National Database: Burn injuries, substance misuse, and the CAGE questionnaire. Burns 2020; 46:745-747. [PMID: 31901407 DOI: 10.1016/j.burns.2019.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022]
Abstract
Burn survivors who misuse alcohol and/other substances have been associated with poorer long-term outcomes and clinical complications following injury. The self-reported CAGE questionnaire (Cut down, Annoyed, Guilty, and Eye-opener) is an outcomes assessment tool used to screen for potential substance misuse. Understanding the persistence and emergence of potential substance misuse through examination of CAGE scores may provide important information about this population. Using data collected from the Burn Model System National Database, demographic and clinical characteristics of individuals who reported positive CAGE scores (total score of ≥2) and those who reported negative CAGE scores (total score of 0 or 1) for either alcohol or other drugs were compared.
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Affiliation(s)
- Gabrielle G Grant
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Catherine R Thorpe
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States
| | - Nicole S Gibran
- Department of Surgery, University of Washington, Seattle, WA, United States
| | | | - Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX, United States
| | - Frederick J Stoddard
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Robert L Sheridan
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Colleen M Ryan
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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14
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Amtmann D, Bocell FD, McMullen K, Bamer AM, Johnson KL, Wiechman SA, Schneider JC. Satisfaction With Life Over Time in People With Burn Injury: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study. Arch Phys Med Rehabil 2020; 101:S63-S70. [DOI: 10.1016/j.apmr.2017.09.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/07/2017] [Accepted: 09/25/2017] [Indexed: 01/07/2023]
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15
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Gueler JR, McMullen K, Kowalske K, Holavanahalli R, Fauerbach JA, Ryan CM, Stoddard FJ, Wiechman SA, Roaten K. Exploratory analysis of long-term physical and mental health morbidity and mortality: A comparison of individuals with self-inflicted versus non-self-inflicted burn injuries. Burns 2019; 46:531-538. [PMID: 31640886 DOI: 10.1016/j.burns.2019.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/20/2019] [Accepted: 09/12/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Self-inflicted burn (SIB) injuries are relatively rare, but patients may experience complex biopsychosocial challenges. This study aimed to compare long-term physical and psychological outcomes for individuals with SIB and non-SIB injuries. METHODS Records of adult SIB (n = 125) and non-SIB (n = 3604) injuries were collected from U.S. burn centers within the Burn Model System between 1993 and 2018. Assessments were administered at discharge, 6 months, 24 months, 5 years, and 10 years. RESULTS SIB patients were more often younger, unmarried, unemployed, male, struggling with pre-morbid psychiatric issues, and injured by fire/flame (all p < 0.001). SIB injury predicted prolonged mechanical ventilation, hospitalization, and rehabilitation (all p < 0.001). After injury, SIB patients had increased anxiety at 24 months (p = 0.0294), increased suicidal ideation at 5 years (p = 0.004), and clinically worse depression at 10 years (p = 0.0695). SIB patients had increased mortality across 24 months compared to non-SIB patients (OR = 4.706, p = 0.010). CONCLUSION SIB injuries are associated with worse physical and psychological outcomes compared to non-SIB injuries including complicated hospitalizations and chronic problems with anxiety, depression, suicidality, and mortality, even when controlling for common indicators of severity such as burn size. This underscores the importance of multidisciplinary treatment, including mental healthcare, and long-term follow-up for SIB patients. Identified pre-morbid risk factors indicate the need for targeted injury prevention.
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Affiliation(s)
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Karen Kowalske
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - Radha Holavanahalli
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - James A Fauerbach
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Hospital for Children, Boston, MA, USA
| | - Frederick J Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Shriners, USA
| | - Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Kimberly Roaten
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
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16
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Sinha I, Nabi M, Simko L, Wolfe A, Wiechman SA, Giatsidis G, Bharadia D, McMullen K, Gibran N, Kowalske K, Kazis LE, Ryan CM, Schneider JC. 57 Association of Head and Neck Burns With Long-term Patient-reported Dissatisfaction With Appearance: A Burn Model System National Database Study. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- I Sinha
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - M Nabi
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - L Simko
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - A Wolfe
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - S A Wiechman
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - G Giatsidis
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - D Bharadia
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - K McMullen
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - N Gibran
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - K Kowalske
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - L E Kazis
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - C M Ryan
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
| | - J C Schneider
- Brigham and Women’s Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA; University of Washington, Seattle, WA; University of California - San Francisco, San Francisco, CA; University of Washington Harborview, Seattle, WA; University of Texas Southwestern Medical Center, Dallas, TX; Boston University School of Public Health, Boston, MA; Massachusetts General Hospital; Shriner
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17
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Soltani M, Drever SA, Hoffman HG, Sharar SR, Wiechman SA, Jensen MP, Patterson DR. Virtual reality analgesia for burn joint flexibility: A randomized controlled trial. Rehabil Psychol 2018; 63:487-494. [PMID: 30284865 PMCID: PMC6235624 DOI: 10.1037/rep0000239] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We conducted a randomized controlled study to determine the effects of virtual reality (VR) distraction on pain and range of motion (ROM) in patients hospitalized for burn care during active physical therapy exercises. METHOD Thirty-nine participants aged 15 to 66 (M = 36) years with significant burn injuries (mean burn size = 14% TBSA) participated. Under therapist supervision, using a within-subjects design, participants performed unassisted active ROM exercises both with and without VR distraction in a randomized order. Therapists provided participants with instructions but did not physically assist with stretches. Maximum active ROM was measured using a goniometer. A 0-100 Graphic Rating Scale (GRS) was used to assess the cognitive, affective, and sensory components of pain. A GRS rating of the amount of "fun" during stretching served as a measure of positive experience. RESULTS Participants reported lower mean GRS ratings during VR, relative to No VR, for worst pain, pain unpleasantness, and time spent thinking about pain. They also reported having a more positive experience during VR than during No VR. However, patients did not show greater ROM during VR. CONCLUSION Immersive VR reduced pain during ROM exercises that were under the control of the patient. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Sam R Sharar
- Department of Anesthesiology, University of Washington
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18
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Abstract
This pilot study explored the feasibility of using ketamine to increase hypnotizability scores. Ketamine, classified as a dissociative hallucinogen, is used clinically as an anesthetic in high doses and as a treatment for chronic pain and depression in lower doses. Low-dose ketamine can contribute to dissociation and heightened perceptions and feelings of detachment, arguably hypnotic-like states. The authors predicted that a low dose of ketamine in healthy volunteers who scored in the low hypnotizable range on the Stanford Clinical Hypnotizability Scale would (a) cause an increase in subjective ratings of dissociation and (b) lead to an increase in hypnotizability. The findings were in the predicted direction, warranting further investigation into the use of this agent to increase hypnotizability.
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Affiliation(s)
| | | | - Mark P Jensen
- a University of Washington School of Medicine , Seattle , USA
| | | | - Sam R Sharar
- a University of Washington School of Medicine , Seattle , USA
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19
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Al Ghriwati N, Sutter M, Pierce BS, Perrin PB, Wiechman SA, Schneider JC. Two-Year Gender Differences in Satisfaction With Appearance After Burn Injury and Prediction of Five-Year Depression: A Latent Growth Curve Approach. Arch Phys Med Rehabil 2017; 98:2274-2279. [DOI: 10.1016/j.apmr.2017.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 03/30/2017] [Accepted: 04/14/2017] [Indexed: 11/16/2022]
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Teeley AM, Soltani M, Wiechman SA, Jensen MP, Sharar SR, Patterson DR. Virtual reality hypnosis pain control in the treatment of multiple fractures: a case series. Am J Clin Hypn 2012; 54:184-94. [PMID: 22443021 DOI: 10.1080/00029157.2011.619593] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This case series evaluated the use of virtual reality hypnosis (VRH) for the treatment of pain associated with multiple fractures from traumatic injuries. VRH treatment was administered on 2 consecutive days, and pain and anxiety were assessed each day before and after VRH treatment as well as on Day 3, which was 24 hours after the second treatment session. Pain reduction from baseline to Day 3 was from 70% to 30%, despite opioid analgesic use remaining stable. The subjective pain reduction reported by patients was encouraging, and the results of this case series suggest the importance of further study of VRH with larger samples using randomized controlled trials.
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Wiechman SA, Sharar SR, Patterson DR. Burn Pain. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Abdi S, Abrams BM, Akhouri V, Aldrete JA, Andrasik F, Adhikary SD, Aniq H, Asaad B, Atluri SL, Bajwa ZH, Ballas SK, Bankston DP, Baron R, Binder A, Bogduk N, Borenstein D, Boswell MV, Bove GM, Braiteh F, Bruera E, Burton A, Cady R, Campbell R, Candido KD, Chiang JS, Childers MK, Chohan S, Conaghan PG, Correll DJ, Cozad SC, Craig EV, Creamer P, Datta S, Day MR, Deangelo DA, Deer TR, Diamond S, Dickenson A, Donohoe CD, Savillion Eckmann M, Evans JJ, Falco FJ, Farmer K, Fitzgerald CM, Freitag FG, Garcia MK, Gloth FM, Gordin V, Grabois M, Greenfield MA, Michael Guo H, Hainline B, Hall H, Hazleman BL, Heavner JE, Henshaw DR, Hsu BH, Igarashi T, Janata JW, Kapoor R, Katz J, Kawaguchi Y, Keating RM, Kidd BL, Kidder KA, King PT, Kormylo N, Koyyalagunta D, Landers MH, Lawson EF, Lema MJ, Levin JB, Liu J, Lovrincevic M, Luo ZD, Lyftogt JA, MacDonald JA, Malinowski MN, Manchikanti L, Mazloomdoost D, McGuirk B, Melzack R, Meyer JP, Nissan GR, Pappas JL, Parris WC, Patel DJ, Patt RB, Patterson DR, Perez-Toro MR, Petersen D, Quave BT, B. Racz G, Raj PP, Ramamurthy S, Ranson MT, Reeves KD, Reynolds LW, Rime C, Rosenthal RM, Rupert MP, Saberski LR, Schattschneider J, Schrattenholzer T, Schreiber CP, Schultz DM, Scott J, Sekhadia M, Sharar SR, Sial KA, Sills SM, Simon S, Simopoulos TT, Singh V, Solanki D, Soto-Quijano DA, Sridhara C, Stanton-Hicks M, Stiles MA, Supernaw RB, Swenson RS, Taylor VM, Treffer KD, Trout R, Urban GJ, Vinjamuri S, Waldman CW, Waldman HJ, Waldman JE, Waldman SD, Wallace MS, Warfield CA, Whitworth ML, Wiechman SA, Winnie AP, Wong CA, Yaksh TL, Ybarra M. Contributors. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
Pain following traumatic injuries is common, can impair injury recovery and is often inadequately treated. In particular, the role of adjunctive nonpharmacologic analgesic techniques is unclear. The authors report a randomized, controlled study of 21 hospitalized trauma patients to assess the analgesic efficacy of virtual reality hypnosis (VRH)-hypnotic induction and analgesic suggestion delivered by customized virtual reality (VR) hardware/software. Subjective pain ratings were obtained immediately and 8 hours after VRH (used as an adjunct to standard analgesic care) and compared to both adjunctive VR without hypnosis and standard care alone. VRH patients reported less pain intensity and less pain unpleasantness compared to control groups. These preliminary findings suggest that VRH analgesia is a novel technology worthy of further study, both to improve pain management and to increase availability of hypnotic analgesia to populations without access to therapist-provided hypnosis and suggestion.
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Affiliation(s)
- David R Patterson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98104, USA.
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Fauerbach JA, McKibben J, Bienvenu OJ, Magyar-Russell G, Smith MT, Holavanahalli R, Patterson DR, Wiechman SA, Blakeney P, Lezotte D. Psychological distress after major burn injury. Psychosom Med 2007; 69:473-82. [PMID: 17585064 PMCID: PMC5788166 DOI: 10.1097/psy.0b013e31806bf393] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To track the prevalence and stability of clinically significant psychological distress and to identify potentially modifiable in-hospital symptoms predictive of long-term distress (physical, psychological, and social impairment). METHOD We obtained data from the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The Brief Symptom Inventory (BSI) was used to assess symptoms in-hospital (n = 1232) and at 6 (n = 790), 12 (n = 645), and 24 (n = 433) months post burn. Distress was examined dimensionally (BSI's Global Severity Index (GSI)) and categorically (groups formed by dichotomizing GSI: T score > or =63). Attrition was unrelated to in-hospital GSI score. RESULTS Significant in-hospital psychological distress occurred in 34% of the patients, and clinically significant and reliable change in symptom severity by follow-up visits occurred infrequently. Principal components analysis of in-hospital distress symptoms demonstrated "alienation" and "anxiety" factors that robustly predicted distress at 6, 12, and 24 months, controlling for correlates of baseline distress. CONCLUSIONS This is the largest prospective, multisite, cohort study of patients with major burn injury. We found that clinically significant in-hospital psychological distress was common and tends to persist. Two structural components of in-hospital distress seemed particularly predictive of long-term distress. Research is needed to determine if early recognition and treatment of patients with in-hospital psychological distress can improve long-term outcomes.
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Affiliation(s)
- James A Fauerbach
- Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Abstract
This study is the first to use virtual-reality technology on a series of clinical patients to make hypnotic analgesia less effortful for patients and to increase the efficiency of hypnosis by eliminating the need for the presence of a trained clinician. This technologically based hypnotic induction was used to deliver hypnotic analgesia to burn-injury patients undergoing painful wound-care procedures. Pre- and postprocedure measures were collected on 13 patients with burn injuries across 3 days. In an uncontrolled series of cases, there was a decrease in reported pain and anxiety, and the need for opioid medication was cut in half. The results support additional research on the utility and efficacy of hypnotic analgesia provided by virtual reality hypnosis.
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Affiliation(s)
- David R Patterson
- University of Washington School of Medicine, Seattle, Washington, USA.
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Fauerbach JA, Lezotte D, Hills RA, Cromes GF, Kowalske K, de Lateur BJ, Goodwin CW, Blakeney P, Herndon DN, Wiechman SA, Engrav LH, Patterson DR. Burden of Burn: A Norm-Based Inquiry into the Influence of Burn Size and Distress on Recovery of Physical and Psychosocial Function. ACTA ACUST UNITED AC 2005; 26:21-32. [PMID: 15640730 DOI: 10.1097/01.bcr.0000150216.87940.ac] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This prospective, longitudinal study examined the influence of baseline physical and psychological burden on serial assessments of health-related quality of life among adults with major burns from three regional burn centers (n = 162). Physical burden groups were defined by % TBSA burned: <10%, 10% to 30%, or >30%. Psychological burden groups were defined by in-hospital distress using the Brief Symptom Inventory Global Severity Index T-score with scores of < 63 or > or = 63. Analyses compared groups across level of burden and with published normative data. Assessments reflected health and function (Short Form 36) during the month before burn, at discharge, and at 6 and 12 months after burn. Physical functioning was significantly more impaired and the rate of physical recovery slower among those with either large physical burden or large psychological burden. Notably, psychosocial functioning also was more impaired and the rate of psychosocial recovery slower among those with greater psychological burden. These results suggest that, in addition to aggressive wound closure, interventions that reduce in-hospital distress may accelerate both physical and psychosocial recovery.
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Affiliation(s)
- James A Fauerbach
- Johns Hopkins University School of Medicine, c/o Baltimore Regional Burn Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA
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Sullivan SR, Friedrich JB, Engrav LH, Round KA, Heimbach DM, Heckbert SR, Carrougher GJ, Lezotte DC, Wiechman SA, Honari S, Klein MB, Gibran NS. “Opioid creep” is real and may be the cause of “fluid creep”. Burns 2004; 30:583-90. [PMID: 15302427 DOI: 10.1016/j.burns.2004.03.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2004] [Indexed: 11/26/2022]
Abstract
Recent studies have shown that burn patients receive larger volumes of fluids than predicted by the Baxter formula and the reason for this is unclear. One potential reason is that increased analgesics are used which could blunt the response to fluid resuscitation. The purpose of this study was to compare the administration of opioid agonists in patients treated at a single burn center in the 1970s and in the year 2000. We performed a retrospective chart review comparing two matched cohorts. Group I consisted of 11 patients admitted between 1975 and 1978. Group II consisted of 11 patients admitted in 2000 matched for age, sex and %TBSA. Patients in Group II received a significantly higher mean opioid equivalent than those in Group I (26.5 +/- 12.3 versus 3.9 +/- 2.2 in the first 24h, P < 0.001). In addition, in Group II, a larger variety and combination of opioid agonists were used. This review demonstrates a significant increase from the 1970s to 2000 in the type, dose prescribed and dose delivered of opioid agonists. Along with "fluid creep", we have also increased our use of opioid agonists or "opioid creep". Higher doses of opioid agonists may have hemodynamic consequences, which may contribute to the increased fluid volumes.
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Affiliation(s)
- Stephen R Sullivan
- Harborview Medical Center, Division of Plastic Surgery, University of Washington, Harborview Medical Center, Box 359796, 325 Ninth Avenue, Seattle, WA, USA
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Affiliation(s)
- Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA
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Patterson DR, Finch CP, Wiechman SA, Bonsack R, Gibran N, Heimbach D. Premorbid Mental Health Status of Adult Burn Patients: Comparison with a Normative Sample. ACTA ACUST UNITED AC 2003; 24:347-50. [PMID: 14501409 DOI: 10.1097/01.bcr.0000086070.91033.7f] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presence of psychiatric problems in burn patients has been found to have an impact on their burn care and long-term adjustment. This study investigated rates of previous mental health symptoms in a sample of 199 hospitalized burn patients screened for previous psychiatric diagnoses. Patients were instructed to fill out a questionnaire about their mental health functioning on the Rand Inventory for the month preceding their burn injury. Scores compared with a national normative sample on the Rand Mental Health Inventory revealed that burn patients scored higher on psychological distress, anxiety, depression, and loss of behavioral and emotional control. These results reflect other studies in the literature, indicating that burn patients are premorbidly more psychologically vulnerable than the general population, a factor that likely contributes to many of them sustaining their injuries.
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Affiliation(s)
- David R Patterson
- University of Washington School of Medicine, Harborview Medical Center, Seattle, 98104-2499, USA
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Abstract
It is commonly assumed that patients hospitalized for burn treatment will experience some level of depression. However, little is known about the trends in severity of depression over time. The purpose of this study was to determine the rates and severity of depression over a 2-year period. The Beck Depression Inventory was administered at 1 month (N = 151), 1 year (N = 130), and 2 years (N = 125) after discharge. At 1 month, 54% of patients showed symptoms of moderate to severe depression, and at 2 years, 43% of the patients responding still reported moderate to severe depression. The average correlation between scores over time was high. Women had higher depression scores than men at each time period. An interaction between gender and having a head or neck injury was also observed at 1 month and 1 year after discharge. Results suggest that routine outpatient screening for depression is warranted.
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Affiliation(s)
- S A Wiechman
- University of Washington School of Medicine-Harborview Medical Center, Seattle, USA
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Leffingwell TR, Wiechman SA, Smith RE, Smoll FL, Christensen DS. Sport psychology training within a clinical psychology program and a department of intercollegiate athletics. Professional Psychology: Research and Practice 2001. [DOI: 10.1037/0735-7028.32.5.531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wiechman SA, Ehde DM, Wilson BL, Patterson DR. The management of self-inflicted burn injuries and disruptive behavior for patients with borderline personality disorder. J Burn Care Rehabil 2000; 21:310-7. [PMID: 10935812 DOI: 10.1067/mbc.2000.108147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
One of the greatest behavioral and ethical challenges faced by a burn team is the treatment of a patient whose burn injury is the result of parasuicidal behavior. Parasuicidal behavior is defined as intentional self-injurious behavior that, although not fatal, may result in tissue damage or risk of death. There are a number of reasons, usually psychiatric, that patients engage in parasuicidal behavior; however, our contention is that the majority of these patients have a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis II diagnosis of borderline personality disorder. We describe the nature of borderline personality disorder and how it leads to disruptive behavior, including self-harm behavior, on the burn unit, We also argue that if staff members fail to recognize the borderline personality disorder diagnosis, it will lead to responses from staff that can heighten disruptive behavior. We present a series of recommendations for treating such patients with burns and an illustrative case report.
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Affiliation(s)
- S A Wiechman
- Department of Psychology, University of Washington, Seattle, USA
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Wiechman SA, Smith RE, Smoll FL, Ptacek JT. Masking effects of social desirability response set on relations between psychosocial factors and sport injuries: a methodological note. J Sci Med Sport 2000; 3:194-202. [PMID: 11104311 DOI: 10.1016/s1440-2440(00)80081-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Social desirability has long been viewed as a potential source of error variance in self-report measures. We suggest that social desirability (whether in the form of impression management or self-deception) has the capacity to mask relations between psychosocial variables and sport-related outcome or criterion measures that are not measured by selfreport. To illustrate what can occur, we present data from a longitudinal study in which life stress and psychological coping skills were studied as predictors of behaviorally-defined athletic injuries. When data from the entire sample of 352 athletes were analyzed, virtually no injury variance was accounted for by life stress, psychological coping skills, or their interaction. In contrast, deletion from the sample of athletes with high social desirability response set scores resulted in significant predictive relations involving both life stress and coping skills, as well as a significant moderator effect for coping skills. We propose that social desirability masking effects can significantly increase the likelihood of Type II errors in sports medicine research that involves self-report measures, and that social desirability responding needs to be controlled or minimized.
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Affiliation(s)
- S A Wiechman
- University of Washington, Seattle 98195-1525, USA
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Abstract
The occurrence and predictors of post-traumatic stress symptoms 1 year after a burn injury were assessed in a large prospective sample (N = 172). Participants completed a self-report post-traumatic stress symptom checklist at 3 time points: within 24 hours of admission to a burn center, 1 month after the injury, and 1 year after the injury. A notable number of participants had a range of post-traumatic stress symptoms both at 1 month and at 1 year after the burn injury. More than half of the sample reported recurrent intrusive recollections of the burn injury at 1 month and at 1 year. Other commonly endorsed symptoms were sleep disturbance, avoidance of thoughts or feelings associated with the burn, and distress at reminders of the burn. The number of post-traumatic stress symptoms endorsed at 1 month was the only significant predictor of post-traumatic stress symptoms at 1 year. These results suggest that it is common for patients to have some post-traumatic symptoms 1 year after a burn injury and that early experiences of post-traumatic stress symptoms may be associated with the development or maintenance of post-traumatic stress disorder. We recommend that burn care professionals identify and intervene with patients who have clinically significant distress as a result of their burn injuries.
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Affiliation(s)
- D M Ehde
- Department of Rehabilitation Medicine and University of Washington Burn Center, Seattle, USA
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Abstract
The occurrence and predictors of acute post-traumatic stress symptoms were assessed in a large, prospective sample of persons with new burn injuries (N = 172). Participants completed a self-report post-traumatic stress symptom checklist, pain ratings, and a premorbid mental health inventory within 24 h of admission to a burn center (Day 1). Over half of the sample reported sleep disturbance and recurrent, intrusive recollections of the burn injury on Day 1. Other commonly endorsed symptoms were difficulties concentrating, avoidance of thoughts/feelings associated with the burn, flashbacks, and exaggerated startle response. Persons with less favorable premorbid mental health and larger burns reported a greater number of stress symptoms on Day 1. These results suggest that experiencing some post-traumatic stress symptoms immediately following a burn trauma is normal. It is recommended that burn care professionals identify and intervene with patients who are suffering clinically significant distress early in the hospitalization.
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Affiliation(s)
- D M Ehde
- Department of Rehabilitation Medicine and University of Washington Burn Center, University of Washington School of Medicine, Seattle, USA
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