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Fanstone R, Price P, Bodger O, Potokar T, Khan MRK. Risk factors for burn contractures: A cross-sectional study in a lower income country. Burns 2024; 50:454-465. [PMID: 37980272 DOI: 10.1016/j.burns.2023.09.003] [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: 05/02/2023] [Revised: 07/31/2023] [Accepted: 09/09/2023] [Indexed: 11/20/2023]
Abstract
Risk factors for burn contractures require further study, especially in low and middle-income countries (LMICs); existing research has been predominantly conducted in high income countries (HICs). This study aimed to identify risk factors for burn contractures of major joints in a low-income setting. Potential risk factors (n = 104) for burn contracture were identified from the literature and a survey of clinicians with extensive experience in low and middle-income countries (LMIC). An observational cross-sectional study of adult burn survivors was undertaken in Bangladesh to evaluate as many of these risk factors as were feasible against contracture presence and severity. Forty-eight potential risk factors were examined in 48 adult patients with 126 major joints at risk (median 3 per participant) at a median of 2.5 years after burn injury. Contractures were present in 77% of participants and 52% of joints overall. Contracture severity was determined by measurement of loss of movement at all joints at risk. Person level risk factors were defined as those that were common to all joints at risk for the participant and only documented once, whilst joint level risk factors were documented for each of the participant's included joints at risk. Person level risk factors which were significantly correlated with loss of range of movement (ROM) included employment status, full thickness burns, refusal of skin graft, discharged against medical advice, low frequency of follow up and lack of awareness of contracture development. Significant joint level risk factors for loss of ROM included anatomical location, non-grafted burns, and lack of pressure therapy. This study has examined the largest number of potential contracture risk factors in an LMIC setting to date. A key finding was that risk factors for contracture in low-income settings may differ substantially from those seen in high income countries, which has implications for effective prevention strategies in these countries. Better whole person and joint outcome measures are required for accurate determination of risk factors for burn contracture. Recommendations for planning and reporting on future contracture risk factor studies are made.
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Affiliation(s)
- RuthAnn Fanstone
- Centre for Global Burn Injury Policy and Research, Swansea University, UK.
| | - Patricia Price
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
| | - Owen Bodger
- Faculty of Medicine, Health and Life Sciences, Swansea University, UK
| | - Tom Potokar
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
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Young A, Davies A, Tsang C, Kirkham J, Potokar T, Gibran N, Tyack Z, Meirte J, Harada T, Dheansa B, Dumville J, Metcalfe C, Ahuja R, Wood F, Gaskell S, Brookes S, Smailes S, Jeschke M, Cinar MA, Zia N, Moghazy A, Mathers J, Falder S, Edgar D, Blazeby JM. Establishment of a core outcome set for burn care research: development and international consensus. BMJ Med 2022; 1:e000183. [PMID: 36936572 PMCID: PMC9978679 DOI: 10.1136/bmjmed-2022-000183] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Abstract
Objective To develop a core outcome set for international burn research. Design Development and international consensus, from April 2017 to November 2019. Methods Candidate outcomes were identified from systematic reviews and stakeholder interviews. Through a Delphi survey, international clinicians, researchers, and UK patients prioritised outcomes. Anonymised feedback aimed to achieve consensus. Pre-defined criteria for retaining outcomes were agreed. A consensus meeting with voting was held to finalise the core outcome set. Results Data source examination identified 1021 unique outcomes grouped into 88 candidate outcomes. Stakeholders in round 1 of the survey, included 668 health professionals from 77 countries (18% from low or low middle income countries) and 126 UK patients or carers. After round 1, one outcome was discarded, and 13 new outcomes added. After round 2, 69 items were discarded, leaving 31 outcomes for the consensus meeting. Outcome merging and voting, in two rounds, with prespecified thresholds agreed seven core outcomes: death, specified complications, ability to do daily tasks, wound healing, neuropathic pain and itch, psychological wellbeing, and return to school or work. Conclusions This core outcome set caters for global burn research, and future trials are recommended to include measures of these outcomes.
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Affiliation(s)
- Amber Young
- Centre for Surgical Research, Population Health Sciences, Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Davies
- Centre for Surgical Research, Population Health Sciences, Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carmen Tsang
- Centre for Surgical Research, Population Health Sciences, Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jamie Kirkham
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Tom Potokar
- Centre for Global Burn Injury Policy and Research, Swansea University, Swansea, UK
| | - Nicole Gibran
- UW Medicine Regional Burn Center, Harborview Medical Center, UW Department of Surgery, University of Washington (UW), Seattle, WA, USA
| | - Zephanie Tyack
- Child Health Research Centre, Faculty of Medicine, Centre for Children’s Burns and Trauma Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jill Meirte
- Department of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Teruichi Harada
- Seitokai Medical and Social Welfare Corporation, Teramoto Memorial Hospital, Kawachinagano, Osaka, Japan
| | - Baljit Dheansa
- Department of plastic surgery and burns, Queen Victoria Hospital, East Grinstead, UK
| | - Jo Dumville
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
- Division of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, UK
| | - Chris Metcalfe
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Rajeev Ahuja
- Department of Burns & Plastic Surgery, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India
| | - Fiona Wood
- Burn service, University of Western Australia, Perth, WA, Australia
| | - Sarah Gaskell
- Paediatric Psychosocial Service, Royal Manchester Children's Hospital, Manchester, UK
| | - Sara Brookes
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sarah Smailes
- Department of physiontherapy, Broomfield Hospital, Mid Essex Hospitals, Chelmsford, UK
| | - Marc Jeschke
- Department of Surgery and Plastic Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Murat Ali Cinar
- Department of Physical Therapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amr Moghazy
- Department of plastic surgery, Suez Canal University, Ismailia, Egypt
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sian Falder
- Department of plastic surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Dale Edgar
- Adult Burns Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Jane Mary Blazeby
- Centre for Surgical Research, Population Health Sciences, Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, UK
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Collier ZJ, Bourcier AJ, Naidu P, Magee WP, Potokar T, Gillenwater J. 57 Understanding the Burden of Burn Injury in Latin America & the Caribbean. J Burn Care Res 2022. [PMCID: PMC8946571 DOI: 10.1093/jbcr/irac012.060] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction Burn injuries are a global health problem disproportionately affecting low- and middle-income countries, especially in Latin America and Caribbean (LAC) where cooking methods, dangerous work conditions, and minimal housing regulations place people at increased risk of burn injury. Until recently, there was limited global epidemiological data on burn injuries. Following publication of the 2017 Global Burden of Disease (GBD17) database, we obtained objective and comparable data on burn injuries while specifically focusing on LAC countries. Methods Data from all 35 LAC countries were collected from GBD17 for fire, heat, and hot substance-related injuries to calculate burn incidence, deaths, and Disability-Adjusted Life Years (DALYs) with respect to country, age, and gender from 1990 to 2017. Incidence and deaths were reported as rates per 100,000 persons. Mortality rate was reported as a percentage of deaths-to-incidence. DALYs were reported in years per 100,000 persons. Incidence, death, DALY, and mortality rate trends were assessed using age-standardized, age-stratified, and gender-specific cohorts. All statistical analyses were performed using Excel. Results Over 27 years, LAC’s rates for burn incidence (-19%), deaths (-63%), DALYs (-62%), and mortality (-54%) all decreased with the greatest improvements seen in Brazil and Paraguay. All indicators improved around 15% more than the global averages during the same period with LAC’s rates 30-40% below global rates by 2017. The highest burn incidence (227 cases/100,000) was in Southern Latin America (Argentina, Chile, Uruguay). The Caribbean had the worst DALYs (124 years/100,000). In 2017, LAC accounted for 7% of global burns, 5.5% of deaths, and 5.1% of DALYs with Central America contributing the greatest numbers. For 27 years, Chile had the highest burn incidence but Haiti had the greatest death, DALY, and mortality rates of all LAC. Children under 14 years of age and males were disproportionately affected compared to other regional and global cohorts. Conclusions Despite a relatively greater reduction in burn severity and lifelong disability within LAC compared to the world, certain regions and countries exhibited significantly higher rates of burn injury, morbidity, and mortality. Central America (e.g. Costa Rica, Belize, Mexico) and the Caribbean (e.g. Haiti, Cuba) were particularly affected, comprising the majority of cases, deaths, and DALYs. This study provides essential analyses for developing regional and country-specific strategies to reduce the burden of burns through targeted interventions for prevention, workforce, and capacity building efforts. ![]()
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Affiliation(s)
- Zachary J Collier
- Keck School of Medicine, University of Southern California, Los Angeles, California; University of California - Los Angeles, Los Angeles, California; University of Cape Town, South Africa, Cape Town, Western Cape; Children’s Hospital Los Angeles, Los Angeles, California; Interburns, Geneva, Geneve; USC/LAC+USC Medical Center, Los Angeles, California
| | - Alexandre J Bourcier
- Keck School of Medicine, University of Southern California, Los Angeles, California; University of California - Los Angeles, Los Angeles, California; University of Cape Town, South Africa, Cape Town, Western Cape; Children’s Hospital Los Angeles, Los Angeles, California; Interburns, Geneva, Geneve; USC/LAC+USC Medical Center, Los Angeles, California
| | - Priyanka Naidu
- Keck School of Medicine, University of Southern California, Los Angeles, California; University of California - Los Angeles, Los Angeles, California; University of Cape Town, South Africa, Cape Town, Western Cape; Children’s Hospital Los Angeles, Los Angeles, California; Interburns, Geneva, Geneve; USC/LAC+USC Medical Center, Los Angeles, California
| | - William P Magee
- Keck School of Medicine, University of Southern California, Los Angeles, California; University of California - Los Angeles, Los Angeles, California; University of Cape Town, South Africa, Cape Town, Western Cape; Children’s Hospital Los Angeles, Los Angeles, California; Interburns, Geneva, Geneve; USC/LAC+USC Medical Center, Los Angeles, California
| | - Tom Potokar
- Keck School of Medicine, University of Southern California, Los Angeles, California; University of California - Los Angeles, Los Angeles, California; University of Cape Town, South Africa, Cape Town, Western Cape; Children’s Hospital Los Angeles, Los Angeles, California; Interburns, Geneva, Geneve; USC/LAC+USC Medical Center, Los Angeles, California
| | - Justin Gillenwater
- Keck School of Medicine, University of Southern California, Los Angeles, California; University of California - Los Angeles, Los Angeles, California; University of Cape Town, South Africa, Cape Town, Western Cape; Children’s Hospital Los Angeles, Los Angeles, California; Interburns, Geneva, Geneve; USC/LAC+USC Medical Center, Los Angeles, California
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Collier ZJ, McCool K, Magee WP, Potokar T, Gillenwater J. 58 Burn Injuries in Asia: A Global Burden of Disease Study. J Burn Care Res 2022. [PMCID: PMC8945951 DOI: 10.1093/jbcr/irac012.061] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Burn injuries disproportionately affect low- and middle-income countries. Work conditions, rapid industrialization, social conditions, cultural activities, political conflict, and lack of access to safe and affordable surgery are key barriers to effective burn care in Asia. This study aimed to better define the burn burden in Asia, its sub-regions, and related sex and age disparities to elucidate populations where targeted burn care interventions are most needed. Methods The 2019 Global Burden of Disease (GBD19) of the Global Health Data Exchange was used to acquire 151,741 sources of epidemiological data on fire, heat, and hot substance-related injuries for 53 countries in Asia from 1990 to 2019. Measures used to derive summative statistics included incidence, deaths, disability-adjusted life years (DALYs), and mortality ratio (deaths: incidence) by year, sex, age, and location. Spatial mapping was performed to geographically delineate burn indicators. Results From 1990 to 2019, an estimated 117 million burns occurred in Asia. The relative proportion of global burns, deaths, and DALYs from Asia increased during that time. By 2019, 46% of global burn cases, 47% of deaths, and 46% of DALYs were from Asia. The two most burdened regions were South and Southeast Asia, accounting for 30-40% of all global cases, deaths, and DALYs. Compared to global averages, the incidence, death, and DALY rates for Asia were 32%, 22%, and 23% higher. Central Asia had the worst rates, averaging 2.9, 2.3, and 2.6 times the global averages. Throughout Asia, men were 32%, 63%, and 47% more likely to be burned, die, and suffer DALYs than women versus the global disparities of 7%, 26%, and 10%. Only South Asia’s trend was reversed with women suffering 15%, 20%, and 27% more burns, deaths, and DALYs than men. In Asia, those under 5 years were most impacted by DALYs (314 years/100,000 people), 5-14 year olds had the highest burn rate (219 cases/100,000), and 70+ year olds had the highest death rate (8.4 deaths/100,000) and mortality ratio (54%). Conclusions In 2019, Asia had an estimated 3.8 million burns comprising nearly half of all the world’s burn cases, deaths, and DALYs. While Asia’s burn indicators have declined since 1990, global improvements have surpassed Asia’s. South and Southeast Asia accounted for the greatest burden of burn morbidity and mortality, but Central Asia consistently had the highest rates relative to overall population. Men were more affected than women, except in South Asia, and the extremes of age (< 5 and 70+ years) suffered the greatest rates of disability and death. ![]()
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Affiliation(s)
- Zachary J Collier
- Keck School of Medicine, University of Southern California, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; Children’s Hospital Los Angeles, Los Angeles, California; Interburns, Geneva, Geneve; USC/LAC+USC Medical Center, Los Angeles, California
| | - Katherine McCool
- Keck School of Medicine, University of Southern California, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; Children’s Hospital Los Angeles, Los Angeles, California; Interburns, Geneva, Geneve; USC/LAC+USC Medical Center, Los Angeles, California
| | - William P Magee
- Keck School of Medicine, University of Southern California, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; Children’s Hospital Los Angeles, Los Angeles, California; Interburns, Geneva, Geneve; USC/LAC+USC Medical Center, Los Angeles, California
| | - Tom Potokar
- Keck School of Medicine, University of Southern California, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; Children’s Hospital Los Angeles, Los Angeles, California; Interburns, Geneva, Geneve; USC/LAC+USC Medical Center, Los Angeles, California
| | - Justin Gillenwater
- Keck School of Medicine, University of Southern California, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; Children’s Hospital Los Angeles, Los Angeles, California; Interburns, Geneva, Geneve; USC/LAC+USC Medical Center, Los Angeles, California
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5
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Almeland SK, Hughes A, Leclerc T, Ogura T, Hayashi M, Mills JA, Norton I, Potokar T. "Reply: Letter to the Editor on recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020.". Burns 2022; 48:482-484. [PMID: 34903407 DOI: 10.1016/j.burns.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Stian Kreken Almeland
- Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
| | - Amy Hughes
- Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK; Humanitarian and Conflict Response Institute (HCRI), University of Manchester, UK; Cambridge Hospital NHS Foundation Trust (Addenbrookes), Paediatric ICU Department, UK.
| | - Thomas Leclerc
- Burn Centre, Percy Military Teaching Hospital, Clamart, France; Val-de-Grâce Military Medical Academy, Paris, France.
| | - Takayuki Ogura
- Tochigi Emergency and Critical Care Centre, Imperial Foundation Saiseikai, Utsunomiya Hospital, Japan.
| | - Minoru Hayashi
- St.Mary's Hospital, Department of Plastic and Reconstructive Surgery, Japan.
| | - Jody-Anne Mills
- Rehabilitation Programme, Department of NCD, World Health Organization, Geneva, Switzerland.
| | - Ian Norton
- World Health Organization (2014-2019), Geneva, Switzerland; Respond Global, Australia.
| | - Tom Potokar
- Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK; Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK; World Health Organization, Emergency Medical Teams Technical Working Group on Burns, Switzerland.
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Gunsmaa G, Shono A, Price PE, Kondo M, Hebron C, Potokar T, Ichikawa M. Parental acceptance and willingness to pay for a newly designed kitchen rack to reduce paediatric burns. Burns 2022; 48:381-389. [PMID: 34092419 DOI: 10.1016/j.burns.2021.05.008] [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] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/14/2022]
Abstract
The majority of pediatric burns in Mongolia occur within the home, particularly in the spaces dedicated to cooking. This makes home environment modification a priority for injury prevention. Many of these injuries are caused by electric appliances used in traditional tent-like dwellings (called a ger). In the present study, we designed and provided a context appropriate kitchen rack to 50 households with children aged 0-3 years living in gers and investigated parental views on the acceptability of the rack and willingness-to-pay (WTP) through face-to-face structured individual and group interviews and the contingent valuation method. We used the DCchoice package of R to estimate the median WTP and its 95% confidence interval by the household income, previous experience of childhood burn injury, and the number of children in the household. There was a total of 89 children aged <5 years in the 50 households, with a total of 59 burn experiences since birth including 29 treated at inpatient facilities. The median WTP was MNT 106,000 (about USD 37). The WTP appeared to be higher for the households with a higher income, more severe child burn experiences, and a greater number of children in the household. In the group interviews conducted after 4-6 weeks of routine use, the participants indicated that the use of the rack had resulted in a less stressful cooking environment, and the kitchen rack was described as a positive contribution to the reduction of risk to their young children. Whilst there were some suggestions for minor modifications, the rack was well accepted as a means of child burn prevention by the parents of infants and toddlers in Mongolia.
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Affiliation(s)
- Gerelmaa Gunsmaa
- Department of Global Public Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
| | - Aiko Shono
- Laboratory of Social Pharmacy and Regulatory Science, Showa Pharmaceutical University, Tokyo, Japan
| | - Patricia E Price
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK; Interburns, Swansea, UK
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Caitlin Hebron
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Tom Potokar
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK; Interburns, Swansea, UK
| | - Masao Ichikawa
- Department of Global Public Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Potokar T, Bendell R, Phuyal K, Dhital A, Karim E, Falder S, Kynge L, Price PE. The development of the Delivery Assessment Tool (DAT) to facilitate quality improvement in burns services in low-middle income countries. Burns 2021; 48:1488-1496. [PMID: 34903404 DOI: 10.1016/j.burns.2021.10.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/02/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
Implementation science is a useful tool to consider ways in which we can introduce improvements to burn services in low-and-middle income countries (LMICs), where the majority of the burden of burn injury is now experienced. This paper outlines the development of the Delivery Assessment Tool (DAT), a method for facilitating quality improvement in burn services in LMICs. We used a participatory approach that ensured that local clinicians and experts were fully involved in piloting the tool. The DAT is based on internationally agreed operational standards for burn care service delivery and has undergone an iterative process of improvement and refinement through an initial three-year project in Nepal and Bangladesh. The DAT, a 50-item tool organised into 10 subsections, is used to assess a service through a participatory focus group discussion with a mixed, multidisciplinary team of staff working at the burn service, typically 6-10 participants. This usually lasts 2-3 h. The staff in the unit then select priority areas for quality improvement programmes that are within their control to achieve, which starts a cycle of audit and review. The final version of the tool was used in a further three-year project to evaluate 11 hospitals in Nepal and Bangladesh. Education and training are key components of this work; both were provided by Interburns as part of on-going support for the clinical teams. At the end of the project a>19% improvement in scores was demonstrated using the final version of the DAT in both Nepal and Bangladesh; this achievement is remarkable given the continued difficulties in service provision where patient numbers far outstrip the resources available to care for them. As a result of this work, we have made a digital version of the tool available free of charge.
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Affiliation(s)
- T Potokar
- Interburns, Cardiff, Wales, UK; Centre for Global Burn injury Policy and Research, Swansea University, UK.
| | | | - K Phuyal
- Interburns, Cardiff, Wales, UK; SAGUN: A Search for Harmony, Kupandol, Lalitpur, Nepal
| | - A Dhital
- Interburns, Cardiff, Wales, UK; SAGUN: A Search for Harmony, Kupandol, Lalitpur, Nepal
| | - E Karim
- Acid Survivors Trust, Bangladesh
| | - S Falder
- Interburns, Cardiff, Wales, UK; Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - L Kynge
- Interburns, Cardiff, Wales, UK
| | - P E Price
- Interburns, Cardiff, Wales, UK; Centre for Global Burn injury Policy and Research, Swansea University, UK
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Denekew B, Hebron C, Mekonnen A, Ayele M, Negash K, Desalegne M, Price P, Potokar T. Investigating burn cases, knowledge, attitudes and practices to burn care and prevention in Ethiopia: a community-survey. Journal of Global Health Reports 2021. [DOI: 10.29392/001c.24353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Baye Denekew
- Amref Health Africa in Ethiopia, Addis Ababa, Ethiopia
| | | | | | - Mihret Ayele
- Amref Health Africa in Ethiopia, Addis Ababa, Ethiopia
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Abstract
Abstract
Introduction
Over 1 million burns occur in Sub-Saharan Africa (SSA) each year leading to significant morbidity and mortality. Financial constraints, social stigma, political strife, inaccessible healthcare facilities, limited perioperative resources, and low workforce capacity results in steep barriers to obtaining timely and effective burn care. This study set out to better define the burn burden as well as the age and gender-related disparities within SSA, to identify specific sub-regions and countries that would benefit most from targeted interventions to enhance burn care.
Methods
Data for all 46 SSA countries were acquired from the 2017 Global Burden of Disease (GBD17) database of the Global Health Data Exchange. Information regarding fire, heat, and hot substance-related injuries was derived from 17,792 data sources to estimate burn-related incidence, deaths, and Disability Adjusted Life Years (DALYs) by year, sex, age, and location from 1990 to 2017. Summative statistics were created for burn incidence, deaths, DALYs, and mortality ratio (deaths: incidence; %). Spatial mapping was performed to identify burn burden for specific regions and countries.
Results
An estimated 28,127,199 burns occurred in SSA from 1990–2017. On average, SSA accounted for 16% of worldwide burns, 21% of burn deaths, and 25% of DALYs. Furthermore, the mortality rate was 2.2 times the global average and remained nearly double the entire 27-year period. While all SSA regions had higher incidence, deaths, and DALYs compared to the global cohort, the Southern SSA region consistently had the highest incidence (211 cases per 100,000), deaths (7 per 100,000), and DALYs (355 years per 100,000) throughout the time period, with Lesotho, Swaziland, and Zimbabwe having the highest rates. In contrast to gender similarities globally for burn indicators, all regions within SSA showed higher incidence rates (144 vs 136 cases per 100,000), deaths (5.4 vs 4.7 deaths per 100,000), and DALYs (289 vs 272 years per 100,000) for men than women when age standardized.
Conclusions
With an estimated 1.4 million burn injuries in 2017, SSA accounted for over 15% of all worldwide burns and 20% of global burn deaths. Although all trended rates improved over the years for each country, they were consistently worse and slower to improve in all regions of SSA compared to the rest of the world. While both Central and Southern SSA regions had the greatest burn burden, burns in Central SSA more significantly impacted those under 5 years whereas Southern SSA saw the greatest burden on the 15–49-year age group.
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Affiliation(s)
- Zachary J Collier
- University of Southern California, Division of Plastic & Reconstructive Surgery, Los Angeles, California; University of Cape Town, Cape Town, Western Cape; University of Southern California Keck School of Medicine, Los Angeles, California; Keck School of Medicine, Los Angeles, California; Swansea University, Swansea, Wales; University of Southern California, Los Angeles, California
| | - Priyanka Naidu
- University of Southern California, Division of Plastic & Reconstructive Surgery, Los Angeles, California; University of Cape Town, Cape Town, Western Cape; University of Southern California Keck School of Medicine, Los Angeles, California; Keck School of Medicine, Los Angeles, California; Swansea University, Swansea, Wales; University of Southern California, Los Angeles, California
| | - Katherine J Choi
- University of Southern California, Division of Plastic & Reconstructive Surgery, Los Angeles, California; University of Cape Town, Cape Town, Western Cape; University of Southern California Keck School of Medicine, Los Angeles, California; Keck School of Medicine, Los Angeles, California; Swansea University, Swansea, Wales; University of Southern California, Los Angeles, California
| | - Christopher H Pham
- University of Southern California, Division of Plastic & Reconstructive Surgery, Los Angeles, California; University of Cape Town, Cape Town, Western Cape; University of Southern California Keck School of Medicine, Los Angeles, California; Keck School of Medicine, Los Angeles, California; Swansea University, Swansea, Wales; University of Southern California, Los Angeles, California
| | - Tom Potokar
- University of Southern California, Division of Plastic & Reconstructive Surgery, Los Angeles, California; University of Cape Town, Cape Town, Western Cape; University of Southern California Keck School of Medicine, Los Angeles, California; Keck School of Medicine, Los Angeles, California; Swansea University, Swansea, Wales; University of Southern California, Los Angeles, California
| | - Justin Gillenwater
- University of Southern California, Division of Plastic & Reconstructive Surgery, Los Angeles, California; University of Cape Town, Cape Town, Western Cape; University of Southern California Keck School of Medicine, Los Angeles, California; Keck School of Medicine, Los Angeles, California; Swansea University, Swansea, Wales; University of Southern California, Los Angeles, California
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Hughes A, Almeland SK, Leclerc T, Ogura T, Hayashi M, Mills JA, Norton I, Potokar T. Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020. Burns 2021; 47:349-370. [PMID: 33041154 PMCID: PMC7955277 DOI: 10.1016/j.burns.2020.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022]
Abstract
Health and logistical needs in emergencies have been well recognised. The last 7 years has witnessed improved professionalisation and standardisation of care for disaster affected communities - led in part by the World Health Organisation Emergency Medical Team (EMT) initiative. Mass casualty incidents (MCIs) resulting in burn injuries present unique challenges. Burn management benefits from specialist skills, expert knowledge, and timely availability of specialist resources. With burn MCIs occurring globally, and wide variance in existing burn care capacity, the need to strengthen burn care capability is evident. Although some high-income countries have well-established disaster management plans, including burn specific plans, many do not - the majority of countries where burn mass casualty events occur are without such established plans. Developing globally relevant recommendations is a first step in addressing this deficit and increasing preparedness to deal with such disasters. Global burn experts were invited to a succession of Technical Working Group on burns (TWGB) meetings to: 1) review literature on burn care in MCIs; and 2) define and agree on recommendations for burn care in MCIs. The resulting 22 recommendations provide a framework to guide national and international specialist burn teams and health facilities to support delivery of safe care and improved outcomes to burn patients in MCIs.
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Affiliation(s)
- Amy Hughes
- Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK,Humanitarian and Conflict Response Institute (HCRI), University of Manchester, UK,Cambridge Hospital NHS Foundation Trust (Addenbrookes), Paediatric ICU Department, UK
| | - Stian Kreken Almeland
- Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Bergen, Norway,Faculty of Medicine, University of Bergen, Norway
| | - Thomas Leclerc
- Burn Centre, Percy Military Teaching Hospital, Clamart, France,Val-de-Grâce Military Medical Academy, Paris, France
| | - Takayuki Ogura
- Japanese Society for Burn Injuries, The Disaster Network Committee
| | - Minoru Hayashi
- Japanese society for burn injuries, The Academic Committee
| | - Jody-Ann Mills
- Rehabilitation Programme, Department of NCD, World Health Organization, Geneva, Switzerland
| | - Ian Norton
- World Health Organization (2013-2019), Emergency Medical Team Initiative Lead, Geneva,Respond Global, Queensland, Australia,Co-Chair World Health Organization EMT Technical Working Group on Burns, Geneva
| | - Tom Potokar
- Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK,Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK,Co-Chair World Health Organization EMT Technical Working Group on Burns, Geneva,Corresponding author at: Co Chair WHO-EMT Technical Working Group on Burns; Centre for Global Burn Injury Policy & Research; Swansea University; Wales; UK.
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11
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Potokar T, Bendell R, Chamania S, Falder S, Nnabuko R, Price PE. A comprehensive, integrated approach to quality improvement and capacity building in burn care and prevention in low and middle-income countries: An overview. Burns 2020; 46:1756-1767. [PMID: 32616426 PMCID: PMC7772751 DOI: 10.1016/j.burns.2020.05.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
Quality improvement requires a comprehensive integrated approach. Clinical standards are a vital first step in improving outcomes for LMICs. Capacity building needs a range of educational courses from basic to advanced. Evaluation tools are needed to measure progress.
Consistent evidence has emerged over many years that the mortality and morbidity outcomes for burn patients in low and middle-income countries (LMICs) lag behind those in more resource rich countries. Interburns is a charity that was set up with the aim of working to reduce the disparity in the number of cases of burns as well as the outcomes for patients in LMICs. This paper provides an overview of a cyclical framework for quality improvement in burn care for use in LMICs that has been developed using an iterative process over the last 10 years. Each phase of the process is outlined together with a description of the tools used to conduct a gap analysis within the service, which is then used to frame a programme of capacity enhancement. Recent externally reviewed projects have demonstrated sustained improvement with the use of this comprehensive and integrated approach over a three-year cycle. This overview paper will be supported by further publications that present these results in detail.
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Affiliation(s)
- T Potokar
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK; Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK.
| | - R Bendell
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK
| | - S Chamania
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK; Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - S Falder
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK; Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - R Nnabuko
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK; Mercy Clinics Enugu Nigeria, Federal University Teaching Hospital Abakaliki, Nigeria
| | - P E Price
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK; Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK
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12
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Phuyal K, Ogada EA, Bendell R, Price PE, Potokar T. Burns in Nepal: a participatory, community survey of burn cases and knowledge, attitudes and practices to burn care and prevention in three rural municipalities. BMJ Open 2020; 10:e033071. [PMID: 32114463 PMCID: PMC7050363 DOI: 10.1136/bmjopen-2019-033071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES As part of an ongoing, long-term project to co-create burn prevention strategies in Nepal, we collected baseline data to share and discuss with the local community, use as a basis for a co-created prevention strategy and then monitor changes over time. This paper reports on the method and outcomes of the baseline survey and demonstrates how the data are presented back to the community. DESIGN A community-based survey. SETTING Community based in three rural municipalities in Nepal. PARTICIPANTS 1305 households were approached: the head of 1279 households participated, giving a response rate of 98%. In 90.3% of cases, the head of the household was male. RESULTS We found that 2.7% (CI 1.8 to 3.7) of 1279 households, from three representative municipalities, reported at least one serious burn in the previous 12 months: a serious burn was defined as one requiring medical attention and/or inability to work or do normal activities for 24 hours. While only 4 paediatric and 10 adult cases in the previous 12 months reached hospital care, the impact on the lives of those involved was profound. Only one patient was referred on from primary to secondary/tertiary care; the average length of hospital stay for those presenting directly to secondary/tertiary care was 21 days. A range of first-aid behaviours were used, many of which are appropriate for the local context while a few may be potentially harmful (eg, the use of dung). CONCLUSION The participatory approach used in this study ensured a high response rate. We have demonstrated that infographics can link the pathway for each of the cases observed from initial incident to final location of care.
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Affiliation(s)
| | - Edna Adhiambo Ogada
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - Patricia E Price
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK
- Interburns, Swansea, UK
| | - Tom Potokar
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK
- Interburns, Swansea, UK
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Lowin J, Winfield T, Price P, Anderson P, Potokar T. Estimating the cost impact of dressing choice in the context of a mass burns casualty event. Ann Burns Fire Disasters 2019; 32:222-226. [PMID: 32313537 PMCID: PMC7155402] [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] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 06/11/2023]
Abstract
Mass casualty burn events (MCBs) require intense and complex management. Silver-infused longer use dressings might help optimise management of burns in an MCB setting. We developed a model estimating the impact of dressing choice in the context of an MCB. The model was developed in Excel in collaboration with experienced emergency response clinicians. The model compares use of silver-infused dressings with use of traditional dressings in patients with partial thickness burns covering 30% of their body. Costs were estimated from a UK perspective as a proxy for a funded emergency response team and limited to cost of dressings, bandages, padding, analgesia and staff time. Expected patient costs and resource use were summarised over an acute 2-week intervention period and extrapolated to estimate possible time savings in a hypothetical MCB. Per patient costs were estimated at £2,002 (silver) and £1,124 (traditional) (a daily additional spend of £63). Per patient staff time was estimated at 864 minutes (silver) and 1,200 minutes (traditional) (a daily time saving of 24 minutes). Multiplying up to a possible MCB population of 20 could result in a saving equivalent to 9 staff shifts over the 2-week intervention period. The model was sensitive to type of silver dressing, frequency of dressing change and staff costs. We found increased costs through use of silver dressings but time savings that might help optimise burns management in an MCB. Exploring the balance between costs and staff time might help future MCB response preparation.
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Affiliation(s)
- J. Lowin
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - T. Winfield
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - P. Price
- Centre for Global Burn Injury Policy & Research, Swansea University, Swansea, UK
| | - P. Anderson
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - T. Potokar
- Centre for Global Burn Injury Policy & Research, Swansea University, Swansea, UK
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Jagnoor J, Lukaszyk C, Fraser S, Chamania S, Harvey L, Potokar T, Ivers R. Rehabilitation practices for burn survivors in low and middle income countries: A literature review. Burns 2018; 44:1052-1064. [DOI: 10.1016/j.burns.2017.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/15/2017] [Accepted: 10/13/2017] [Indexed: 12/21/2022]
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Jagnoor J, Lukaszyk C, Christou A, Potokar T, Chamania S, Ivers R. Where to from here? A quality improvement project investigating burns treatment and rehabilitation practices in India. BMC Res Notes 2018; 11:224. [PMID: 29615112 PMCID: PMC5883359 DOI: 10.1186/s13104-018-3314-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/21/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To describe the capacity of the Indian healthcare system in providing appropriate and effective burns treatment and rehabilitation services. Results Health professionals involved in burns treatment or rehabilitation at seven hospitals from four states in India were invited to participate in consultative meetings. Existing treatment and rehabilitation strategies, barriers and enablers to patient flow across the continuum of care and details on inpatient and outpatient rehabilitation were discussed during the meetings. Seventeen health professionals from various clinical backgrounds were involved in the consultation process. Key themes highlighted (a) a lack of awareness on burn first aid at the community level, (b) a lack of human resource to treat burn injuries in hospital settings, (c) a gap in burn care training for medical staff, (d) poor hospital infrastructure and (e) a variation in treatment practices and rehabilitation services available between hospitals. A number of opportunities exist to improve burns treatment and rehabilitation in India. Improvements would most effectively be achieved through promoting multidisciplinary care across a number of facilities and service providers. Further research is required to develop context-specific burn care models, determining how these can be integrated into the Indian healthcare system.
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Affiliation(s)
- J Jagnoor
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street Newtown, Sydney, 2042, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia.
| | - C Lukaszyk
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street Newtown, Sydney, 2042, Australia
| | - A Christou
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street Newtown, Sydney, 2042, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - T Potokar
- Human and Health Sciences Central, Swansea University, Swansea, Wales, UK
| | - S Chamania
- Choithram Hospital and Research Centre, Indore, India
| | - R Ivers
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street Newtown, Sydney, 2042, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Southgate Institute, Flinders University, Adelaide, Australia
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16
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Jagnoor J, Bekker S, Chamania S, Potokar T, Ivers R. Identifying priority policy issues and health system research questions associated with recovery outcomes for burns survivors in India: a qualitative inquiry. BMJ Open 2018; 8:e020045. [PMID: 29523568 PMCID: PMC5855167 DOI: 10.1136/bmjopen-2017-020045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/06/2018] [Accepted: 02/07/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to identify priority policy issues and health system research questions associated with recovery outcomes for burns survivors in India. DESIGN Qualitative inquiry; data were collected through semistructured in-depth interviews and focus group discussions. SETTING Nine sites in urban and rural settings across India, through primary, secondary and tertiary health facilities. PARTICIPANTS Healthcare providers, key informants, burns survivors and/or their carers. RESULTS Participants acknowledged the challenges of burns care and recovery, and identified the need for prolonged rehabilitation. Challenges identified included poor communication between healthcare providers and survivors, limited rehabilitation services, difficulties with transportation to health facility and high cost associated with burns care. Burns survivors and healthcare providers identified the stigma attached with burns as the biggest challenge within the healthcare system, as well as in the community. Systems barriers (eg, limited infrastructure and human resources), lack of economic and social support, and poor understanding of recovery and rehabilitation were identified as major barriers to recovery. CONCLUSIONS Though further research is needed for addressing gaps in data, strengthening of health systems can enable providers to address issues such as developing/providing, protocols, capacity building, effective coordination between key organisations and referral networks.
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Affiliation(s)
- Jagnoor Jagnoor
- The George Institute for Global Health, New Delhi, India
- Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sheree Bekker
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia
| | - Shobha Chamania
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - Tom Potokar
- Centre for Global Burn Injury Policy & Research, Swansea University, Swansea, UK
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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17
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Burkle FM, Potokar T, Gosney JE, Dallas C. Justification for a Nuclear Global Health Workforce: multidisciplinary analysis of risk, survivability & preparedness, with emphasis on the triage management of thermal burns. Confl Health 2017; 11:13. [PMID: 28781608 PMCID: PMC5537978 DOI: 10.1186/s13031-017-0116-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/02/2017] [Indexed: 12/03/2022] Open
Abstract
Major challenges and crises in global health will not be solved by health alone; requiring rather a multidisciplinary, evidence-based analytical approach to prevention, preparedness and response. One such potential crisis is the continued spread of nuclear weapons to more nations concurrent with the increased volatility of international relations that has significantly escalated the risk of a major nuclear weapon exchange. This study argues for the development of a multidisciplinary global health response agenda based on the reality of the current political analysis of nuclear risk, research evidence suggesting higher-than-expected survivability risk, and the potential for improved health outcomes based on medical advances. To date, the medical consequences of such an exchange are not credibly addressed by any nation at this time, despite recent advances. While no one country could mount such a response, an international body of responders organized in the same fashion as the current World Health Organization’s global health workforce initiative for large-scale natural and public health emergencies could enlist and train for just such an emergency. A Nuclear Global Health Workforce is described for addressing the unprecedented medical and public health needs to be expected in the event of a nuclear conflict or catastrophic accident. The example of addressing mass casualty nuclear thermal burns outlines the potential triage and clinical response management of survivors enabled by this global approach.
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Affiliation(s)
- Frederick M Burkle
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA USA.,Woodrow Wilson International Center for Scholars, Washington, DC USA.,Harvard Humanitarian Initiative, c/o 452 Iana Street, Kailua, HI 96734 USA
| | - Tom Potokar
- Global Burn Injury Policy & Research, College of Human & Health Sciences, Consultant Burns Surgeon, Welsh Center for Burns & Plastic Surgery, Morriston Hospital, Swansea University, Swansea, Wales UK
| | | | - Cham Dallas
- Institute for Disaster Management, Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA USA.,Emergency Medicine, Department of Emergency Medicine, Medical College of Georgia, Georgia Regents University, Augusta, USA
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18
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Abstract
Modern burn care in a sophisticated well-resourced centre in a rich country
utilises an increasing number of expensive adjuncts to optimise outcomes such as
dermal templates, cultured keratinocytes, biological and silver impregnated
dressings. Translating the use of these into a low resource environment is not a
simple matter of providing the materials free of charge and there needs to be
careful consideration of both the positive and negative consequences and the
impact on both an individual and a population level.
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Affiliation(s)
- Tom Potokar
- College of Human & Health Sciences, University of Swansea, Consultant Plastic Surgeon, Welsh Centre for Burns & Plastic Surgery, Director Interburns (International Network for training, Education and Research in Burns), UK
| | - Pippa Anderson
- Head Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, UK
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Walters A, Lyons R, Turner S, Fry R, Potokar T. 417 Incidence and epidemiology of burns treated in the welsh centre for burns. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.417] [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: 11/03/2022]
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20
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Spolton-Dean CA, Lye G, Potokar T. Epidermal burn at a PEG site. BMJ 2015; 351:h5530. [PMID: 26481665 DOI: 10.1136/bmj.h5530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - George Lye
- Department of Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Tom Potokar
- Department of Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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21
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Ivers RQ, Hunter K, Clapham K, Coombes J, Fraser S, Lo S, Gabbe B, Hendrie D, Read D, Kimble R, Sparnon A, Stockton K, Simpson R, Quinn L, Towers K, Potokar T, Mackean T, Grant J, Lyons RA, Jones L, Eades S, Daniels J, Holland AJA. Understanding burn injuries in Aboriginal and Torres Strait Islander children: protocol for a prospective cohort study. BMJ Open 2015; 5:e009826. [PMID: 26463225 PMCID: PMC4606434 DOI: 10.1136/bmjopen-2015-009826] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Although Aboriginal and Torres Strait Islander children in Australia have higher risk of burns compared with non-Aboriginal children, their access to burn care, particularly postdischarge care, is poorly understood, including the impact of care on functional outcomes. The objective of this study is to describe the burden of burns, access to care and functional outcomes in Aboriginal and Torres Strait Islander children in Australia, and develop appropriate models of care. METHODS AND ANALYSIS All Aboriginal and Torres Strait Islander children aged under 16 years of age (and their families) presenting with a burn to a tertiary paediatric burn unit in 4 Australian States (New South Wales (NSW), Queensland, Northern Territory (NT), South Australia (SA)) will be invited to participate. Participants and carers will complete a baseline questionnaire; follow-ups will be completed at 3, 6, 12 and 24 months. Data collected will include sociodemographic information; out of pocket costs; functional outcome; and measures of pain, itch and scarring. Health-related quality of life will be measured using the PedsQL, and impact of injury using the family impact scale. Clinical data and treatment will also be recorded. Around 225 participants will be recruited allowing complete data on around 130 children. Qualitative data collected by in-depth interviews with families, healthcare providers and policymakers will explore the impact of burn injury and outcomes on family life, needs of patients and barriers to healthcare; interviews with families will be conducted by experienced Aboriginal research staff using Indigenous methodologies. Health systems mapping will describe the provision of care. ETHICS AND DISSEMINATION The study has been approved by ethics committees in NSW, SA, NT and Queensland. Study results will be distributed to community members by study newsletters, meetings and via the website; to policymakers and clinicians via policy fora, presentations and publication in peer-reviewed journals.
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Affiliation(s)
- Rebecca Q Ivers
- Injury Division, The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia School of Midwifery and Nursing, Flinders University, Adelaide, South Australia, Australia
| | - Kate Hunter
- Injury Division, The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia Poche Centre for Indigenous Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kathleen Clapham
- Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Julieann Coombes
- Injury Division, The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Fraser
- School of Midwifery and Nursing, Flinders University, Adelaide, South Australia, Australia
| | - Serigne Lo
- Injury Division, The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Delia Hendrie
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - David Read
- National Critical Care & Trauma Response Centre, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Roy Kimble
- Australian Centre for Children's Burns and Trauma Research, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Sparnon
- Paediatric Burn Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Kellie Stockton
- Australian Centre for Children's Burns and Trauma Research, University of Queensland, Brisbane, Queensland, Australia
| | - Renee Simpson
- National Critical Care & Trauma Response Centre, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Linda Quinn
- Paediatric Burn Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Kurt Towers
- Aboriginal Health, Northern and Central Adelaide Local Health Networks, Adelaide, South Australia, Australia
| | - Tom Potokar
- Department of Burns & Plastic Surgery, Welsh Centre for Burns & Plastic Surgery, Swansea, UK
| | - Tamara Mackean
- Poche Centre for Indigenous Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
| | - Julian Grant
- School of Midwifery and Nursing, Flinders University, Adelaide, South Australia, Australia
| | - Ronan A Lyons
- Farr Institute, Swansea University Medical School, Wales, UK
| | - Lindsey Jones
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Sandra Eades
- Department of Aboriginal Health, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - John Daniels
- Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrew J A Holland
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Abstract
INTRODUCTION The use of home exercise equipment is increasing and treadmills are becoming more popular. This has brought with it an emerging but preventable problem. We present our experience, highlight the importance and promote public awareness of this type of injury. To our knowledge this has not been reported previously in the UK. METHODS A retrospective review was conducted of the medical records at two regional burn units of children who sustained treadmill-related injuries between July 2003 and July 2009. Data on patient demographics, mechanism of injury, management, surgical intervention and outcome were recorded. RESULTS Twenty-nine children (15 boys, 14 girls) sustained treadmill-related injuries. The mean age was 3.8 years (range: 1-13 years). All injuries occurred at home and the majority of children trapped their hand under the running belt when an adult was using the machine. Most of the injuries were to the upper limb (97%) with less than 1% of the total body surface area burnt. More than two-thirds of patients had deep burns and 17 (58%) required surgical intervention. Five patients developed hypertrophic scars. All patients achieved a good functional outcome. CONCLUSIONS Treadmills can pose a significant danger to children. These injuries are preventable. Regulatory authorities, manufacturers and parents should take steps to prevent this emerging health problem.
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Affiliation(s)
- P Lohana
- Birmingham Children's Hospital NHS Foundation Trust, UK.
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Abstract
This paper discusses the requirements for training in burn care within a resource limited environment, what is currently practiced and goes on to suggest a strategy for effective delivery of education and training.
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Affiliation(s)
- Tom Potokar
- Welsh Centre for Burns & Plastic Surgery and Swansea University School of Medicine, Swansea, Wales, UK
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Potokar T, Ali S, Bouali R, Walusimbi M, Chamania S. Training of medical and paramedical personnel in burn care and prevention. Indian J Plast Surg 2010. [DOI: 10.1055/s-0039-1699468] [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: 10/25/2022] Open
Abstract
ABSTRACTThis paper discusses the requirements for training in burn care within a resource limited environment, what is currently practiced and goes on to suggest a strategy for effective delivery of education and training.
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Affiliation(s)
- Tom Potokar
- Welsh Centre for Burns & Plastic Surgery and Swansea University School of Medicine, Swansea, Wales, UK
| | - Shariq Ali
- Princess Alexandra Hospital, Essex, UK, and Primary Trauma Care and Burns Centre, Dow University of Health Sciences, Karachi, Pakistan
| | - Redouane Bouali
- Division Chair Critical Care, University of Ottawa, Canada, and Ministry of Health and Long Term Care, Ontario, Canada and Canadian Patient Safety Institute, Uganda
| | - Monica Walusimbi
- Burns & Plastic Surgery Unit, Mulago National Referral Hospital, Uganda
| | - Shobha Chamania
- Choithram Hospital & Research Center and Burn Care Foundation, Indore, Madhya Pradesh, India
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Maguire S, Moynihan S, Mann M, Potokar T, Kemp A. A systematic review of the features that indicate intentional scalds in children. Burns 2008; 34:1072-81. [DOI: 10.1016/j.burns.2008.02.011] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 02/18/2008] [Indexed: 11/24/2022]
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26
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Wilson Jones N, Wong P, Potokar T. Electric hair straightener burns an epidemiological and thermodynamic study. Burns 2008; 34:521-4. [DOI: 10.1016/j.burns.2007.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2007] [Accepted: 07/16/2007] [Indexed: 10/22/2022]
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27
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Affiliation(s)
- D.Q.A. Nguyen
- Department of Burns and Plastic Surgery, Morriston Hospital, Swansea, Wales, UK
| | - T. Potokar
- Department of Burns and Plastic Surgery, Morriston Hospital, Swansea, Wales, UK
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28
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Abstract
This is a retrospective study of the epidemiology and management of isolated foot burns presenting to the Welsh Centre for Burns from January 1998 to December 2002. A total of 289 were treated of which 233 were included in this study. Approximately 40% were in the paediatric age group and the gender distribution varied dramatically for adults and children. In the adult group the male:female ratio was 3.5:1, however in the paediatric group the male:female ratio was more equal (1.6:1). Scald burns (65%) formed the largest group in children and scald (35%) and chemical burns (32%) in adults. Foot burns have a complication rate of 18% and prolonged hospital stay. Complications include hypertrophic scarring, graft loss/delayed healing and wound infection. Although isolated foot burns represent a small body surface area, over half require treatment as in patients to allow for initial aggressive conservative management of elevation and regular wound cleansing to avoid complications. This study suggests a protocol for the initial acute management of foot burns. This protocol states immediate referral of all foot burns to a burn centre, admission of these burns for 24-48 h for elevation, regular wound cleansing with change of dressings and prophylactic antibiotics.
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Affiliation(s)
- S Hemington-Gorse
- The Welsh Regional Burns and Plastic Surgical Unit, Morriston Hospital, Swansea, South Wales SA6 6NL, United Kingdom.
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29
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Abstract
OBJECTIVE To investigate the accuracy of assessment of burn surface area and depth using a basic camera-equipped mobile phone. METHODS 31 patients with minor burns were assessed at the Welsh Centre for Burns & Plastic Surgery. RESULTS A high correlation was found between assessment of burn surface area and burn depth using a camera mobile phone compared with a live assessment. CONCLUSION There are a number of implications for the use of mobile phone technology in hospitals and its potential use in the management of major in addition to minor burns, as well as other forms of trauma. The untapped potential for this technology in a hospital environment is highlighted.
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30
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Potokar T, Shobha C, Shariq A. International network for training, education and research in burns. Indian J Plast Surg 2007. [DOI: 10.1055/s-0039-1699184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- T. Potokar
- Welsh Centre for Burns and Plastic Surgery, Swansea,Wales, UK,
| | | | - Ali Shariq
- Burns Centre Civil Hospital and Dow University of Health Sciences, Karachi, Pakistan
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31
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32
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33
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Dodd JK, Jones PM, Chinn DJ, Potokar T, Laing H. Neonatal accessory digits: a survey of practice amongst paediatricians and hand surgeons in the United Kingdom. Acta Paediatr 2004; 93:200-4. [PMID: 15046274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
AIM To describe the management of neonatal accessory digits, comparing views of paediatricians with those of hand surgeons, giving particular emphasis to the form of partial, ulnar duplication of the little finger (ulnar or postaxial polydactyly type B) which has a narrow pedicle. METHODS Postal questionnaire of management preference using three photographs of ulnar accessory digits of varying complexity. RESULTS The response rate was 64% in 234 paediatricians and 25% in 260 surgeons. All respondents would intervene in cases of ulnar polydactyly type B with a narrow pedicle: 79% of paediatricians but only 67% of hand surgeons would recommend referral of these cases for specialist assessment, the remainder advocating ligation by the paediatrician in the nursery. Paediatricians and neonatologists working in regional centres or with an on-site specialist service were more likely to refer. There was almost unanimous agreement on the management of the most complex case, but no general consensus on that of the simplest form. CONCLUSION There is uncertainty and inequality in initial treatment decisions for infants with all but the most complex of accessory digits. Despite published evidence that ligation gives satisfactory results, most respondents in this survey advocate specialist referral, with evidence that the availability of specialist services influences decision making.
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Affiliation(s)
- J K Dodd
- Department of Paediatrics, Bishop Auckland General Hospital, Bishop Auckland Co, Durham, UK
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34
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Affiliation(s)
- T Potokar
- Welsh Regional Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, Wales 5A6 6NL, UK.
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35
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Abstract
This double-blinded randomised clinical trial investigated whether application of ADCON-T/N to zone II tendon repairs improved their outcome. Fifty-nine patients were randomised into control or ADCON-T/N treated groups and all followed an early mobilisation regime following tendon repair. Tendon rupture rates were comparable between the control and ADCON-T/N treated patients. At six months follow-up, the ADCON-T/N treated group had better proximal interphalangeal motion.
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Affiliation(s)
- S H Liew
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom.
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36
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Abstract
This is a retrospective study of the epidemiology and management of isolated buttock burns presenting to the Welsh Regional Burns Centre from January 1996 to December 1999. A total of 36 cases have been treated of which 31 are included in this study. Approximately, 50% are in the paediatric age group and the sex distribution is equal for both adults and children. Contact burns form the largest group, and in children resulted in superficial burns requiring dressings only. The adult population is more likely to sustain deeper burns that require skin grafting, and approximately 50% will have a contributing premorbid condition. Despite difficulties in dressing and positioning of the patients, grafting of full thickness burns is appropriate without recourse to faecal diversion.
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Affiliation(s)
- T Potokar
- The Welsh Regional Burns Centre, Morriston Hospital, Wales SA6 6NL, Swansea, UK
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37
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Oliver DW, Potokar T, Lamberty BG. Experience of methicillin-resistant Staphylococcus aureus in a plastic surgery unit. Br J Plast Surg 1999; 52:509-10. [PMID: 10673934 DOI: 10.1054/bjps.1999.3152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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38
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Degiannis E, Levy RD, Velmahos GC, Potokar T, Florizoone MG, Saadia R. Gunshot injuries of the head of the pancreas: conservative approach. World J Surg 1996; 20:68-71; discussion 72. [PMID: 8588416 DOI: 10.1007/s002689900012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [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: 01/31/2023]
Abstract
This study is comprised of 48 patients with gunshot injuries of the head of the pancreas, many of which were high velocity injuries. The purpose of this study was to evaluate our management policy for these injuries based on our recent wide experience. Patients with grade II and III injuries underwent conservative surgery, with 0% and 21% postoperative mortality, respectively, directly related to the pancreatic injury. For patients in whom the duodenum was involved, pyloric exclusion was applied depending on the grade of the duodenal injury. We concluded that moderate gunshot injuries of the head of the pancreas (grade II) can be safely treated by débridement and suture repair, with or without drainage. Severe (grade IV) injuries warrant a pancreaticoduodenectomy. Most grade III injuries can be treated by débridement and drainage unless an associated severe duodenal injury is present, in which case resection may be indicated.
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Affiliation(s)
- E Degiannis
- Department of Surgery, Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
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39
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Abstract
A study was made of 45 patients with diaphragmatic herniation after penetrating trauma. In 29 the diagnosis was established during the first admission (early presentation) and in 16 during a subsequent admission (delayed presentation). The mortality rate in the early presentation group was 3 per cent compared with 25 per cent in the delayed presentation group. The presence of gangrenous or perforated abdominal viscus in the chest cavity was the single most common and severe aggravating factor. The need for diagnosis of diaphragmatic herniation during the initial admission is emphasized. As isolated diaphragmatic injuries provide few helpful clinical features to aid diagnosis, appropriate investigations and good follow-up are of paramount importance in preventing late herniation of intra-abdominal viscera through a penetrating diaphragmatic injury.
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MESH Headings
- Adult
- Female
- Hernia, Diaphragmatic, Traumatic/etiology
- Hernia, Diaphragmatic, Traumatic/mortality
- Hernia, Diaphragmatic, Traumatic/surgery
- Humans
- Male
- Middle Aged
- Postoperative Complications
- Retrospective Studies
- Wounds, Gunshot/complications
- Wounds, Gunshot/surgery
- Wounds, Stab/complications
- Wounds, Stab/surgery
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Affiliation(s)
- E Degiannis
- Department of Surgery, Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, South Africa
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Abstract
This study comprised 57 patients with gunshot injury of the distal pancreas. There were 16 grade II, 29 grade III and 12 grade IV pancreatic injuries. The intraoperative mortality rate was 12 per cent. Patients with the most severe grade II injuries and all those with grade III and IV injuries had distal pancreatectomy and splenectomy, with a 14 per cent fistula formation rate and 2.3 per cent postoperative mortality rate directly related to the pancreatic injury. The remaining patients with grade II injuries were managed by debridement and drainage; there were no fistulas or deaths. The method of closure of the pancreatic resection margin is unrelated to fistula formation, and identification of the duct for ligation is unnecessary. Liberal use of distal pancreatectomy with splenectomy for gunshot injuries of the distal pancreas is suggested.
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Affiliation(s)
- E Degiannis
- Department of Surgery, Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, South Africa
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41
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Abstract
This is a retrospective study of 32 patients with penetrating injury of the axillary artery. There was an overall mortality of 6% entirely accounted for by associated injuries. Pre-operative angiography was used in 12 of these patients either to confirm the presence of an injury or to define its location. Twelve patients underwent lateral arteriorrhaphy or an end-to-end anastomosis and 19 patients had an interposition graft. No immediate problems were experienced with polytetrafluoroethylene grafts compared with autogenous vein grafts. There were 14 patients with a concomitant venous injury; 13 were repaired and only transient arm oedema was experienced. Eleven patients had a brachial plexus injury and, of these, nine underwent a secondary nerve repair with a poor outcome. Axillary artery injury has a good prognosis with a morbidity related mainly to associated nerve injury and a mortality accounted for by injuries to other body systems.
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Affiliation(s)
- E Degiannis
- Department of Surgery, Baragwanath Hospital, University of Witwatersrand Medical School, Johannesburg, Republic of South Africa
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42
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Abstract
This is a retrospective study of 72 patients with non-iatrogenic penetrating injuries of the brachial artery treated between 1991 and 1993. The mechanism of injury was stabbing in 39 per cent, a bullet in 51 per cent, pellets in 4 per cent and a dog bite in 6 per cent. We believe that angiography is rarely indicated, as in all our patients the diagnosis was made on clinical grounds. The proximity of the injury to neurovascular bundles was a poor predictor of arterial injury. One month after discharge 95 per cent of the patients had palpable distal pulses. Long-term morbidity is mainly attributed to associated nerve injuries.
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Affiliation(s)
- E Degiannis
- Department of Surgery, Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
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43
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Abstract
This is a retrospective study of 106 patients with penetrating injuries to the femoral artery. The cause of injury was gunshot in 82 per cent, stabbing in 13 per cent and pellets in 5 per cent. We believe that angiography is unnecessary in patients with 'hard' signs of vascular injury: 97 patients underwent immediate exploration with positive findings. The presence of 'soft' signs alone mandates angiography as five of 12 patients with suspected injury were saved a negative exploration. Proximity of injury was a poor predictor of arterial injury. There were four amputations. Ligation of the femoral vein is not reliably associated with amputation but it was an aggravating factor in the setting of severe arterial disruption and delay to surgery.
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Affiliation(s)
- E Degiannis
- Department of Surgery, Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, South Africa
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44
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Music E, Kumelj M, Prlja D, Paulin A, Potokar T. [Comparison of amoxicillin and amoxiclav in the therapy of respiratory infections]. Plucne Bolesti 1989; 41:187-92. [PMID: 2636405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Randomly hospitalized patients with respiratory tract infections admitted to three pulmonary departments of the Golnik Institute for Pulmonary Diseases and Tuberculosis were enrolled in an open, comparative clinical study of Amoksiklav and Amoxicillin. A group of 26 patients with a mean age of 64.5 years presenting with pneumonia (13), exacerbation of chronic bronchitis (12) and bronchiectasis (1) were given Amoskilav, while another 20 patients with a mean age of 61.4 years presenting with pneumonia (9), exacerbation of chronic bronchitis (5), bronchiectasis (5) and sinusitis (1) received Amoxicillin. The efficacy of treatment was assessed by bacteriological findings of respiratory tract specimens, sputum and blood leucocytosis, macroscopic purulence of sputum and the presence of fever. The bacteriological findings are shown in detail. Leucocytosis and macroscopic purulence of sputum significantly improved on Amoksiklav therapy (p less than 0.05) while with Amoxicillin there was no significant improvement. With respect to the presence of fever, there was no significant difference between Amoksiklav and Amoxicillin. The overall clinical and bacteriological response was very good and good in 88.5% of patients treated with Amoksiklav compared to 75% of those receiving Amoxicillin. Additionally, 1000 pathogenic strains were tested for their response to Amoksiklav and Amoxicillin. Amoksiklav proved superior against strains of Branhamella catarrhalis, E. coli, coagulase-negative staphylococci and K. pneumoniae (p less than 0.01).
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45
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Music E, Potokar T, Rosandić-Pilas M. [Experience on the therapy of diffuse pulmonary fibroses with D-penicillamin)]. Plucne Bolesti Tuberk 1978; 30:170-6. [PMID: 674433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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46
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Furlan-Hrabar J, Stangl B, Fortic M, Potokar T, Prlja D. [Bronchial hyperreactivity in patients with bronchial asthma (author's transl)]. Plucne Bolesti Tuberk 1978; 30:9-18. [PMID: 209489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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47
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Kovacic M, Potokar T. [Value of biochemical tests in the diagnosis of sarcoidosis]. Plucne Bolesti Tuberk 1973; 25:95-8. [PMID: 4794818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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48
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Potokar T. [Paraneoplastic syndromes during bronchopulmonary carcinoma (comprehensive review)]. Plucne Bolesti Tuberk 1972; 24:244-9. [PMID: 4571641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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