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| 2. |
- Chaghazardi, S, et al.
(author)
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Comparing the Effect of Gabapentin, Ketamine, Dexmedetomidine, and Entonox on Pain Control in Burn Wound Dressing
- 2020
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In: Journal of burn care & research : official publication of the American Burn Association. - : Oxford University Press (OUP). - 1559-0488. ; 41:1, s. 151-158
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Journal article (peer-reviewed)abstract
- This study aimed to evaluate differences in the experience of pain, nausea, and vomiting, as well as the hemodynamic parameters including heart rate (HR) and blood pressure (BP) in burn patients across four pain treatment groups—i.e., gabapentin, ketamine, dexmedetomidine, and entonox. In a single blinded randomized comparative study, 25 burn patients with second- or third-degree burns between 20% and 50% of their body surface were assigned to different treatment groups by using block randomization, while keeping the investigator blind to the size of the block. We recorded demographics, the hemodynamics, adverse effects, and pain levels before the treatment and again 5, 10, 15, 30, 60, 120, 240, and 360 minutes postadministration of pain medication (after-treatment). Gabapentin ketamine, dexmedetomidine, and entonox had significant effects in treatment of pain in burn patients. Entonox had the best analgesic effect with the least adverse effects and hemodynamic changes. Gabapentin also had good pain management effects; however, it showed less desirable effects on hemodynamic variables. Entonox caused the least amount of hemodynamic changes and the least adverse reactions, but since the medication is delivered by a facemask it limited its application with our patients. Gabapentin offered good benefits but caused a gradual drop in BP and HR and had some unfavorable reactions. However, since it is administered orally and often is cheaper, it could be considered as the drug of choice.
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| 3. |
- Gauffin, Emelie, et al.
(author)
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Stability in personality after physical trauma
- 2021
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In: Journal of Burn Care & Research. - : Oxford University Press. - 1559-047X .- 1559-0488. ; 42:3, s. 415-419
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Journal article (peer-reviewed)abstract
- Personality trait stability may be influenced by several factors, there among different life events such as psychological trauma. However, little is known regarding trait stability after physical trauma. Therefore, our primary aim was to assess the extent of stability in personality in burn patients during the first year after injury. Eighty-four burn patients, admitted to a national burn center, were assessed with the Swedish universities Scales of Personality during acute care and 12 months postburn. Personality domain scores remained stable between acute care and 12 months postburn. On the trait level, the only change was seen in personality trait Stress Susceptibility, where burn patients’ scores were lower compared with norm scores during acute care but then increased, and normalized, at 12 months postburn. To conclude, personality scores remained relatively stable during the first year after burn trauma.
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| 4. |
- Gilljam, Karin M, et al.
(author)
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Alginate and nanocellulose dressings with extract from salmon roe reduce inflammation and accelerate healing of porcine burn wounds.
- 2023
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In: Journal of Burn Care & Research. - : Oxford University Press (OUP). - 1559-047X .- 1559-0488. ; 44:5, s. 1140-
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Journal article (peer-reviewed)abstract
- Partial thickness thermal burn wounds are characterized by prolonged inflammatory response, oxidative stress, tissue damage, and secondary necrosis. An optimal dressing for burn wounds would reduce inflammation and oxidative stress while providing a moist, absorbent, and protective cover. We have developed an extract from unfertilized salmon roe containing components with potential anti-inflammatory and antioxidative properties, called HTX. HTX has been combined with alginate from brown algae and nanocellulose from tunicates, and 3D printed into a solid hydrogel wound dressing called Collex. Here, Collex was tested on partial thickness burn wounds in Göttingen minipigs compared to Jelonet, and a variant of Collex without HTX. We found that dermal treatment of burn wounds with Collex resulted in accelerated healing at a majority of measured points over 23 days, compared to treatment with Jelonet. In comparison to Collex without HTX, Collex enhanced healing in the first week after trauma where wound progression was pronounced. Notably, Collex reduced the inflammatory response in the early post-injury phase. The anti-inflammatory response of Collex was investigated in more detail on activated M1 macrophages. We found that Collex, as well as HTX alone, significantly reduced secretion of pro-inflammatory interleukin-1β as well as intracellular levels of oxidative stress. The results from this study indicate that Collex is a potent dressing for treatment of burn wounds, with the anti-inflammatory effect of HTX beneficial in the initial phase, and the moist qualities of the hydrogel favorable both in the initial and the proceeding proliferative phase of wound healing.
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| 5. |
- Graner, Mariana, et al.
(author)
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Who Gets Burned in Brazil?
- 2023
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In: Journal of Burn Care & Research. - : OXFORD UNIV PRESS. - 1559-047X .- 1559-0488.
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Journal article (peer-reviewed)abstract
- Burns are preventable injuries that still represent a relevant public health issue. The identification of risk factors might contribute to the development of specific preventive strategies. Data of patients admitted at the Hospital due to acute burn injuries from May 2017 to December 2019, was extracted manually from medical records. The population was analyzed descriptively, and differences between groups were tested using the appropriate statistical test. The study population consisted of 370 patients with burns admitted to the Hospital burn unit during the study period. The majority of the patients were males (257/370, 70%), median age was 33 (IQR:18-43), median TBSA% was 13 (IQR 6.35-21.5 and range 0-87.5%), and 54% of patients had full-thickness burns (n = 179). Children younger than 13 years old represented 17% of the study population (n = 63), 60% of them were boys (n = 38), and scalds was the predominant mechanism of burn injury (n = 45). No children died, however 10% of adults did (n = 31). Self-inflicted burns were observed in 16 adults (5%), of whom 6 (38%) died during admission, however self-inflicted burns were not observed in children. Psychiatric disorders and substance misuse were frequent in this subgroup. White adults male from urban areas who had not completed primary school degree were the major risk group for burns. Smoking and alcohol misuse were the most frequent comorbidities. Accidental domestic flame burns were the predominant injuries in the adult population and scalds in the pediatric.
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| 6. |
- Gus, Eduardo, et al.
(author)
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Burn unit design - the missing link for quality and safety.
- 2021
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In: Journal of Burn Care & Research. - : Oxford University Press. - 1559-047X .- 1559-0488. ; 42:3, s. 369-375
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Research review (peer-reviewed)abstract
- The relationship between infrastructure, technology, model of care and human resources influences patient outcomes and safety, staff productivity and satisfaction, retention of personnel, and treatment and social costs. This concept underpins the need for evidence-based design, and has been widely adopted to inform hospital infrastructure planning. The aim of this review is to establish evidence-based, universally-applicable key features of a burn unit that support function in a comprehensive patient-centred model of care. A literature search in medical, architectural and engineering databases was conducted. Burn associations' guidelines and relevant articles published in English, between 1990 and 2020, were included, and the available evidence is summarized in the review. Few studies have been published on burn unit design in the last thirty years. Most of them focus on the role of design in infection control and prevention, and consist primarily of descriptive or observational reports, opportunistic historical cohort studies, and reviews. The evidence available in the literature is not sufficient to create a definitive infrastructure guideline to inform burn unit design, and there are considerable difficulties in creating evidence that will be widely applicable. In the absence of a strong evidence base, consensus guidelines on burn unit infrastructure should be developed, to help healthcare providers, architects and engineers make informed decisions, when designing new or renovated facilities.
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| 7. |
- Holm, Sebastian, 1993-, et al.
(author)
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Is the pre-operative wound culture necessary before skin grafting minor burns? A pilot study in a low resource setting burn service
- 2024
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In: Journal of Burn Care & Research. - : Oxford University Press. - 1559-047X .- 1559-0488.
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Journal article (peer-reviewed)abstract
- The most common cited cause of split-thickness skin graft failure is infection and due to the association between bacterial findings in wound beds an attempt to decrease the bacterial burden before skin-grafting evolved. Thus, pre-operative microbiology swabs of the wound bed became routine at some institutions prior to grafting. This is not standard practice in the Pietermaritzburg burn service. Emphasis is instead placed on a strict protocol of intra-operative wound bed preparation to promote adequate graft take. This pilot study aims to evaluate whether pre-operative wound swabs are appropriate. We performed a prospective observational study to determine if positive wound cultures were associated with graft failure. All patients with a burn surface area of less than 10 %, where delayed grafting (later than 28 days from time of burn injury) was performed, from March to December 2021 were analyzed. Patient demographics, days from burn to graft, %TBSA burn, %TBSA grafted, whether sharp debridement prior to grafting in the same procedure was performed or not, use of topical gentamicin intra-operatively, graft outcome (% graft loss), need for regraft, and organism grown were recorded into an excel spread sheet for analysis. The sample included 52 patients. Of these, 17 (31.5%) were female. The median %TBSA grafted was 8% (IQR 4-13%) and similar in both groups. The median days from burn to grafting was 35 days. Thirty-nine patients (75%) had graft Take and 13 (25%) had graft Failure. In the failed group, median % graft failure was 50% (30 - 70%). Of the group with successful graft take, 90% were noted to have had a positive wound culture prior to grafting. A positive wound culture was not found to be a risk factor for graft failure (p=0.993). Despite the positive wound cultures graft take was more than 90 % in 75% of grafts performed and only 2/52 patients required supplementary grafting. We believe that this demonstrates that our local protocol is reasonable in this setting and that waiting for negative wound swabs prior to grafting should not be a reason to delay grafting.
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| 8. |
- Miranda, Elizabeth, et al.
(author)
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Recording Patient Data in Burn Unit Logbooks in Rwanda : Who and What Are We Missing?
- 2021
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In: Journal of Burn Care & Research. - : Oxford University Press. - 1559-047X .- 1559-0488. ; 42:3, s. 526-532
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Journal article (peer-reviewed)abstract
- Systematic data collection in high-income countries has demonstrated a decreasing burn morbidity and mortality, whereas lack of data from low- and middle-income countries hinders a global overview of burn epidemiology. In low- and middle-income countries, dedicated burn registries are few. Instead, burn data are often recorded in logbooks or as one variable in trauma registries, where incomplete or inconsistently recorded information is a known challenge. The University Teaching Hospital of Kigali hosts the only dedicated burn unit in Rwanda and has collected data on patients admitted for acute burn care in logbooks since 2005. This study aimed to assess the data registered between January 2005 and December 2019, to evaluate the extent of missing data, and to identify possible factors associated with "missingness." All data were analyzed using descriptive statistics, Fishers exact test, and Wilcoxon Rank Sum test. In this study, 1093 acute burn patients were included and 64.2% of them had incomplete data. Data completeness improved significantly over time. The most commonly missing variables were whether the patient was referred from another facility and information regarding whether any surgical intervention was performed. Missing data on burn mechanism, burn degree, and surgical treatment were associated with in-hospital mortality. In conclusion, missing data is frequent for acute burn patients in Rwanda, although improvements have been seen over time. As Rwanda and other low- and middle-income countries strive to improve burn care, ensuring data completeness will be essential for the ability to accurately assess the quality of care, and hence improve it.
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| 9. |
- Murhula, Gauthier Bahizire, Sr, et al.
(author)
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Factors Associated With Outcomes After Burn Care : A Retrospective Study in Eastern Democratic Republic of Congo
- 2022
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In: Journal of Burn Care & Research. - : Oxford University Press. - 1559-047X .- 1559-0488. ; 43:1, s. 85-92
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Journal article (peer-reviewed)abstract
- In low-income countries, the incidence of burns is high and severe burns are frequently managed at peripheral facilities. Outcome after burn care is poorly studied although it might help identify risk-group and improve treatment strategies. This study aimed to study factors associated with in-hospital outcomes in a burn cohort in the Democratic Republic of Congo. In this retrospective study, we included burn patients admitted to the surgical department at the Hôpital Provincial Général de Référence de Bukavu between January 2013 and December 2018. Differences between groups were tested using χ 2 test or Fisher's exact tests or Wilcoxon rank sum test, as appropriate. Multivariate logistic regression was used to analyze the effect of patients and of burn characteristics on in-hospital mortality, prolongated length of stay (=LOS ≥ 25 days), and occurrence of complications. The study population consisted of 100 patients, mainly young males with the rural origin, moderate-sized but deep burns. Of them, 46 developed complications, 12 died. Median LOS was 25 days (IQR: 15–42). In-hospital death was independently associated with Total Burn Surface Area percentage “TBSA%” (OR = 3.96; 95% CI = 1.67–9.40) and Full-thickness Burns (FTB) (10.68; 1.34–84.74); prolongated LOS with FTB (3.35; 1.07–10.49), and complication with rural origin (5.84; 1.51–22.53), TBSA% (3.96; 1.67–9.40), FTB (4.08; 1.19–14.00), and burns on multiple sites (4.38; 1.38–13.86). In-hospital death was associated with TBSA% and FTB, prolongated LOS with FTB, and complications with burns characteristics and rural origin of the patients. Additional studies are necessary to investigate the effect of provided burn care on outcomes.
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| 10. |
- Pompermaier, Laura, 1975-, et al.
(author)
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Patient Reported Experiences at a Swedish National Burn Centre
- 2022
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In: Journal of Burn Care & Research. - : Oxford University Press. - 1559-047X .- 1559-0488. ; 43:1, s. 249-254
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Journal article (peer-reviewed)abstract
- Previous studies have shown that burn patients were satisfied with the received care. Satisfaction was not strongly associated to burns or to psycho-social characteristics, suggesting that other factors, related to burn care specific aspects, may be important. The aim of this study was to analyze the independent effect of provided workload on the general satisfaction in adult patients at a Swedish national Burn Centre. The study population (n = 122) included patients ≥18 years, treated at the Linköping Burn Centre between 2016 and 2017. Experienced burn care was evaluated with the PS-RESKA survey (score range: 0-4), and provided workload was scored with the Burn Scoring System (BSC). Groups were compared with χ 2 test, MW test, or Fisher´s exact test. Multivariable logistic regression analyzed the independent effect of BSC on the outcome High Satisfaction (= score ≥3 to the survey-question: "How would you score your global experience at the Burn Centre?"). In-patients (n = 60) had more often larger burns and required more workload than out-patients (median[IQR]: TBSA% = 6.3 [3-12.3] % vs. 0.7 [0.3-2] %, p < .001; BSC = 65 [25.5-135.5] vs. 6 [4-9], p < .001). Both groups were highly satisfied with the experienced care (mean score [SD] = 3.68 [0.57] vs. 3.41 [0.77], p = .03). Neither characteristics of the patients (age, sex), nor TBSA% nor provided workload (BSC) were independently associated with High Satisfaction. Regardless of burn severity, demographics and provided workload, adult patients with burns were highly satisfied with the experienced burn care. This finding suggested that the reason of the satisfaction was multifactorial.
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