Search

Trauma-informed care practices are associated with a culture of safety following traumatic experiences, including medical trauma. An interactive, web-based training package ('Responsive CARE') was developed for voluntary uptake by paediatric burns health professionals to increase staff knowledge about trauma-informed practice. This paper reports on a mixed methods process evaluation conducted alongside a preliminary effectiveness study of 'Responsive CARE'. The process evaluation was conducted using The Consolidated Framework for Implementation Research (CFIR) and a logic model, to examine feasibility of both the intervention and implementation strategy. Health practitioners (including senior managers) delivering care to children and caregivers attending an outpatient burns service were eligible to enrol in 'Responsive CARE'. Qualitative interview data and quantitative metadata were used to evaluate the implementation outcomes (adoption, acceptability, fidelity, feasibility and preliminary effectiveness). Children and caregivers attending an outpatient service for change of burn wound dressing or burn scar management during the 3-month control or 3-month intervention period were eligible to enrol in the effectiveness study. The impact on child pain and distress, as well as cost, was investigated using a pretest-posttest design. Thirteen (from anticipated 50 enrolled) health professionals (all female) with mean 10 years (SD=11) of experience with paediatric burns hospital-based outpatient care completed an average of 65% (range 36% to 88%) of available content. Twenty-five semi-structured interviews were completed with health practitioners (21 female) and with 14 caregivers (11 female). Four themes were identified as influencing feasibility and acceptability of the intervention: 1) Keeping a trauma-informed lens; 2) Ways of incorporating trauma-informed care; 3) Working within system constraints; and 4) Being trauma-informed. Preliminary effectiveness data included 177 participants (median age 2 years, and median total body surface area burn 1%). Causal assumptions within the logic model were unable to be fully tested, secondary to lower-than-expected adoption and fidelity. We found no significant difference for pain, distress and per-patient hospital care costs between groups (pre- and post-intervention). Future implementation strategies should include organizational support to keep a trauma-informed lens and to incorporate trauma-informed principles within a medical model of care. Despite efforts to co-design a staff education intervention and implementation approach focused on stakeholder engagement, adaptations are indicated to both the intervention and implementation strategies to promote uptake highlighting the complexity of changing clinician behaviours. ● The Consolidated Framework for Implementation Research was a good fit for study purpose. ● Strategies targeting stakeholder engagement were insufficient for optimal uptake. ● Assessing readiness and capacity for change may be central to successful implementation. [ABSTRACT FROM AUTHOR]

Multiplatform messaging applications also referred to as cross-platform instant messaging play an important role in delivery of healthcare and education with its low cost, ease of use and accessibility. To evaluate the existing evidence regarding the use of multiplatform messaging applications in facilitating consultations and decision-making processes in the context of burns care, as well as to assess the impact of such applications on burns care and rehabilitation. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and PROSPERO protocol CRD42021265203. The CASP and JBI tools were used to evaluate the quality of the studies. Eight hundred fifty-three papers were retrieved from PubMed, CINAHL, Scopus, EMBASE and LILACS published up to July 2022 (updated August 2023) with no time restrictions applied. An analysis of the seven studies included in this review, inclusive of 16 Multiplatform messaging applications, revealed six themes. These encompassed the utilization of social media for directing and managing clinical practice, as a mode of communication, for evaluating the quality-of-care provision, for investigating available platforms and their technological features, measuring quality of life and for examining issues related to confidentiality. Multiplatform messaging applications offer a solution for individuals with burn injuries to stay in direct contact with burn specialist clinicians for their follow-up and subsequent rehabilitation phase of recovery. • Multiplatform messaging applications play an important role in burn care. • Such platforms avoid unnecessary admissions and are easily accessible and cost- effective. • Multiplatform messaging apps allow burn survivors and caregivers to maintain direct communication with clinicians. • Multiplatform messaging applications lack transparency regarding confidentiality and privacy. [ABSTRACT FROM AUTHOR]

Evidence on the impact of virtual care for patients with burn injuries is variable. This review aims to evaluate its use in remote assessment, rounding, and follow-up through outcomes of efficacy, usability, costs, satisfaction, clinical outcomes, impacts on triage and other benefits/drawbacks. A PRISMA-compliant qualitative systematic review (PROSPERO CRD42021267787) was conducted in four databases and the grey literature for primary research published between 01/01/2010 and 12/31/2020. Study quality was appraised using three established tools. Evidence was graded by the Oxford classification. The search provided 481 studies, of which 37 were included. Most studies (n = 30, 81%) were Oxford Level 4 (low-level descriptive/observational) designs and had low appraised risk-of-bias (n = 20, 54%). Most applications were for the acute phase (n = 26, 70%). High patient compliance, enhanced specialist access, and new educational/networking opportunities were beneficial. Concerns pertained to IT/connection, virtual communication barriers, privacy/data-security and logistical/language considerations. Low-to-moderate-level (Oxford Grade C) evidence supported virtual burn care's cost-effectiveness, ability to improve patient assessment and triage, and efficiency/effectiveness for remote routine follow-up. We find growing evidence that virtual burn care has a place in acute-phase specialist assistance and routine outpatient follow-up. Low-to-moderate-level evidence supports its effectiveness, cost-effectiveness, usability, satisfactoriness, and capacity to improve triage. • Virtual care may improve assessment and triage of patients with burn injuries. • Routine follow-up via virtual care may save cost/travel without hindering outcomes. • Comparative evidence lacking, unclear superiority among programs and vs. in-person. • Only 4 randomized controlled trials in 37 identified papers, study quality varied. [ABSTRACT FROM AUTHOR]

Appropriate and timely first aid reduces morbidity in burns. This study aims to assess the knowledge of first aid in burns among healthcare workers (HCW) and nonhealthcare workers. (NHCW). A survey, distributed in both paper and Google survey formats, presented five sample cases with multiple-choice answers. Participants recorded the most suitable first aid management for each scenario. Correct answers were provided on completion. Out of the total 753 participants, only 89 (11.8%) got all five answers correct. 16% HCW and 6% NHCW could answer all 5 questions correctly (with a true HCW:NHCW ratio of 2.67:1). Providing care for individuals with burns substantially raised the probability of giving accurate responses (p = 0.0001). While attending the general First Aid Course did not affect the responses (p = 0.08), participation in the Burns First Aid Course demonstrated slightly improved results (p = 0.052). The scenario involving liquid petroleum gas leakage saw a high proportion of correct responses, likely influenced by media coverage. We find a clear need for adequate training in burns first aid due to low awareness among healthcare workers (HCW) and non-healthcare workers (NHCW). Factors such as participation in burn first aid courses and gaining firsthand experience in treating burns were found to be linked to improved knowledge of burns prevention and first aid. Utilizing various media channels could be a valuable strategy to reach a broader audience, especially in remote and inaccessible areas. • There is limited awareness of burns first aid and prevention among both healthcare and non-healthcare workers • Experience in treatment of burn injuries improves knowledge of burns first aid better than first aid training. • Efficient use of multimedia and technology enhances burns prevention and first aid knowledge, reaching remote areas. [ABSTRACT FROM AUTHOR]

Electrical burns (EI) differ from other burn injuries in the immediate treatment given and delayed sequelae they manifest. This paper reviews our burn center's experience with electrical injuries. All patients with electrical injuries admitted from January 2002 to August 2019 were included. Demographics; admission, injury, and treatment data; complications, including infection, graft loss, and neurologic injury; pertinent imaging, neurology consultation, neuropsychiatric testing; and mortality were collected. Subjects were divided into those who were exposed to high (>1000 volts), low (<1000 volts), and unknown voltage. The groups were compared. P < 0.05 was considered significant. One hundred sixty-two patients with electrical injuries were included. Fifty-five suffered low voltage, 55 high voltage, and 52 unknown voltage injuries. High voltage injuries were more likely to be male (98.2% vs. 83.6% low voltage vs. 94.2% unknown voltage, p = 0.015), to experience loss of consciousness (69.1% vs. 23.6% vs. 33.3%, p < 0.001), cardiac arrest (20% vs. 3.6% vs. 13.4%, p = 0.032), and undergo amputation (23.6% vs. 5.5% vs. 8.2%, p = 0.024). No significant differences were observed in long-term neurological deficits. Twenty-seven patients (16.7%) were found to have neurological deficits on or after admission; 48.2% recovered, 33.3% persisted, 7.4% died, and 11.1% did not follow-up with our burn center. Electrical injuries are associated with protean sequelae. Immediate complications include cardiac, renal, and deep burns. Neurologic complications, while uncommon, can occur immediately or are delayed. • Retrospective review of electrical burn injuries. • Subjects suffering high-voltage electrical injuries had higher rates of amputation. • Immediate complications included cardiac, renal, and deep burns. • Neurologic complications, while uncommon, occurred either immediately or later on. [ABSTRACT FROM AUTHOR]

Background: Much of the recent literature on bromelain based enzymatic debridement of burn injury has focused on its use in smaller burn injury and specialist areas such as the hands or genitals (Krieger et al., 2012; Schulz et al., 2017a,b,c,d). This is despite the original papers describing its use in larger burn injury (Rosenberg et al., 2004, 2014). The current EMA license for Nexobrid™ advises that it should not be used for burn injuries of more than 15% TBSA and should be used with caution in patients with pulmonary burn trauma and suspected pulmonary burn trauma. The original safety and efficacy trial of NexoBrid™ limited its use to 15% TBSA aliquots with concern regarding the effect of bromelain on coagulation. In a European consensus paper of experienced burns clinicians, now on its second iteration, 100% of respondents agreed that "up to 30% BSA can be treated by enzymatic debridement based on individual decision" (Hirche et al., 2017). Hofmaenner et al.'s recent study on the safety of enzymatic debridement in extensive burns larger than 15% provides some further evidence that "bromelain based enzymatic debridement can be carried out safely in large-area burns" (Hofmaenner et al., 2020) but the literature is scant in these larger debridement areas. In our centre we have been using enzymatic debridement for resuscitation level burn injury since 2016. We have gained significant learning in this time; this article aims to describe our current protocol for enzymatic debridement in this patient population and highlight specific learning points that might aid other centres in using enzymatic debridement for larger burn injury.Method: We performed a search of the IBID database to identify all adult patients who satisfied the inclusion criteria of resuscitation level burn injury (defined as total burn surface area (TBSA) ≥15% in patients aged >16 years), or level 3 admission following burn injury and who underwent Enzymatic Debridement. A case note review was completed, and details comprising patient demographics, TBSA, mechanism of burn, presence of inhalation injury, sequencing of debridement, length of ICU and hospital stay, blood product utilisation and the need for autografting were recorded. No ethical approval has been sought for this retrospective review.Results: We identified 29 patients satisfying the inclusion criteria (Table 1). Between June 2016 and June 2020 the average total burn size of patients who had at least some of their burn treated by enzymatic debridement increased from 21.4% in 2016/17 to 34.7% in 2019/20. In these patients the actual area treated by enzymatic debridement also increased from 11.9% TBSA to 20.3% TBSA. 19 patients (66%) had enzymatic debridement performed within 24 h of injury, a further 2 patients (7%) within 48 h after injury. Patients were more likely to have enzymatic debridement commenced in the first 24 h after injury if they had circumferential limb injury (39% vs 9%) or were planned for enzyme only debridement (78% vs 28%). Those who were planned for combination enzyme and surgical debridement were more likely to have enzymatic debridement commenced after the first 48 h (75%). We have performed enzymatic debridement overnight on one occasion, for a patient who presented with circumferential limb injury and was determined to undergo urgent debridement.Conclusion: Much of the literature has described the use of enzymatic debridement in smaller burns, and specialist areas. However, it is our opinion that the advantages of enzymatic debridement appear to be greater in larger burns with a facility for whole burn excision on the day of admission in the ICU cubicle. We have demonstrated significantly reduced blood loss, improved dermal preservation, reduced need for autografting, and a reduction in the number of trips to theatre. We would advocate that both the team and the patient need to be as prepared as they would be for a traditional surgical excision. The early part of our learning curve for enzymatic debridement in resuscitation level injuries was steep, and we were able to build on experience from managing smaller injuries. We recommend any team wishing to using enzymatic debridement gain experience in the same way and develop robust local pathways prior to attempting use in larger burn injuries. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Burns are thermal injuries that may have a wide variety of clinical consequences from simple injuries to mortality. There are many aspects that must be medicolegally addressed in both non-survivors and survivors from burn injuries. The objective of this study was to determine sociodemographic characteristics, injury patterns, treatment requirements and prognoses of patients with burn injuries to evaluate the findings of neglect-abuse and forensic reporting processes. This study also aimed to contribute to the medicolegal classification criteria in respect of the factors that have an effect on the prognosis in the analyses.Material and Method: The study was conducted by retrospective review of digital files and paper records of patients who received therapy in the Burns Unit of KTU Farabi Hospital between 1st January, 2013, and 31st December, 2017.Results: Evaluation was made of a total of 1225 patients, comprising 769 (62.8%) males and 456 (37.2%) females, with a mean age of 21.8 ± 23.8 years (range, 1-89 years). The mean burnt body surface area was 14.29 ± 13.74. A trauma-related psychiatric disorder was diagnosed in 60 (4.9%) patients during treatment. When the medical history and physical examination findings were evaluated together, burn injuries suggested physical abuse in 54 patients (4.4%). The doctors who evaluated the patients with burn injuries in the emergency room and those who applied treatment in the Burns Unit made a forensic notification for 379 (30.9%) patients. The mean age of non-survivors was significantly higher than that of patients who survived to discharge (56.54 ± 28.60 years for non-survivors and 19.39 ± 23.12 years for survivors; p < 0.001).Conclusion: Burn injuries are frequently encountered, and they require precautionary measures. Burn injuries due to abuse are more frequently observed in the elderly and especially in children. Thus, the findings must be correctly interpreted, and more effort should be made to improve the knowledge of healthcare professionals about forensic reporting. Moreover, regulations should be implemented in respect of the medicolegal classification of trauma. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Burn care is centralized in highly specialized burn centers in Europe. These centers are of limited capacity and may be overwhelmed by a sudden surge in case of a burn mass casualty incident. Prior incidents in Europe and abroad have sustained high standards of care through well-orchestrated responses to share the burden of care in several burn centers. A burn mass casualty incident in Romania in 2015 sparked an initiative to strengthen the existing EU mechanisms. This paper aims to provide insight into developing a response plan for burn mass casualties within the EU Civil Protection Mechanism.Methods: The European Burns Association drafted medical guidelines for burn mass casualty incidents based on a literature review and an in-depth analysis of the Romanian incident. An online questionnaire surveyed European burn centers and EU States for burn mass casualty preparedness.Results: The Romanian burn mass casualty in 2015 highlighted the lack of a burn-specific mechanism, leading to the late onset of international transfers. In Europe, 71% of respondents had existing mass casualty response plans, though only 35% reported having a burn-specific plan. A burns response plan for burn mass casualties was developed and adopted as a Commission staff working document in preparation for further implementation. The plan builds on the existing Union Civil Protection Mechanism framework and the standards of the WHO Emergency Medical Teams initiative to provide 1) burn assessment teams for specialized in-hospital triage of patients, 2) specialized burn care across European burn centers, and 3) medevac capacities from participating states.Conclusion: The European burn mass casualty response plan could enable the delivery of high-level burn care in the face of an overwhelming incident in an affected European country. Further steps for integration and implementation of the plan within the Union Civil Protection Mechanism framework are needed. [ABSTRACT FROM AUTHOR]

Background: Only a few papers are published on the safety and effectiveness of acute burn care in low-income countries. A cohort study was therefore carried out to determine such outcomes.Methods: The study was conducted in a rural Tanzanian hospital in 2017-2018. All patients admitted with burns were eligible. Complications were scored during admission as an indication for safety. Survivors of severe burn injuries were evaluated for time of reepithelialization, graft take, disability (WHODAS2.0) and quality of life (EQ5D-3L) up to 3 months post-injury, as an indication of effectiveness.Results: Patients presented on average at 5 days after injury (SD 11, median 1, IQR 0-4). Three patients died at admission. The remaining 79 were included in the cohort. Their median age was 3 years (IQR 2-9, range 0.5-49), mean TBSA burned 12% (SD10%) and mortality rate 11.4%. No surgery-related mortality or life-threatening complications were observed. Skin grafting was performed on 29 patients at a delayed stage (median 23 days, IQR 15-47). Complications of skin grafts included partial (25% of procedures) and complete graft necrosis (8% of procedures). The mean time to reepithelialization was 52 (SD 42) days after admission. Disability and quality of life improved from admission to 3 months after injury (p<0.001, p<0.001, respectively).Conclusion: In this resource-limited setting patients presented after a delay and with multiple complications. The mortality during the first two weeks after admission was high. Surgery was found to be safe and effective. A significant improvement in disability and quality of life was observed. [ABSTRACT FROM AUTHOR]

The use of robust evidence is a key component of providing high quality care to patients. Synthesised evidence to support clinical decision-making is lacking for many aspects of clinical burn care. Identifying the most important areas of care that lack high quality evidence and requires research is necessary, as funding for primary research is limited. Priority setting research studies are a joint endeavour between patients, carers and clinicians to identify and rank topics for research in a healthcare area in order to reduce research waste. Such an exercise has yet to be undertaken in burns. The aim of this paper is to outline the importance of research prioritisation in burn care, to discuss how it facilitates the maximum benefit from limited research funding and to explain the methodologies used. [ABSTRACT FROM AUTHOR]

Background: Visual evaluation is the most common method of evaluating burn wounds. Its subjective nature can lead to inaccurate diagnoses and inappropriate burn center referrals. Machine learning may provide an objective solution. The objective of this study is to summarize the literature on ML in burn wound evaluation.Methods: A systematic review of articles published between January 2000 and January 2021 was performed using PubMed and MEDLINE (OVID). Articles reporting on ML or automation to evaluate burn wounds were included. Keywords included burns, machine/deep learning, artificial intelligence, burn classification technology, and mobile applications. Data were extracted on study design, method of data acquisition, machine learning techniques, and machine learning accuracy.Results: Thirty articles were included. Nine studies used machine learning and automation to estimate percent total body surface area (%TBSA) burned, 4 calculated fluid estimations, 19 estimated burn depth, 5 estimated need for surgery, and 2 evaluated scarring. Models calculating %TBSA burned demonstrated accuracies comparable to or better than paper methods. Burn depth classification models achieved accuracies of >83%.Conclusion: Machine learning provides an objective adjunct that may improve diagnostic accuracy in evaluating burn wound severity. Existing models remain in the early stages with future studies needed to assess their clinical feasibility. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The study aimed to determine the factors which influence clinician behaviour and adherence to best practice when clinicians provide the initial care for paediatric burn patients admitted to a burns unit.Background: Optimal initial care of burn patients influences morbidity and mortality. Non-burn specialist clinician adherence to best practice is influenced by previously unexplored factors.Design: General inductive qualitative methods were used to explore factors which influenced clinicians providing acute pre-admission burn care for children in Western Australia.Methods: Interviews of nineteen clinicians using standardised open-ended questions based on the Gilbert Behaviour Engineering Model were used to collect data.Results: The main influencing factors identified were the telehealth service which supported practice, whilst IT issues provided challenges to clinicians.Conclusion: Telehealth services support clinicians when providing burn care, however IT issues are an major barrier to both best practice and accessing the telehealth service and should be optimised to support clinical care IMPACT STATEMENT: What does this paper contribute to the wider global community? It provides burn clinicians with an insight into the factors which facilitate optimal care for patients prior to transfer to burn units, as well as the barriers faced by non-burn specialist clinicians when patients initially present for care. Models of care which acknowledge these factors can help facilitate optimal patient care. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic is sweeping the globe. Any outpatient or new inpatient especial in burn department during the pandemic should be as a potential infectious source of COVID-19. It is very important to manage the patients and wards carefully and correctly to prevent epidemic of the virus in burn centers. This paper provides some strategies regarding management of burn ward during the epidemic of COVID-19 or other respiratory infectious diseases. [ABSTRACT FROM AUTHOR]

Ocular burns are ophthalmological emergencies, owing to their potentially serious visual complications. Prompt recognition, irrigation and comprehensive examination including fluorescein staining is recommended to optimise outcomes. Burns standards recommend ophthalmological services be available in a 'timely' manner. This paper is a retrospective review of facial burn admissions between November 2017 and November 2018 at the Queen Elizabeth Hospital Birmingham (QEHB), a regional burns centre in the United Kingdom. This study aims to assess referral rates to ophthalmology, timeliness of review and the proportion of patients reviewed within a 24h window. From the data available we also aim to determine the frequency of fluorescein examination. Of 88 patients admitted with facial burns, data was available for 80 patients. The majority (n=77, 87.6%) suffered thermal burns. Twenty-two (27.5%) patients were referred to ophthalmology, and 18 (22.5%) had a documented review. Mean time from admission to review was 45.0h, with 10 (52.6%) patients being seen within 24h. Of 80 patients, 50 (62.5%) patients had no documented fluorescein examination. Further prospective studies are necessary to inform clinical guidelines and optimise management of facial burns. [ABSTRACT FROM AUTHOR]

Background: Good family functioning is important to improve outcomes for children who have sustained a burn injury. While knowledge regarding parental distress is increasing, less is known about parents' need for support during their child's hospitalisation.Aim: To systematically synthesise existing research focussing on the support needs of parents of children hospitalised with a burn injury.Methods: An integrative review was conducted using a literature search from multiple health-related databases. Original studies reporting on support for parents during their child's hospitalisation at a burn facility were included. A Ricoeur-inspired method was the framework used for the analysis.Results: Of the 468 identified papers, only seven studies met the inclusion criteria. In total, 521 parents and caregivers from six different countries were represented. Key findings related to the support needs of parents, including the need for information through all stages of treatment, support needs during emotional distress, feelings of guilt and blame relating to the injury and having someone to lean on or being alone.Conclusion: Findings from this review describe parental feelings of distress, guilt and blame and parental needs of information and support. Further research is needed to facilitate the development of evidence-based support programmes for parents of burn injured children that address these parental needs. [ABSTRACT FROM AUTHOR]

A rise in the current trend of corrosive substance attacks have been reported in the UK, causing devastating effects on victims. The optimal management of these patients requires the specialist skills of the burn multidisciplinary team (MDT) to address the resulting physical and psychological trauma experienced. However, burn care must commence in the pre-hospital setting. The public and first responders are invaluable resources in helping to limit the adverse effects of burns. Challenges of burn care outside the Burns Unit are not limited to the treatment of the injured patient and the rehabilitation of survivors. These challenges also encompass better education of the public and allied health professionals, as well as planning strategies to reduce the incidence of acid attacks. Prevention is always better than cure. This paper discusses the broadening of the MDT to improve outcomes in acid attacks by exploring the wider roles of the public, media, emergency services, police, legislation and better education. [ABSTRACT FROM AUTHOR]

Response to the 2010 Haitian earthquake included an array of diverse yet critical actions. This paper will briefly review the evacuation of a small group of patients with burns to burn centers in the southeastern United States (US). This particular evacuation brought together for the first time plans, groups, and organizations that had previously only exercised this process. The response to the Haitian earthquake was a glimpse at what the international community working together can do to help others, and relieve suffering following a catastrophic disaster. The international response was substantial. This paper will trace one evacuation, one day for one unique group of patients with burns to burn centers in the US and review the lessons learned from this process. The patient population with burns being evacuated from Haiti was very small compared to the overall operation. Nevertheless, the outcomes included a better understanding of how a larger event could challenge the limited resources for all involved. This paper includes aspects of the patient movement, the logistics needed, and briefly discusses reimbursement for the care provided. [ABSTRACT FROM AUTHOR]

Introduction: Majority of burn injuries occur in developing world. There have been many advances in burn care management. But this advance comes at a price of ever increasing burn sequel of scarring. Burn scar contractures, in spite of being preventable, continue to be a common reality in our world. This paper aims to evaluate the lacunae in burn care leading to formation of contractures, to evaluate common sites of contractures, practice of advising splintage and anti-deformity positioning.Procedure: This retrospective observational study was conducted over a period of six years (January 2010-December 2015) at a tertiary Burn unit in Mumbai (India). The records of burn contracture patients were scrutinized to obtain the data regarding patient's socio-demographic profile, details of burn injury, splinting and exercises advised and details of surgeries required. Data was tabulated and analysed.Results: There was a significantly lower prevalence of advice regarding splinting, mobilization exercises and pressure garments. The prevalence of early surgery was also found to be low.Conclusions: Attempt has been made to identify the factors affecting the prevalence of burn scar contractures. Authors recommend that efforts be made for improving the knowledge of the treating doctors. Also, efforts should be made to increase awareness of burn prevention and emergent management. [ABSTRACT FROM AUTHOR]

Background: As a result of the Spanish healthcare system overhaul, quality of care is becoming increasingly important. All burn service providers are required to measure patient satisfaction with care as an imperative need. Nevertheless, there are very few papers regarding patient satisfaction in burn units or in plastic surgery in general. The aim of this study is to examine patient satisfaction in our burn unit and to identify areas for improvement.Materials and Methods: Participants were all patients admitted to the Burn Unit at the Getafe University Hospital (Madrid, Spain) between January 2014 and December 2016. Patient satisfaction was assessed using the SERVQHOS questionnaire and Kano methodology. The SERVQHOS questionnaire was given to all patients at the time of discharge with completion thereof voluntary and anonymous. The Kano model consisted of an in-depth personal interview with patients and their relatives to identify patient requirements. Further, we developed a Kano questionnaire and analysed the results to prioritise the requirements for development activities.Results: A total of 164 SERVQHOS questionnaires were collected, which means 58% of the discharged patients who were asked to participate returned the questionnaire. Mean overall satisfaction score was 3.7 (range 1-4). Ninety-seven per cent of patients would not hesitate to recommend the hospital to others, 90% believed they had stayed in the hospital for the time necessary and 89% did not have any pain relief problems. The issues that were rated the worst by users were those related to objective quality such as room conditions, location directions, ease of discharge from the hospital and employee appearance. The best-valued aspects were those related to subjective quality such as willingness to help patients, ability to inspire trust and confidence, courtesy and personal attention.Conclusions: Patients hospitalised in our burn unit are highly satisfied with the care they receive, especially with regard to subjective quality. The evaluation of the satisfaction outcomes helped us to identify several strengths and weaknesses in the healthcare services we provide as well as strategies to improve the weaknesses. Evaluating care quality and patient satisfaction in any burn unit is appropriate and recommendable given that it offers clients' first-hand opinions. [ABSTRACT FROM AUTHOR]

Acute management of a severely burned patient is an infrequent and stressful situation that requires medical knowledge as well as immediate coordinated action. Many adverse events in health care result from issues related to the application of 'non-technical' skills such as communication, teamwork, leadership and decision making rather than lack of medical knowledge. Training in these skills is known as Crisis Resource Management (CRM) training. In order to create well-prepared burn teams, it is critical to teach CRM principles through high-fidelity simulation (HFS). While CRM teaches foundational non-technical skills, HFS incorporates lifelike, whole-body, fully-responsive mannequins in order to provide a realistic emergency situation. The aim of the study is to describe the development of a novel high-fidelity simulation course called "SIMBurns: High Fidelity Simulation Program for Emergency Burn Management" that uses CRM as its foundation and is focused on management of burn injuries. The course was designed by a panel of simulation and burns experts from Meyer Children's Hospital in Italy and Birmingham Children's Hospital in the U.K. Simulation Program experts were certified by Boston Children's Hospital's Simulation Program. In this paper, we describe the course's design, development, structure, and participant's assessment of the course. Since the creation of the SIMBurns course in 2013, 9 courses have been conducted and 101 participants have attended the course. The course was well-received and its "Overall Satisfaction" was rated at 4.8/5. The primary objective in the SIMBurns course - to teach teamwork and CRM skills to medical staff involved in emergency burn care - was also met at 4.8/5. Participants felt that the course developed their ability to interact with other team members, further improved their understanding of how to appropriately use resources, emphasized the importance of role clarity and developed their communication skills. Additional quantitative and qualitative analyses obtained from participants were also reviewed after each course. The SIMBurns course aims to contribute to the education of those in healthcare in order to improve patient safety and to continue advancing the education of our emergency burn care teams. [ABSTRACT FROM AUTHOR]

Objective: To describe the monthly variation in the prevalence and patterns of unfinished nursing care and to determine the relationships between the system of nursing care and unfinished nursing care at the US Army Burn Center.Methods: This was a repeated measures, descriptive study. For one week per month for six months, all nurses providing direct patient care on two inpatient burn units (intensive care and progressive care) were asked to complete an anonymous paper survey, which contained the Perceived Implicit Rationing of Nursing Care instrument, to estimate the prevalence of unfinished nursing care on their unit. Unit administrative data also were collected from the unit nursing leaders each month. Descriptive statistics and multilevel modeling were used in the analysis.Results: Most (80.5%) eligible nurses participated at least once; 46.6% participated three or more times. A high proportion (85.7-100%) of nurses left at least one element of care unfinished; the mean number of activities left unfinished over each 7 shift period per nurse was 16.2. Only nursing care hours provided by float staff significantly predicted nurse estimates of unfinished nursing care, β=.008, SE=.001, p<.05.Conclusions: The prevalence of unfinished nursing care at the US Army Burn Center was high and generally consistent with other studies of unfinished nursing care in non-burn settings. The inability to meet the demand for nursing care, as evidenced by the presence of unfinished nursing care, may be the result of a limited surge capacity. Implications for research, policy, and practice were discussed. [ABSTRACT FROM AUTHOR]

Abstract: The assessment of surface area of the body affected by a burn (TBSA) has long been estimated with manual charts. Initial assessment of burned patients is made frequently by clinicians with limited experience producing significant errors. Paper copies of burn charts are unwieldy, subject to loss and tend towards overestimation. Thus, a simple method of calculation, recording and transmission via email or telemedicine may produce benefits in both initial treatment and data recording. Although computer-based systems have been reported previously none have entered routine clinical practice in the UK. We devised a PC-based program, “Burn Calculator”, whereby digital transcription of the burn allows automatic area calculation allowing not only a rapid, accurate figure for determination of fluid resuscitation, but also the potential for rapid electronic transmission. It also calculates fluid requirements to minimise errors during resuscitation. This initial pilot study compared figures from 50 paper charts with those from Burn Calculator to determine its accuracy and reproducibility. Previously reported variations in TBSA estimation were confirmed, as was the tendency towards TBSA underestimation resulting from transcription of a three-dimensional clinical situation to a two-dimensional representation. Burn Calculator showed high correlation (r =0.9850; p <0.0001) and reproducibility (R =0.9957) that would simplify assessment and referral plus facilitate data collection, interpretation and research. [Copyright &y& Elsevier]

In India approximately 1 million people get burnt every year and most of them are from the lower or middle income strata. Therefore it is obligatory to find out an economic way of treatment for the affected populace. Since use of human skin allograft is the gold standard for the treatment of burn wound, in-house skin banking for a burn unit hospital is prerequisite to make the treatment procedure affordable. Although, there was one skin bank at India till 2009, but it was difficult for a single bank to cover the entire country's need. Looking at the necessities, National Burns Centre (a tertiary burn care centre) along with Rotary International and Euro Skin Bank collaborated and developed an effective cadaveric skin banking model in Mumbai, Maharashtra in 2009. Initial two to three years were formation phase; by the year 2013 the entire system was organized and started running full fledged. The model has also been replicated in other states of India to accommodate the large burn population of the country. This paper therefore, gives a step by step account of how the bank evolved and its present status. [ABSTRACT FROM AUTHOR]

Introduction: This study assessed patient-perceived levels of scar assessment and burn-specific quality of life (QOL) in Korean burn patients admitted to burn care centers and identified differences in scar assessment and QOL based on various patient characteristics.Methods: A cross-sectional descriptive study using anonymous paper-based survey methods was conducted with 100 burn patients from three burn centers specializing in burn care in South Korea.Results: Mean subject age was 44.5 years old, and 69% of the subjects were men. The overall mean QOL was 2.91 out of 5. QOL was lowest for the work subdomain (2.25±1.45) followed by the treatment regimen subdomain (2.32±1.16). The subjects' mean total scar assessment score was 35.51 out of 60, and subjects were most unsatisfied with scar color. Subjects with low income, flame-source burns, severe burns, visible scars, and scars on face or hand reported significantly lower QOL. Subjects with severe burn degree and burn range perceived their burn scar condition to be worse than that of others.Conclusion: The results show that burn subjects experience the most difficulties with their work and the treatment regimen. Subjects with severe burn and visible scarring have a reduced QOL and a poor scar status. Scar management intervention may improve QOL of burn patients especially those with severe burn and visible scars. Further studies are warranted to evaluate the relationship between scar assessment and QOL. [ABSTRACT FROM AUTHOR]

Introduction: Excisional surgical debridement (SD) is still the gold standard in the treatment of deeply burned hands, though the intricate anatomy is easily damaged. Previous studies demonstrated that enzymatic debridement with the bromelain debriding agent NexoBrid® (EDNX) is more selective and thus can preserve viable tissue with excellent outcome results. So far no method paper has been published presenting different treatment algorithms in this new field. Therefore our aim was to close this gap by presenting our detailed learning curve in EDNX of deeply burned hands.Methods: We conducted a single-center prospective observational clinical trial treating 20 patients with deeply burned hands with EDNX. Different anaesthetic procedures, debridement and wound treatment algorithms were compared and main pitfalls described.Results: EDNX was efficient in 90% of the treatments though correct wound bed evaluation was challenging and found unusual compared to SD. Post EDNX surprisingly the majority of the burn surface area was found overestimated (18 wounds). Finally we simplified our process and reduced treatment costs by following a modified treatment algorithm and treating under plexus anaesthesia bedside through a single nurse and one burn surgeon solely. Suprathel® could be shown to be an appropriate dressing for wound treatment after EDNX. Complete healing (less 5% rest defect) was achieved at an average of day 28.Conclusion: EDNX in deep burned hands is promising regarding handling and duration of the treatment, efficiency and selectivity of debridement, healing potential and early rehabilitation. Following our treatment algorithm EDNX can be performed easily and even without special knowledge in burn wound depth evaluation. [ABSTRACT FROM AUTHOR]

Introduction: The diffuse epidermal exfoliation seen in Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) is similar to skin loss in second degree burns, and many of these patients are referred for treatment at burn centers. Treatment can differ markedly from center to center, and mortality can range from 25% to 70%, including a considerable morbidity. However, our experience over a 15-year period from 2000 to 2015 with 40 patients found a mortality rate of only 10% (4/40). The purpose of this paper is to discuss our treatment algorithm as a model for other centers treating SJS/TENs patients.Methods: Records were reviewed for all patients admitted to the LAC+USC burn unit between 2000 and 2015 and 40 patients were identified with biopsy-proven SJS or TENS. These cases were reviewed for age, gender, initial and greatest TBSA, causative drug, pre-existing medical conditions, and morbidity and mortality. All data were entered into the SPSS statistical software package and all statistical analyses were performed using this program.Results: Our treatment algorithm focused on early referral to a specialty burn unit, immediate discontinuation of the offending drug, fluid resuscitation, nutritional supplementation, and meticulous wound care. Average time to transfer to a burn unit was 3.36 days. Silver-releasing antimicrobial dressings were applied to the affected skin surface and changed every 3 days. Mupirocin coated petroleum gauze was used for facial involvement. Steroids were tapered and discontinued if initiated at an outside facility (58% of patients), and starting after 2001, all patients received a course of IVIG. All patients received fluid resuscitation and the majority received supplemental tube feedings (69%). Average length of total stay was 17.1 days and length of ICU stay 15.9 days. While 44% were transferred to another facility for further rehabilitative care, 37% of patients discharge to home. In patients discharged home with complete resolution of skin lesions, time to healing was an average of 14 days.Discussion: With our 10% mortality rate in 40 patients, our study represents a relatively large study population while maintaining a relatively low mortality rate. The demographic data from our study largely aligns with the existing literature, and we therefore feel that our low mortality rate is due to our treatment algorithm, rather than to a less severe pathology in our patient population. This claim is supported by a standard mortality ratio of 1.68. This ratio proves a significantly improved mortality than would be expected based on disease severity on admission. [ABSTRACT FROM AUTHOR]

Objective: Few studies have been conducted on treatment adherence to burn care. Given the prevalence of burn injuries across the lifespan and the impact of proper burn care on associated morbidity, it is important to understand factors associated with regimen non-adherence in this population. The purpose of this paper is to summarize and critique all published literature on patient adherence to burn care.Method: With no restriction on publication date, 13 relevant articles met the following inclusion criteria: (a) utilized a sample of patients who sustained a burn injury or their medical staff; (b) focused on treatment or healthcare adherence of the patient (e.g., adherence to pressure garment therapy, physical therapy, occupational therapy, diet, dressing changes, or sunscreen use); and (c) publication written or translated into English.Results: Most studies (70%) used a correlational design, while only four studies used an experimental design (either longitudinal or single subject) to assess adherence to burn care treatment. Current research suggests that burn treatment characteristics, knowledge, and beliefs are associated with adherence to burn care regimens.Conclusions: Given that adherence may vary as a function of different factors, future research should assess pediatric burn patients as a separate population, as well as investigate adherence to multiple aspects of the burn care regimen. To enhance adherence to burn care, healthcare providers should educate their patients on various treatment components and tailor these components to meet patients' goals and needs, as feasible. [ABSTRACT FROM AUTHOR]

Purpose: In this paper an automatic system to diagnose burn depths based on colour digital photographs is presented.Justification: There is a low success rate in the determination of burn depth for inexperienced surgeons (around 50%), which rises to the range from 64 to 76% for experienced surgeons. In order to establish the first treatment, which is crucial for the patient evolution, the determination of the burn depth is one of the main steps. As the cost of maintaining a Burn Unit is very high, it would be desirable to have an automatic system to give a first assessment in local medical centres or at the emergency, where there is a lack of specialists.Method: To this aim a psychophysical experiment to determine the physical characteristics that physicians employ to diagnose a burn depth is described. A Multidimensional Scaling Analysis (MDS) is then applied to the data obtained from the experiment in order to identify these physical features. Subsequently, these characteristics are translated into mathematical features. Finally, via a classifier (Support Vector Machine) and a feature selection method, the discriminant power of these mathematical features to distinguish among burn depths is analysed, and the subset of features that better estimates the burn depth is selected.Results: A success rate of 79.73% was obtained when burns were classified as those which needed grafts and those which did not.Conclusions: Results validate the ability of the features extracted from the psychophysical experiment to classify burns into their depths. [ABSTRACT FROM AUTHOR]

We conducted a one-month study of the working time and workload of nurses in a 15 beds burn center (including 8 intensive care beds). Nurses' tasks were categorized according to their nature (medical care, local treatments, post anesthetic monitoring, administrative time related to health care, administrative time unrelated to health care, cleaning, rest). The time taken to complete a given task was measured for each task. The time devoted to walk and unavailable for patients care was also measured.Our study revealed that work distribution was far from optimal since administrative tasks occupy more than 30% of workload. This represents inefficiency and the literature shows that when time is saved from administrative work it is reinvested in health care. One third of the administrative tasks are unrelated to care and thus could be performed by non-specialized clerks. The other two third of the administrative workload are closely linked to care. An answer to reduce administrative time lost to care activities is the implementation of dedicated ICU software which carries several other advantages such as reducing the use of paper, improving the safety of prescriptions, automating repetitive and unrewarding tasks and saving physician time. This expensive solution can be quickly repaid through costs containment due to the time saved. A significant part of the working time is spent walking but reducing the ambulatory time may be considered only through structural improvements. [ABSTRACT FROM AUTHOR]

Abstract: Background: Burns are a challenge for trauma care and a contribution to the surgical burden. The former Soviet republic of Ukraine has a foundation for burn care; however data concerning burns in Ukraine has historically been scant. The objective of this paper was to compare a new burn database to identify problems and implement improvements in burn care and prevention in this country. Methods: Retrospective analyses of demographic and clinical data of burn patients including Tukey's post hoc test, analysis of variance, and chi square analyses, and Fisher's exact test were used. Data were compared to the American Burn Association (ABA) burn repository. Results: This study included 1752 thermally injured patients treated in 20 hospitals including Specialized Burn Unit in Municipal Hospital #8 Lviv, Lviv province in Ukraine. Scald burns were the primary etiology of burns injuries (70%) and burns were more common among children less than five years of age (34%). Length of stay, mechanical ventilation use, infection rates, and morbidity increased with greater burn size. Mortality was significantly related to burn size, inhalation injury, age, and length of stay. Wound infections were associated with burn size and older age. Compared to ABA data, Ukrainian patients had double the length of stay and a higher rate of wound infections (16% vs. 2.4%). Conclusion: We created one of the first burn databases from a region of the former Soviet Union in an effort to bring attention to burn injury and improve burn care. [Copyright &y& Elsevier]

Abstract: Methods: In this cross-sectional retrospective study, frequency, type, time of occurrence and atiology of seizures in children with burn was investigated. All cases were under 18 years and were hospitalized in Shahid Motahari Burns Hospital during 2006–2011. Extracted data from patients’ medical records was reviewed and statistically analyzed. Results: Among 1103 patients, 69 (6.2%) had seizures, more frequently in the first 24h following burn. Thermal burn, especially with boiling water was the cause of burn in most of the children. Seizures occurred more commonly in children less than 3 years old and was generalized (tonic–clonic). Seizure was found to be primarily associated with febrile seizure, while hyponatremia was diagnosed as the second cause. Previous seizure history and seizure with unknown cause were identified as other etiologies. This paper summarizes the key information about seizure following burn, which health professionals, especially those in burn centers, should be aware. However, since this study was single-center more investigations in other centers are needed. [Copyright &y& Elsevier]

Objective: There currently exists a need for evidence-based information and tools in burns care. It was therefore the aim of a working party of the Joanna Briggs Institute to establish an evidence based resource to assist professionals in the burns community to practice evidence based healthcare. Methods: After receiving initial funding to create this resource, a steering committee was developed consisting of representatives of the funding agencies and Joanna Briggs Institute staff. This evolved into a tiered international reference group to provide feedback, topic suggestions, and content for the resource. Resources were developed systematically based upon an agreed taxonomy, and included evidence summaries, recommended procedures, audit criteria and information for consumers/patients. Results: As of 2012, the resource is now available online. There are 63 international experts on the reference groups providing feedback on all of the resources available. There are 102 evidence summaries covering a wide range of burns topics online, 55 recommended practices, 13 audit topics and 33 consumer information pamphlets. Conclusion: This paper outlines the details and processes surrounding the development of the JBI Burns Node, and how it has grown from humble beginnings into a resource that can assist in the translation of evidence into practice for burns care professionals. [Copyright &y& Elsevier]

Abstract: The 21st century burn care team epitomises integrated multidisciplinary care. The physical, psychological and socials needs of burn victims necessitates the close collaboration of a broad spectrum of health care professionals. The ultimate aim is to return the patient to the optimal level of physical and psychological health and social function. The modern burn care team must not only consider the staffing and structure of the team, but also the way in which the team is to be delivered to the patient. Furthermore, the 21st century burn care team must be willing to adapt and evolve during the likely NHS re-structuring that will come with the Health and Social Care Act 2012, as well as integrate with the new UK trauma networks. This paper discusses the staffing and structure of the 21st century burn care team along with the future challenges and opportunities it may be presented with. [Copyright &y& Elsevier]

Abstract: Aim: To review casualty profiles of major UK burn disasters over the last 30 years in order to provide guidance to aid burn and emergency service planning and provision so as to improve emergency preparedness for future national disasters. Methods: A review of published literature was undertaken for disasters within the UK that had occurred between 1980 and 2009. Those producing 10 or more casualties with at least one sustaining cutaneous burns injuries were included. Frequency and extent of burns were recorded and analysed. Results: In total 37 disasters were included in this study, their frequency of occurrence falling over the 30 years reviewed. Burns tended to make up a small proportion of all casualties and were often relatively small in size with only 3 disasters having more than 5 patients with >10% burns. Discussion: This paper can help guide appropriate staffing and bed capacity planning for regional burns units and provide realistic figures to guide scenarios for national emergency training exercises. Due to the infrequent nature of major disasters, Critical Care, Trauma Care and Burn Care Networks will all need to be closely integrated and their implementation rehearsed so as to ensure optimal response to a major national disaster. [Copyright &y& Elsevier]

Abstract: Introduction: Helicopter emergency medical services play a valuable role in the transfer of critically ill patients. This paper reviews the role of air ambulance services in the provision of regional burns care and suggests guidelines for their use. Methods: A retrospective review of patients treated at the Midlands Adult Burns Centre over a 3-year period. Results: 27 adult burns patients were transported by air ambulance during the study period. Patients were aged 19–89 years (average 41.3 years) with an estimated burn size of 5–70% TBSA. Distance travelled was 11–79miles (average 41.2miles). All patients were appropriately referred to the burns centre according to national referral guidelines but in 7 cases (26%) it was felt that transport by air ambulance was not clinically indicated and land transfer would have been safe and appropriate. Conclusion: Air ambulances offer a fast and effective means of transferring patients to a regional burns centre in selected cases. There is limited data for the beneficial effects of helicopters and survival benefit is seen only in the most severely injured patients. We suggest criteria for the use of air ambulances in burns patients in order to maximise the benefit and reduce unnecessary flights. [Copyright &y& Elsevier]

Abstract: The Burn Specific Health Scale (BSHS) is the most commonly used instrument used to evaluate burn survivors’ quality of life (QOL). Multiple forms of the instrument exist; however, the literature lacks clarity in regard as to why a particular version of the BSHS was used and how the instrument performed in a variety of samples. This paper provides a review of the literature of the variations of the BSHS, its utility for research and clinical practice, and scoring concerns. [Copyright &y& Elsevier]

Abstract: Lightning is an uncommon but potentially devastating cause of injury in patients presenting to burn centers. These injuries feature unusual symptoms, high mortality, and significant long-term morbidity. This paper will review the epidemiology, physics, clinical presentation, management principles, and prevention of lightning injuries. [Copyright &y& Elsevier]

Abstract: The prospect of being able to replace damaged tissue by the process of regeneration would dramatically and irrevocably change the impact, management and outcome of burns. The current understanding of stem cell-based modulation and therapy together with their potential developments do bring this prospect ever closer to a clinical reality. This paper gives a background to stem cell strategies in burns care and identifies actual or prospective applications which, collectively, will forever change burns care throughout the world. [Copyright &y& Elsevier]

Objective: This paper presents a series of practical guides for use in planning and responding to a major incident involving large numbers of burns casualties.Method: The guidance is based on the findings of an expert Delphi study published as an accompanying paper.Results: The guidance covers preparation and all aspects of the response from prehospital care and hospital care to resolution recovery. Emphasis is placed on the management of the secondary/tertiary care interface as this is the point at which significant difficulties may arise. The importance of local interpretation of guidelines is emphasised.Conclusion: This practical guide for emergency planners will improve the preparation and response to a major incident involving burns. [Copyright &y& Elsevier]