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Simons M, Harvey G, McMillan L, Ryan EG, De Young AG, McPhail SM, Kularatna S, Senanayake S, Kimble R, Tyack Z. Implementation outcomes of a digital, trauma-informed care, educational intervention targeting health professionals in a paediatric burns setting: A mixed methods process evaluation. Burns 2024; 50:1690-1703. [PMID: 38664169 DOI: 10.1016/j.burns.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/05/2024] [Accepted: 03/31/2024] [Indexed: 06/14/2024]
Abstract
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.
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Affiliation(s)
- Megan Simons
- Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Queensland, Australia; Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia.
| | - Gillian Harvey
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lucinda McMillan
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia
| | - Elizabeth G Ryan
- QCIF Faculty for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Alexandra G De Young
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia; School of Psychology, The University of Queensland, Queensland, Australia; Queensland Centre for Perinatal and Infant Mental Health, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia; Digital Health and Informatics Directorate, Metro South Health, Queensland, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
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Bairagi A, Tyack Z, Kimble RM, McPhail SM, McBride CA, Patel B, Vagenas D, Dettrick Z, Griffin B. Effectiveness of a Regenerative Epithelial Suspension (RES), on the pigmentation of split-thickness skin graft donor sites in children: the d RESsing pilot randomised controlled trial protocol. BMJ Open 2024; 14:e077525. [PMID: 38417964 PMCID: PMC10900329 DOI: 10.1136/bmjopen-2023-077525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/04/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Paediatric donor site wounds are often complicated by dyspigmentation following a split-thickness skin graft. These easily identifiable scars can potentially never return to normal pigmentation. A Regenerative Epidermal Suspension (RES) has been shown to improve pigmentation in patients with vitiligo, and in adult patients following a burn injury. Very little is known regarding the efficacy of RES for the management of donor site scars in children. METHODS AND ANALYSIS A pilot randomised controlled trial of 40 children allocated to two groups (RES or no RES) standard dressing applied to donor site wounds will be conducted. All children aged 16 years or younger requiring a split thickness skin graft will be screened for eligibility. The primary outcome is donor site scar pigmentation 12 months after skin grafting. Secondary outcomes include re-epithelialisation time, pain, itch, dressing application ease, treatment satisfaction, scar thickness and health-related quality of life. Commencing 7 days after the skin graft, the dressing will be changed every 3-5 days until the donor site is ≥ 95% re-epithelialised. Data will be collected at each dressing change and 3, 6 and 12 months post skin graft. ETHICS AND DISSEMINATION Ethics approval was confirmed on 11 February 2019 by the study site Human Research Ethics Committee (HREC) (HREC/18/QCHQ/45807). Study findings will be published in peer-reviewed journals and presented at national and international conferences. This study was prospectively registered on the Australian New Zealand Clinical Trials Registry (available at https://anzctr.org.au/ACTRN12620000227998.aspx). TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry [Available at https://anzctr.org.au/ACTRN12620000227998.aspx].
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Affiliation(s)
- Anjana Bairagi
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Digital Health and Informatics, Metro South Health, Brisbane, Queensland, Australia
| | - Craig Antony McBride
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Bhaveshkumar Patel
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Research Methods Group, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zoe Dettrick
- Research Methods Group, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia
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Lewis CJ, Douglas H, Martin L, Deng Z, Melton P, Fear MW, Wood FM, Rea S. Carbon dioxide laser treatment of burn-related scarring: Results of the ELIPSE (Early Laser Intervention Promotes Scar Evolution) prospective randomized controlled trial. J Plast Reconstr Aesthet Surg 2023; 84:368-376. [PMID: 37393760 DOI: 10.1016/j.bjps.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
AIM To investigate the impact of ablative fractional carbon dioxide laser (AFCO2L) on patient-reported outcomes measures, subjective scar appearance, dermal architecture, and gene transcription in early burn scars. METHODS Fifteen adult patients with a burn-related scar were recruited. Inclusion criteria were two non-contiguous scar areas of 1% total body surface area, similar baseline Vancouver scar scale (VSS) score and 3months since the time of injury. All participants acted as their own control. Scars were randomized to treatment or control. Treatment scars received three AFCO2L treatments at 6-week intervals. Outcome measures were recorded at baseline, 3, 6, and 12-months post-treatment. Measures included blinded VSS, Patient Observer Scar Assessment Scale (POSAS), Brisbane Burn Scar Impact Profile (BBSIP), blinded scar photo assessment, histological tissue analysis, and RNA sequencing analysis. RESULTS No significant difference was found in VSS, scar erythema, or pigmentation. Patient POSAS improved in scar thickness and texture following AFCO2L. All elements of BBSIP improved in control and laser groups. AFCO2L-treated scars were scored better than control scars by blinded raters. RNA sequencing illustrated that AFCO2L induced sustained changes in fibroblast gene expression. CONCLUSIONS AFCO2L treated scars had significantly altered scar thickness and texture 6 months post-laser and were rated better than controls on blinded photo analysis after 3 treatments. RNASeq results suggest laser treatment alters the transcriptome of treated fibroblasts for at least 3 months after treatment. Expansion of this research to study in more depth fibroblast changes in response to laser, as well as assessing the impact on daily activity and quality of life, will be beneficial.
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Affiliation(s)
- Christopher J Lewis
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia.
| | - Helen Douglas
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia
| | - Lisa Martin
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Zhenjun Deng
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Phillip Melton
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; School of Global and Population Health, University of Western Australia, Crawley, WA, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia; Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Suzanne Rea
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia; Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
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Storey K, Lalloz M, Choy KT, McBride CA, McMillan C, Das Gupta R, Patel B, Choo K, Stefanutti G, Borzi P, Phua Y, Bade S, Griffin B, Kimble RM. The versatility of biodegradable temporising matrix – A 63 paediatric case series with complex wounds. BURNS OPEN 2023. [DOI: 10.1016/j.burnso.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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Mistry R, Issa F. No statistically significant difference in long term scarring outcomes of pediatric burns patients treated surgically vs. those treated conservatively. Front Surg 2022; 9:727983. [PMID: 36157426 PMCID: PMC9500338 DOI: 10.3389/fsurg.2022.727983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Paediatric burns are a common clinical presentation. The long-term scar outcomes in paediatric burns patients are relatively unknown as most are discharged after 6 weeks follow up, apart from the small number that are followed up by scar services depending on geographical availability. We aimed to determine whether the long-term scarring outcomes are significantly different in those who had surgical treatment with Versajet® debridement and Biobrane®, vs. those treated conservatively with non-adherent Mepitel® and Acticoat® dressings, in a cohort of paediatric burns patients. Methods The parents of all paediatric burns patients admitted to Stoke Mandeville Hospital from October 2014 to September 2017 were contacted by telephone to fill in the paediatric Brisbane Burn Scar Impact Profile (BBSIP), the only patient reported outcome measure (PROM) specifically aimed at children. The results from the questionnaires underwent statistical analysis to see if there was a significant difference in questionnaire scores between children treated surgically vs. those treated conservatively. Results A total of 107 children were admitted in the timeframe, responses were received from 34 patients with 13 having been treated surgically and 21 having been treated conservatively. In all 58 questions that make up the BBSIP, there was no statistically significant difference observed in the scores of those treated surgically vs. those treated conservatively. For 31 questions on the BBSIP, the lowest score indicating the best outcome was observed in all patients in both groups. Discussion Surgical management for burns is always the last resort. Our results could be interpreted to suggest clinicians need not fear the longer-term impact a scar may have when deciding whether to treat a paediatric burns patient surgically or conservatively. This study is the first to assess longer-term scar outcomes using the BBSIP. A larger data set and comparison with other burn units in the UK may help to provide more information on scar outcomes between different methods of surgical and conservative treatment. We found no statistically significant difference in the long-term scar outcomes as assessed by the BBSIP in paediatric burn patients treated with Versajet® debridement and Biobrane®, vs. those treated conservatively with non-adherent Mepitel® and Acticoat® dressings.
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Affiliation(s)
- Riyam Mistry
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Cuttle L, Fear M, Wood FM, Kimble RM, Holland AJA. Management of non-severe burn wounds in children and adolescents: optimising outcomes through all stages of the patient journey. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:269-278. [PMID: 35051408 DOI: 10.1016/s2352-4642(21)00350-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Abstract
Paediatric burn injuries are common, especially in children younger than 5 years, and can lead to poor physical and psychosocial outcomes in the long term. In this Review, we aim to summarise the key factors and interventions before hospital admission and following discharge that can improve the long-term outcomes of paediatric burns. Care can be optimised through first aid treatment, correct initial assessment of burn severity, and appropriate patient referral to a burns centre. Scar prevention or treatment and patient follow-up after discharge are also essential. As most burn injuries in children are comparatively small and readily survivable, this Review does not cover the perioperative management associated with severe burns that require fluid resuscitation, or inhalational injury. Burns disproportionately affect children from low socioeconomic backgrounds and those living in low-income and middle-income countries, with ample evidence to suggest that there remains scope for low-cost interventions to improve care for those patients with the greatest burden of burn injury. Current knowledge gaps and future research directions are discussed.
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Affiliation(s)
- Leila Cuttle
- Centre for Children's Health Research, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Mark Fear
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia; Burns Service of Western Australia, Perth Children's Hospital and Fiona Stanley Hospital, Perth, WA, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, South Brisbane, QLD, Australia; Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Andrew J A Holland
- The Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, The University of Sydney, NSW, Westmead, Australia
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Bairagi A, Griffin B, Banani T, McPhail SM, Kimble R, Tyack Z. A systematic review and meta-analysis of randomized trials evaluating the efficacy of autologous skin cell suspensions for re-epithelialization of acute partial thickness burn injuries and split-thickness skin graft donor sites. Burns 2021; 47:1225-1240. [PMID: 33941398 DOI: 10.1016/j.burns.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/20/2020] [Accepted: 04/06/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND This systematic review evaluated the efficacy of autologous skin cell suspensions (ASCS) on the re-epithelialization of partial thickness burn injuries and skin graft donor site wounds. METHODS Four databases (EMBASE, Google Scholar, MEDLINE, Web of Science), grey literature and select journal hand-searching identified studies from 1975 - 2020. Randomized trials evaluating partial thickness burn management with non-cultured ASCS compared to any other intervention were included. Time to re-epithelialization (TTRE) was the primary outcome. Three independent researchers completed screening, data extraction and certainty of evidence assessment using Cochrane Risk of Bias Tool and Grading of Recommendations Assessment, Development and Evaluation. RESULTS Five trials (n = 347) reported on adults (2 trials) and children (1 trial) with burn wounds, and adults with donor site wounds (2 trials). The effect of ASCS compared to control on TTRE in adult burn wounds was not estimable. TTRE was shorter in pediatric burn wounds (SMD -1.75 [95% CI: -3.45 to -0.05]) and adult donor site wounds (SMD-5.71 [95% CI: -10.61 to-0.81]) treated with ASCS. The certainty of evidence was very low. CONCLUSION Compared to standard care, ACSC may reduce pediatric partial thickness burn wound and adult split-thickness skin graft donor site TTRE. REGISTRATION PROSPERO CRD42019133171.
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Affiliation(s)
- Anjana Bairagi
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research and Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia; Queensland University of Technology, Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia.
| | - Bronwyn Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research and Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia; Queensland University of Technology, Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia; National Health and Medical Research Council Centre of Research Excellence - Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia..
| | - Tara Banani
- The University of Queensland, Centre for Children's Burns and Trauma Research, Children's Health Research Centre, Brisbane, Queensland, Australia.
| | - Steven M McPhail
- Queensland University of Technology, Australian Centre for Health Service Innovation and Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Metro South Hospital and Health Service, Clinical Informatics Directorate, Brisbane, Queensland, Australia.
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research and Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia; Queensland University of Technology, Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia; The University of Queensland, Centre for Children's Burns and Trauma Research, Children's Health Research Centre, Brisbane, Queensland, Australia.
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research and Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia; The University of Queensland, Centre for Children's Burns and Trauma Research, Children's Health Research Centre, Brisbane, Queensland, Australia; Queensland University of Technology, Australian Centre for Health Service Innovation and Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Metro South Hospital and Health Service, Clinical Informatics Directorate, Brisbane, Queensland, Australia.
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Choo AMH, Ong YS, Issa F. Scar Assessment Tools: How Do They Compare? Front Surg 2021; 8:643098. [PMID: 34250003 PMCID: PMC8260845 DOI: 10.3389/fsurg.2021.643098] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Healing after dermal injury is a complex but imperfect process that results in a wide range of visible scars. The degree of disfigurement is not the sole determinant of a scar's effect on patient well-being, with a number of other factors being critical to outcome. These include cosmetic appearance, symptoms such as itch and pain, functional loss, psychological or social problems, and quality of life. An accurate assessment of these domains can help clinicians measure outcomes, develop, and evaluate treatment strategies. A PubMed literature search was performed up to 31st March 2020. Ten objective scar measurements, four Clinician-Reported Outcome Measures (CROMs), six Patient-Reported Outcome Measures (PROMs), and one combined measure were evaluated for their reliability, clinical relevance, responsiveness to clinical change, and feasibility. Many quantitative tools were limited in their clinical relevance and feasibility, whereas few qualitative CROMs and PROMs have undergone rigorous assessment. This review examines currently available assessment tools, focusing primarily on subjective scar measurements (CROMs, PROMs), and offers a perspective on future directions in the field.
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Affiliation(s)
| | - Yee Siang Ong
- Department of Plastics, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Fadi Issa
- Department of Plastic Surgery and Burns, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom.,Medical Sciences Division, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Price K, Moiemen N, Nice L, Mathers J. Patient experience of scar assessment and the use of scar assessment tools during burns rehabilitation: a qualitative study. BURNS & TRAUMA 2021; 9:tkab005. [PMID: 34212058 PMCID: PMC8240530 DOI: 10.1093/burnst/tkab005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/27/2020] [Indexed: 02/03/2023]
Abstract
Background Scar assessment plays a key role during burns aftercare, to monitor scar remodelling and patients’ psychosocial well-being. To aid assessment, subjective scar assessment scales are available that use health-care professionals’ and patients’ opinions to score scar characteristics. The subjective scales are more widely used in clinical practice over objective scar measures. To date, there is no research that considers patients’ views on scar assessment and the role of subjective and objective assessment tools. Therefore, the aim of this qualitative study was to explore patients’ perspectives on scar assessment and the utility of scar assessment tools during burns rehabilitation. Methods Semi-structured interviews were conducted with 10 adult burn patients who were being reviewed in clinic for scarring. Participants were recruited via their clinical care team and research nurses at the Queen Elizabeth Hospital, Birmingham, UK. Topics covered during interview included patient experience of scar assessment, the use of scar assessment tools and discussion surrounding important factors to be addressed when assessing scars. A thematic analysis using the Framework Method was conducted. Results Participants identified key subthemes that contribute towards the overarching theme of patient-centred scar assessment. These are: patient-led care; continuity in care; learning how to self-manage scarring; and psychological assessment. Links were demonstrated between these subthemes and the remaining themes that describe scar assessment strategies, indicating their potential patient-centred contributions. The subjective opinions of clinicians were found to be valued above the use of subjective or objective scar assessment tools. Scar assessment scales were perceived to be a beneficial method for self-reflection in relation to psychosocial functioning. However, minimal feedback and review of completed assessment scales led to uncertainty regarding their purpose. Patients perceived objective tools to be of primary use for health-care professionals, though the measures may aid patients’ understanding of scar properties. Conclusions Scar assessment tools should be used to support, rather than replace, health-care professionals’ subjective judgements of scarring. Adapting the way in which clinicians introduce and use scar assessment tools, according to patient needs, can support a patient-centred approach to scar assessment.
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Affiliation(s)
- Kate Price
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Naiem Moiemen
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Nice
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Lahdenperä NI, Repo JP, Aartolahti E, Tollow P, Griffiths C, Harcourt D, Vuola J, Lindford A. The CARe Burn Scale-Adult Form: Translation and linguistic validation into Finnish. Burns 2021; 47:1922-1928. [PMID: 33814216 DOI: 10.1016/j.burns.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Burn injury can dramatically deteriorate health-related quality of life. Effective burn care may minimize the impact of the burn injury and ensure optimal functional outcome. This requires continuous improvement in burn care and assessment of treatment results. The aim of this study was to translate, culturally adapt and linguistically validate the CARe Burn Scale-Adult Form, a burn-specific patient-reported outcome measure, into Finnish. METHODS The translation process followed the International Society for Pharmacoeconomics and Outcomes Research guidelines consisting of forward and backward translations, pilot-testing and cognitive debriefing interviews of five burn patients, and proofreading before finalizing. The process involved expert panel meetings and continuous discussion between the developers of the Scale and the research group. RESULTS In the forward translation 10 amendments were required. After the backward translation, 12 items were reworded. Cognitive debriefing interviews led to three alterations enhancing the comprehensiveness and accuracy of the translation. The translation was reviewed by burn occupational therapists for practicality, resulting in 12 modifications. Minor grammatical changes were made after proofreading. CONCLUSION The Finnish version is the first foreign translation of the CARe Burn Scale. It is equivalent to the original Scale and ready for psychometric validation with burn patients in Finland.
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Affiliation(s)
- Noora-Ilona Lahdenperä
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland.
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Eeva Aartolahti
- Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014, Finland
| | - Philippa Tollow
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Catrin Griffiths
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Diana Harcourt
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Jyrki Vuola
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland
| | - Andrew Lindford
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland
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Simons M, De Young A, McPhail SM, Harvey G, Kenardy J, Kularatna S, Kimble R, Tyack Z. A web-based educational intervention to implement trauma-informed care in a paediatric healthcare setting: protocol for a feasibility study using pre-post mixed methods design. Pilot Feasibility Stud 2020; 6:118. [PMID: 32832097 PMCID: PMC7436985 DOI: 10.1186/s40814-020-00636-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022] Open
Abstract
Background Adoption of responsive trauma-informed practices by staff in hospital-based paediatric care may help mitigate downstream costs associated with treatment delivery due to reduced pain and distress for children and care providers, improved health-related quality of life and increased satisfaction with care. A web-based education intervention (termed Responsive CARE) was developed to build self-efficacy of staff in a paediatric medical setting. This protocol paper describes a feasibility study (including preliminary effectiveness) of the implementation of Responsive CARE in a tertiary, outpatient burn clinical setting. Methods A pre-post, mixed methods design will be employed. Children and caregivers attending hospital for change of burn wound dressings or burn scar management during the 3-month control or 3-month intervention period will be eligible, with follow-up to 6-months post-baseline. All children and caregiver/s will receive “standard care” including burn interventions focused on wound healing, scar management, itch management (both pharmacological and non-pharmacological), counselling, age-appropriate procedural support and burn rehabilitation. Health professional participants will be those involved in the management of children with burns during the study period or their senior managers. Health professional participants who attend a weekly educational clinical meeting will be invited to complete the intervention during a 1-month timeframe between the control and intervention period (or upon their commencement in burn outpatients during the intervention period) using an individualised log-in process. A purposive sample of caregivers and health professionals will be sought for participation in semi-structured interviews. Qualitative data will be analysed using Framework analysis. Feasibility will be evaluated via interviews, digital records of intervention usage and technical assistance logs. The primary outcome measures of effectiveness (pain, itch and distress) will be measured using self-report or behavioural observation. Quantitative data will primarily be analysed descriptively and using generalised linear models. Discussion This study will provide insights into factors that impact upon the feasibility of a web-based trauma-informed care education intervention in a clinical practice setting. This knowledge may support other education approaches within healthcare settings related to improving and supporting patients to reduce the risk of healthcare interactions that result in paediatric medical traumatic stress.
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Affiliation(s)
- Megan Simons
- Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Queensland 4101 Australia.,Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia
| | - Alexandra De Young
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia.,School of Psychology, The University of Queensland, St Lucia, Queensland 4072 Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059 Australia.,Clinical Informatics Directorate, Metro South Health, 199 Ipswich Road, Woolloongabba, Queensland 4102 Australia
| | - Gillian Harvey
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059 Australia
| | - Justin Kenardy
- School of Psychology, The University of Queensland, St Lucia, Queensland 4072 Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059 Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia
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