Health utilities in burn injury survivors: A systematic review

Early mobilization after skin graft for burn injury in adults

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of early mobilization after skin graft for burn injury in adults.

Effects of Dignity Therapy on Dignity, Anxiety, Depression and Quality of Life for People With Burns: A Randomised Controlled Trial

AIMS

To evaluate the effect of dignity therapy on dignity, anxiety, depression and overall quality of life for people with burns.

DESIGN

A single-blind, double-arm, parallel randomised controlled study.

METHODS

The Patient Dignity Scale, Hospital Anxiety and Depression Scale, and Burn-Specific Health Scale-Short were employed to assess the dignity, anxiety, depression and overall quality of life for people with burns. These outcome indicators were measured and analysed at baseline, 2-, 4- and 8-week follow-up. The generalised estimating equations were used to analyse the effect of the intervention during each time point.

RESULTS

A total of 99 participants were recruited (50 in the intervention group and 49 in the control group), with a high retention rate of 97 participants (94.95%) completing the 8-week follow-up. All outcome measurement tools met the feasibility criteria related to completeness and responsiveness over time. Dignity was the primary outcome measure, with anxiety, depression and quality of life serving as secondary outcome measures. At the 8-week post-intervention, participants in the intervention group demonstrated a statistically significant decrease in dignity and anxiety and depression, and a statistically significant increase in burn-specific health.

CONCLUSIONS

Dignity therapy can effectively reduce the loss of dignity, anxiety and depression, and improve the quality of life for people with burns. This study has a positive impact on burn dignity nursing practice and provides healthcare professionals with a novel approach to help people with burns return to normal social life with dignity.

IMPLICATIONS FOR THE PROFESSION

It is important to develop patient-centred care for burns with dignity. Focusing on developing a rational understanding of non-discriminatory dignity care practices among clinical providers and to develop dignity-oriented clinical care practices on the wards.

IMPACT

This study validated the feasibility of implementing dignity therapy for people with burns. Dignity therapy is effective in reducing the degree of dignity impairment, reducing anxiety and depressive symptoms, and enhancing the quality of life for people with burns. Our findings can help healthcare professionals to provide personalised dignity care throughout the patient's journey to facilitate a dignified reintegration into society and life for people with burns.

REPORTING METHOD

This randomised controlled trial used the CONSORT guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patients or members of the public participated in the study design, data analysis or interpretation.

CLINICAL TRIALS

This study has been registered in the Chinese Clinical Trial Registry registration number: ChiCTR2200065145, 29 October 2022.

Rosuvastatin accelerates the healing process of partial-thickness burn wounds in rats by reducing TNF-α levels

Introduction

Burn wound healing is a complex, dynamic process that involves a coordinated cascade of cellular responses and phases. Inflammation, proliferation and remodeling are the main phases of tissue repair, while tumor necrosis factor α (TNF-α) and procalcitonin (PCT) seem to be important mediators affecting the inflammatory state. Our aim was to assess the effect of rosuvastatin on tissue repair after partial thickness burn injury in healthy animals.

Material and methods

In this randomized prospective experimental study, 36 male rats were randomly divided into two groups: placebo-treated (PG) and topical rosuvastatin-treated (SG). Under anesthesia, a partial-thickness burn trauma was induced in the dorsal region of the rats using an iron seal. Tissue samples were collected for histopathological examination as well.

Results

Variables of TNF-α, procalcitonin and macroscopic assessment were normally distributed between the two groups on all studied days. The expression of TNF-α was found to be lower in burn injuries treated with topical rosuvastatin in comparison with placebo-treated animals on days 3, 6 and 9. PCT values in rosuvastatin-treated subgroups were statistically significantly lower than in placebo subgroups. Upon macroscopic examination, a significantly smaller burnt area in the statin-treated group was detected compared to the non-statin group on all days, except for day 3. Histopathological examination demonstrated higher levels of mean neutrophil infiltration in the placebo group (day 3). Finally, fibroblast proliferation, angiogenesis and re-epithelization levels were noted to be higher after the topical application of rosuvastatin.

Conclusions

Rosuvastatin accelerated wound healing and down-regulated TNF-α and PCT levels.

A National Mandate for Thermal Fuses for Home Oxygen Users is Cost-Effective in the Prevention of Burn Morbidity, Mortality, and Property Loss

Smoking while using home oxygen leads to explosions, which cause cutaneous burns, death, and loss of property. Thermal fuses interrupt the propagation of ignited oxygen lines and reduce the risk of injury. Prior to mandating thermal fuses for all home oxygen users in the United States, cost-effectiveness analysis should be performed. A Markov model was constructed for suffering a thermal injury while smoking on home oxygen. Societal and Medicare perspectives were adopted, evaluating the costs of a federal policy, including purchasing/shipping thermal fuses to all home oxygen users. Costs included the healthcare required to treat burn patients and extend lives in advanced chronic obstructive pulmonary disease. Cost savings included the avoided property loss. Effectiveness was measured in gains in quality adjusted life years (QALYs). In the status quo, the 10-year societal cost was $28.67 billion compared to $28.36 billion in the policy mandate (saving $305.40 million at 10 years). 1812 QALYs were gained with the policy mandate, yielding, and incremental cost-effectiveness ratio (ICER) of -$160 317. From the Medicare payor perspective, the ICER was $64 981. Deterministic and probabilistic sensitivity analyses showed little variation in the ICER under multiple scenarios. The discrepancy between the dominant ICER for a societal perspective and the cost-effective ICER for a Medicare perspective reflected savings from averted property loss not realized by Medicare. A national policy mandating and paying for thermal fuses for all home oxygen users is dominant from a societal perspective and cost-effective from a Medicare perspective. The US government should adopt such a policy.

Demoralization syndrome in burn patients: A cross-sectional study

AIMS

To investigate the status of demoralization syndrome and the factors affecting demoralization in burn patients.

METHODS

This study employed a cross-sectional research design and utilized a face-to-face questionnaire to gather data from adult burn patients with burn depths classified as second-degree or higher. The Demoralization Scale Mandarin Version, the Perceived Social Support Scale, the Herth Hope Index, and the Medical Coping Method Questionnaire were used to assess the level of demoralization, perceived social support, sense of hope, and coping strategies, respectively. General information, including socio-demographic data and disease characteristics, were collected. The patients' level of demoralization was categorized as the mean ± 1 standard deviation of the DS-MV scores. The data was analyzed using IBM SPSS 26.0 software to explore the relationship between the variables.

RESULTS

This study included 381 burn patients with a mean DS-MV score of 34.62 ± 18.319. Of these, 66 (17.3%) had mild demoralization, 241 (63.3%) had moderate demoralization, and 74 (19.4%) had severe demoralization. Cause of burn, total burn area, average monthly income of the individual, occupation, sense of hope, perceived social support, and medical coping strategies were the important factors associated with the severity of demoralization in burn patients.

CONCLUSIONS

Patients with burn injuries exhibit a notable prevalence and severity of demoralization indicating focused attention. By considering associated risk factors, healthcare professionals can devise and execute tailored intervention strategies aimed at mitigating the occurrence and intensity of demoralization in burn patients.

Factors influence the dignity of burns patients: A cross-sectional study

BACKGROUND

There is a high incidence of burns in China and the sequelae of post-burn scar growth, disfigurement, and other body image disorders can cause serious psychological distress to burns patients, and negatively affecting the patient's dignity. However, there is limited knowledge relating to the dignity of burns patients.

AIM

To investigate the factors that affect dignity in burns patients.

DESIGN

Cross-sectional study.

PARTICIPANTS AND RESEARCH CONTEXT

We recruited 323 burn patients from the burn unit of a tertiary care hospital. The Patient Dignity Scale, Burn Specific Health Scale-Brief, Hospital Anxiety and Depression Scale were used to assess burn patients' dignity, quality of life, anxiety, and depression, respectively. 18 sociodemographic variables were included in the questionnaire.

ETHICAL CONSIDERATIONS

Before the data were collected, the study protocol was reviewed and approved by the Ethics Committee of the Guangzhou Red Cross Hospital of Jinan University (Reference: 2022-149-02) and all patients provided and signed informed consent forms.

FINDINGS

This study included 323 burns patients; of these, 26 (8%) had a mild loss of dignity, 94 (29.1%) had a moderate loss of dignity, 125 (38.7%) had a severe loss of dignity, and 78 (24.1%) had a very severe loss of dignity. The main factors that influence the loss of dignity in burns patients, including the department in which the patient was treated after their burns, gender, the clinical stage of the burn, quality-of-life, depression, resident medical insurance, the cause of the burn, and the burn site.

CONCLUSIONS

In most cases, the loss of dignity after burn injury is serious. Clinical health care professionals can provide personalized whole-life dignity care for patients by considering the factors that affect the dignity of burns patients, developing targeted dignity management programs, and implementing individualized interventions to maintain dignity, thus helping burns injury patients return to social life and work.

The effects of acupressure on post-dressing pain in burn patients: A clinical randomized trial

BACKGROUND AND OBJECTIVES

Burns often cause severe pain, especially during dressing changes. This study aimed to investigate the effect of acupressure on pain during dressing changes in burn patients.

METHODS

This randomized clinical trial was conducted on 76 burn patients. The eligible patients were randomly assigned to the intervention and control groups after obtaining informed consent. Eligible patients were randomly assigned to the intervention and control groups by blocking. The study was conducted over two days using the same method. Before entering the dressing room, acupressure was performed in the intervention group for 10 min in acupressure points and the control group in other points. Pain intensity was measured in two groups 30 min before entering the dressing room and 15 and 30 min after leaving the dressing room using VAS. Finally, the data were analyzed using SPSS software 25th edition.

RESULTS

Pain scores were similar for the two groups before the dressing change. The results of this study revealed a significant decrease in the patient's pain intensity mean in the test group following acupressure compared to the control group on day one which remained on day two (P < 0.05).

CONCLUSION

Considering the experience of severe pain in burn patients, acupressure is recommended as a complementary method along with modern medicine to reduce these patients' pains.

Quality-Adjusted Life Years in Erythropoietic Protoporphyria and Other Rare Diseases: A Patient-Initiated EQ-5D Feasibility Study

Erythropoietic protoporphyria (EPP) is an ultra-rare inborn error of metabolism characterised by painful phototoxic burn injuries after short exposure times to visible light. Patients with EPP are highly adapted to their condition which makes the quantification of their health-related quality of life (QoL) challenging. In the presented patient-initiated feasibility study, we describe a new approach to assess treatment benefits in EPP by measuring QoL with the generic EQ-5D instrument in five patients under long-term (≥two years) treatment with afamelanotide, the first approved therapy for EPP. For the study, we selected patients with EPP who in addition were affected by an involuntary treatment interruption (caused by a temporary reimbursement suspension) because we hypothesized that individuals who had previously unlearned their adaptation are better able to assess their life without treatment than treatment-naïve patients. QoL under treatment was comparable to the age-matched population norm, and retrospective results for a treatment interruption and phototoxic reaction time point were comparable to the QoL of patients with chronic neuropathic pain and acute burn injuries, respectively. The results were accepted by the National Institute for Health and Care Excellence in England for their evaluation of the cost-effectiveness of afamelanotide, i.e., the calculation of quality-adjusted life years.

Admission Circulating Cell-Free DNA Levels as a Prognostic Factor in Pediatric Burns

Background

Burn injuries in children are a major physical and psychological trauma, often a severe condition with long-term consequences. Current methods of assessing the extent of burn injuries on admission are inaccurate. Circulating cell-free DNA (cfDNA) is a potential marker of tissue damage that may be useful in burn care.

Objective

To explore the use of cfDNA admission levels as a prognostic marker of pediatric burn severity and outcome.

Methods

cfDNA levels of 38 pediatric burn patients (otherwise healthy) and 12 matched pediatric controls (minor elective surgery patients) admitted to our center were quantified by a direct fluorometric assay.

Results

We found significantly higher admission cfDNA levels in the patient group (median 724 ng/ml, range 44-4405), compared to the control group (median 423 ng/ml, range 206-970, Mann–Whitney, P = 0.03) and a significant difference between cfDNA levels of partial-thickness burns (median 590 ng/ml, range 44-2909) and full-thickness burns (median 2394 ng/ml, range 528-4405, Mann–Whitney, P = 0.01). We also found significant correlations between cfDNA levels and hospitalization duration (Spearman, R = 0.42, P < 0.01) and undergoing surgical procedures (Spearman, R = 0.40, P < 0.01). PICU admission did not correlate to cfDNA levels (Spearman, R = 0.14, P = NS). Discussion. Admission cfDNA levels may be a valuable objective tool for assessing the severity of pediatric burn injuries on admission, including correlations with the length of hospitalization and surgical burden.

Conclusion

Admission cfDNA levels may be a promising novel pediatric burn assessment method. Further investigation of cfDNA levels in healthy children standardized to age and larger cohorts are needed to establish cfDNA as a valuable prognostic factor for pediatric burn injury.

Pre-Burn Health-Related Quality of Life: Patient and Partner Perspectives

A proxy-assessment of health-related quality of life (HRQL) may be an alternative for burn patients who are medically unable to self-report shortly after being admitted to the hospital. This study examined the patient-partner agreement on the recalled pre-injury HRQL of burn patients. In a multi-centre study of 117 patient-partner pairs, the recalled pre-burn HRQL was assessed with the EQ-5D-3L + Cognition during the acute phase following the burns. Agreement was evaluated with Kappa and ICC statistics. Burn severity and PTSD symptoms were assessed as potential predictors of disagreement. The results showed that pre-burn EQ-Index scores were similar to population norms, whereas the EQ Visual Analog Scale (EQ-VAS) scores of patients were significantly higher. Agreement varied across EQ-5D domains and, after adjusting for prevalence, was substantial to almost perfect. Average agreement on the EQ-Index and EQ-VAS was, respectively, substantial and moderate, but differences between partners were larger at lower levels of HRQL, and specifically in the pain/discomfort domain. Patient-partner differences could not be explained by the patient's age or gender, number of surgeries, partner's presence at the burn event, or post-traumatic stress disorder (PTSD) symptoms of either the patient or partner. In conclusion, patient-partner agreement is substantial and partner-proxy reports of pre-burn EQ-5D domains and EQ-Index scores may be used to complement or serve as a substitute for the patient's assessment. Given the moderate agreement on the EQ-VAS, it may be less suited for proxy assessment.