1
|
Goh E, Press I, Anquandah J, White P, Pleat J. Changes in attitudes towards telemedicine in acute burn care following the Covid-19 pandemic. Burns 2024:S0305-4179(24)00150-5. [PMID: 38789335 DOI: 10.1016/j.burns.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Telemedical referrals after burn injury had been shown to be advantageous over telephone referrals for multiple reasons, however there were several key barriers towards complete implementation. The Covid-19 pandemic facilitated the adoption of telemedicine to ensure the safety of both clinicians and patients. Due to the circumstances, it was unclear whether the pre-pandemic barriers still existed despite the complete implementation of telemedicine. This study aims to evaluate clinicians' views about the barriers towards implementation of a specific telemedicine system for burns referrals, and their changing attitudes following the pandemic, to identify key domains for improvement in current and future telemedicine systems. METHODS A questionnaire was created to evaluate the attitudes of referring clinicians towards telemedicine, following literature searches and administration of a pilot questionnaire. This was administered via telephone to staff working in EDs and MIUs which referred to the South-West United Kingdom Burns Network using the Medical Data Solutions and Services (MDSAS) system, in both 2019 and 2022. A statistical analysis was performed to compare the attitudes of clinicians towards telemedicine both pre- and post-pandemic. RESULTS 100 respondents completed the survey in 2019 and 70 in 2022, with similar demographics of respondents. Out of the twelve barriers identified, the lack of reliable Wi-Fi and need to duplicate notes were identified as the main obstacles to implementation in both time periods. In both years, the single greatest barrier reported was poor access to reliable Wi-Fi (p = 0.944). Miscommunication between clinicians using the system, inadequate numbers of devices and financial constraints were identified less frequently as barriers in 2022 than 2019 (p = 0.005, p = 0.047 and p < 0.001 respectively). However, significantly more respondents reported time pressures when waiting for a response to their telemedicine referral in 2022 (p = 0.022). CONCLUSION Overall, clinicians displayed a positive attitude towards the MDSAS system for acute burns, with clinicians identifying fewer concerns with the system following the Covid-19 pandemic. However, concerns over the time pressures that this telemedicine system places on the referring clinician and existing Wi-Fi infrastructure persist. Further streamlining of the system and investment in internet access is recommended, with continued input from all stakeholders.
Collapse
Affiliation(s)
- Esther Goh
- Department of Plastic Surgery, Aberdeen Royal Infirmary, UK
| | - Isobel Press
- College of Medical and Dental Sciences, University of Birmingham, UK
| | - Jason Anquandah
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
| | - Paul White
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
| | | |
Collapse
|
2
|
Roy S, Mukherjee P, Kundu S, Majumder D, Raychaudhuri V, Choudhury L. Microbial infections in burn patients. Acute Crit Care 2024; 39:214-225. [PMID: 38863352 PMCID: PMC11167422 DOI: 10.4266/acc.2023.01571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/16/2024] [Accepted: 03/27/2024] [Indexed: 06/13/2024] Open
Abstract
Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.
Collapse
Affiliation(s)
- Souvik Roy
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Preeti Mukherjee
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Sutrisha Kundu
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Debashrita Majumder
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Vivek Raychaudhuri
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Lopamudra Choudhury
- Department of Microbiology, Sarsuna College (under Calcutta University), Kolkata, India
| |
Collapse
|
3
|
Amado V, Trott S, Möller J, Couto MT, Wallis L, Laflamme L. Changing patterns in the burden of paediatric injuries during the COVID-19 pandemic: a study in Mozambique's central hospitals. BMC Health Serv Res 2023; 23:1071. [PMID: 37803444 PMCID: PMC10559493 DOI: 10.1186/s12913-023-10073-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION There is a substantial body of knowledge on the effects of the COVID-19 pandemic on injuries showing frequent but inconsistent reductions in both volume and pattern. Yet, studies specifically addressing children are less common, not least from low- and middle-income countries. This study investigated whether changes in the pattern and outcome of paediatric injury admissions to Mozambique's four regional referral hospitals during 2020. METHODS Clinical charts of paediatric patients presenting to the targeted hospitals with acute injuries were reviewed using a set of child, injury, and outcome characteristics during each of two consecutive restriction periods in 2020 using as a comparator the same periods in 2019, the year before the pandemic. Differences between 2020 and 2019 proportions for any characteristic were examined using the t-test (significance level 0.05). RESULTS During both restriction periods, compared with the previous year, reductions in the number of injuries were noticed in nearly all aspects investigated, albeit more remarkably during the first restriction period, in particular, greater proportions of injuries in the home setting and from burns (7.2% and 11.5% respectively) and a reduced one of discharged patients (by 2.5%). CONCLUSION During the restrictions implemented to contend the pandemic in Mozambique in 2020, although each restriction period saw a drop in the volume of injury admissions at central hospitals, the pattern of child, injury and outcome characteristics did not change much, except for an excess of home and burn injuries in the first, more restrictive period. Whether this reflects the nature of the restrictions only or, rather, other mechanisms that came into play, individual or health systems related, remains to be determined.
Collapse
Affiliation(s)
- Vanda Amado
- Department of Global Public Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
- Maputo Central Hospital, Maputo, Mozambique.
| | - Sebastien Trott
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jette Möller
- Department of Global Public Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Maria Tereza Couto
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Medical Council Maputo, Maputo, Mozambique
| | - Lee Wallis
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lucie Laflamme
- Department of Global Public Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Institute for Social and Health Sciences, University of South Africa, Pretoria, South Africa
| |
Collapse
|
4
|
Bhaumik S, Beri D, Zwi AB, Jagnoor J. Snakebite care through the first two waves of COVID-19 in West Bengal, India: a qualitative study. Toxicon X 2023; 18:100157. [PMID: 37089517 PMCID: PMC10091724 DOI: 10.1016/j.toxcx.2023.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
Snakebite is a public health problem in many countries, with India having the highest number of deaths. Not much is known about the effect of the COVID-19 pandemic on snakebite care. We conducted 20 in-depth interviews with those bitten by venomous snakes through the two waves of COVID-19 (March-May 2020; May-November 2021), their caregivers, health care workers and social workers in two areas (Sundarbans and Hooghly) of West Bengal, India. We used a constructivist approach and conducted a thematic analysis. We identified the following themes: 1. Snakebite continued to be recognised as an acute emergency during successive waves of COVID-19; 2. COVID-19 magnified the financial woes of communities with high snakebite burden; 3. The choice of health care provider was driven by multiple factors and consideration of trade-offs, many of which leaned toward use of traditional providers during COVID-19; 4. Rurality, financial and social disadvantage and cultural safety, in and beyond the health system, affected snakebite care; 5. There is strong and shared felt need for multi-faceted community programs on snakebite. We mapped factors affecting snakebite care in the three-delay model (decision to seek care, reaching appropriate health facility, receiving appropriate care), originally developed for maternal mortality. The result of our study contextualises and brings forth evidence on impact of COVID-19 on snakebite care in West Bengal, India. Multi-faceted community programs, are needed for addressing factors affecting snakebite care, including during disease outbreaks - thus improving health systems resilience. Community programs for increasing formal health service usage, should be accompanied by health systems strengthening, instead of an exclusive focus on awareness against traditional providers.
Collapse
Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Injury Division, The George Institute for Global Health, New Delhi, India
| | - Deepti Beri
- Injury Division, The George Institute for Global Health, New Delhi, India
| | - Anthony B Zwi
- School of Social Sciences, University of New South Wales, Sydney, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Injury Division, The George Institute for Global Health, New Delhi, India
| |
Collapse
|
5
|
Handayani E, Wahyuningtyas ES, Nugroho HP. A scoping review of burn care in Southeast Asia. Br J Community Nurs 2023; 28:S24-S34. [PMID: 36809899 DOI: 10.12968/bjcn.2023.28.sup3.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Non-fatal burns are a major cause of morbidity, with incidents often occuring at home and at work. Almost all burn cases occur in the WHO region, precisely in African and Southeast Asian countries. Yet, the epidemiology of these injuries, especially in the WHO-defined Southeast Asian Region, has yet to be adequately defined. METHOD A scoping review of the literature was performed to identify epidemiology of thermal, chemical, and electrical burns in the WHO-defined Southeast Asian Region. The database search screened 1023 articles in total, of which 83 articles were assessed for eligibility at a full-text level, and 58 of these were excluded. Therefore, 25 full-text articles were included for data extraction and analysis. RESULTS Data analysed included demographics, injury details, burn mechanism, total body surface area burned, and in-hospital mortality. CONCLUSION Despite the steady increase on burns research, the Southeast Asian region is still limited in terms of burns data. This scoping review has shown that the largest set of articles on burns come from Southeast Asia, indicating the importance of reviewing data at a regional or local level, as global studies tend to be dominated by data from high-income countries.
Collapse
Affiliation(s)
- Estrin Handayani
- Nursing Lecturer at the Department of Medical Surgical Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia.,Wound Study Center (WOSCE), Magelang, Indonesia
| | - Eka Sakti Wahyuningtyas
- Nursing Lecturer at the Department of Medical Surgical Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia.,Wound Study Center (WOSCE), Magelang, Indonesia
| | - Hananto Ponco Nugroho
- Nursing Lecturer at the Department of Medical Surgical Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia
| |
Collapse
|
6
|
Plaza A, Paratz J, Cottrell M. A six-week physical therapy exercise program delivered via home-based telerehabilitation is comparable to in-person programs for patients with burn injuries: A randomized, controlled, non-inferiority clinical pilot trial. Burns 2023; 49:55-67. [PMID: 36115795 DOI: 10.1016/j.burns.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Exercise programmes are essential for burn rehabilitation, however patients often have barriers accessing these services. Home-based telerehabilitation (HBT) may be an alternative. This study aimed to determine if exercise programs delivered via HBT were as effective as in-person (IP) programs with respect to clinical outcomes and participant and therapist satisfaction. METHODS A single center, randomized, controlled, non-inferiority pilot trial with blinded assessment was undertaken. Forty-five adults with ≤ 25% total body surface area (TBSA) burns were randomized to receive a 6-week exercise program delivered either by HBT or IP. The primary outcome was burn-specific quality of life (Burn Specific Health Scale - Brief). Secondary outcomes included health-related quality of life, burn scar-specific outcomes, exercise self-efficacy, pain severity, muscle strength and range of motion (ROM). Participant and therapist satisfaction, technical disruptions and adverse events were also recorded. RESULTS We found no significant within- or between-group differences for any outcome measures except ROM. Achievement of full ROM was significantly different between groups at Week 12 (IP=100% vs HBT=70%, p = 0.005). Non-inferiority was inconclusive. Participant satisfaction was high (median ≥ 9.8/10), with no significant between-group differences. Therapist satisfaction was high (median ≥ 8.9/10), major technical disruptions low (8%) and no adverse events reported. CONCLUSION HBT is a safe, effective option to deliver exercise programs for patients with burn injuries ≤ 25% TBSA with comparable clinical outcomes to in-person programmes. Ongoing research is required to further analyze ROM and investigate the effectiveness of HBT for patients with larger burns.
Collapse
Affiliation(s)
- Anita Plaza
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia; Professor Stuart Pegg Adult Burn Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
| | - Jennifer Paratz
- Physiotherapy Department, Griffith University, Brisbane, QLD 4222, Australia
| | - Michelle Cottrell
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| |
Collapse
|
7
|
Enzymatic Debridement in Severe Burn COVID-19 Patients: A Case Series. Plast Reconstr Surg Glob Open 2023; 11:e4808. [PMID: 36714389 PMCID: PMC9875794 DOI: 10.1097/gox.0000000000004808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/14/2022] [Indexed: 01/26/2023]
Abstract
The presence of a high number of positive SARS-CoV-2 patients is found daily in the emergency room database, finding evidence of infection also in trauma and burns. Surgical debridement remains the gold standard for eschar removal, but it does not come without complications such as bleeding and high heat loss. In recent years, there has been an increase in the use of enzymatic debridement techniques, replacing surgical escharotomy. Early eschar removal is proven to be important; it has been proved that an early and effective burn treatment in COVID-19 patients can reduce other infection. Five clinical cases of patients arrived at our COVID-19 Major Burns Intensive Care Unit. On admission, burns extension and depth were assessed by an expert burn surgeon. We evaluated eschar removal modality, adverse events, and potential side effects. Enzymatic debridement was efficient in all patients treated with complete eschar removal, and no serious adverse events. All patients were treated within 24 hours of arrival at our facility with Nexobrid by specialized personnel in deep sedation and with O2 support using a face mask or nasal goggles. The use of enzymatic debridement in COVID-19-positive burn patients within dedicated pathways through nonsurgical treatment optimizes the treatment time. We believe that the use of enzymatic debridement could be a valid therapeutic option in burn patients, even with SARS-CoV-2 infection, and its use, when indicated, is safe and effective for the patient and optimizes the use of instrumental and human resources in a pandemic emergency.
Collapse
|
8
|
Zeng Z, Li N, Yang L, Feng X, Zuo F, Luo G, Peng Y, Yuan Z. Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study. Front Public Health 2023; 10:1052293. [PMID: 36699890 PMCID: PMC9868295 DOI: 10.3389/fpubh.2022.1052293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Background Severe burn injury can be a life-threatening experience and can also lead to financial issues for suffers. The purpose of the current study was to analyze the direct hospitalization costs of severe burn inpatients in Southwest China. Methods Data related to all inpatients admitted with severe burns [total body surface area (TBSA) ≥30%] pooled from 2015 to 2021 were reviewed retrospectively at the Institute of Burn Research of Army Medical University. Demographic parameters, medical economics, and clinical data were obtained from medical records. Results A total of 668 cases were identified. The average age was 37.49 ± 21.00 years, and 72.3% were men. The average TBSA was 51.35 ± 19.49%. The median length of stay of inpatients in the burn intensive care unit was 14 [interquartile range (IQR): 5.0-34.8] days, and the median length of stay (LOS) was 41 (IQR: 22.0-73.8) days. The mortality rate was 1.6%. The median total cost was 212,755.45 CNY (IQR: 83,908.80-551,621.57 CNY) per patient varying from 3,521.30 to 4,822,357.19 CNY. The direct cost of scald burns was dramatically lower compared with that of other types of burns, with 11,213.43 to 2,819,019.14 CNY. Medical consumables presented the largest portion of total costs, with a median cost of 65,942.64 CNY (IQR: 18,771.86-171,197.97 CNY). The crucial risk factors for medical cost in our study were TBSA, surgical frequency, LOS, depth of burn, and outcome. Conclusion We conclude that an effective burn prevention program, shorter hospital stays, and facilitating the healing of wounds should be focused on with tailored precautionary protocols to reduce the medical costs of inpatients with severe burns.
Collapse
|
9
|
Ries M. Global key concepts of civil-military cooperation for disaster management in the COVID-19 pandemic-A qualitative phenomenological scoping review. Front Public Health 2022; 10:975667. [PMID: 36187698 PMCID: PMC9521329 DOI: 10.3389/fpubh.2022.975667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/15/2022] [Indexed: 01/25/2023] Open
Abstract
Background In the context of a holistic and comprehensive disaster response effort to the COVID-19 pandemic, many countries across the globe mobilized their military forces in order to cope with sudden and exponential surges of critically ill patients with COVID-19 in stretched healthcare systems. Objective The purpose of this work is to identify, map, and render world-wide key concepts of civil-military cooperation (CIMIC) in disaster management during the COVID-19 crisis visible. Material and methods Literature was systematically searched in three databases (PubMed, Web of Science, Cochrane Library) on 26 January 2022, and analyzed with qualitative, mixed narrative-phenomenological methods in compliance with PRISM-ScR and SRQR. Results Forty-five publications were included in the analysis; pertinent authors were from 22 countries covering five continents. We identified three key thematic clusters in the published literature: Cluster (1) Medico-scientific contributions with the participation of military medical personnel or institutions: members of the military acted as subject matter experts, clinical and experimental (co-) investigators as well as co-founders for enabling COVID-19 relevant research. Areas covered were relevant to the COVID-19 patient's clinical journey from prevention, exposure, diagnostics, and treatment and included pertinent fields such as digital health and telemedicine, global and public health, critical care, emergency and disaster medicine, radiology, neurology, as well as other medical specialties, i.e., respiratory care, pulmonology, burn medicine, and transfusion medicine, in addition to environmental and occupational sciences as well as materials science. Cluster (2) CIMIC field experiences or analyses included areas such as political framework, strategy, structure, nature of civil-military interaction, and concrete mission reports in selected countries. Themes covered a broad spectrum of pandemic disaster management subjects such as capacity and surge capacity building, medical and pharmaceutical logistics, patient care under austere circumstances, SARS-CoV-2 testing support, intelligent and innovative information management, vaccination support, and disaster communication. Cluster (3) The military as a role model for crisis management. Conclusion Civil-military cooperation made a significant contribution to the level of resilience in crisis management on a global scale, positively impacting a broad spectrum of core abilities during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Markus Ries
- Pediatric Neurology and Metabolic Medicine, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Center for Virtual Patients, Medical Faculty, University of Heidelberg, Heidelberg, Germany
- CIMIC District Liaison Command Heidelberg, 3rd Medical Regiment, German Federal Armed Forces, Dornstadt, Germany
| |
Collapse
|
10
|
Gallaher J, Abid M, Kayange L, Purcell L, Charles A. The effect of COVID-19 on burn management and outcomes in a resource-limited setting. Burns 2022; 48:1584-1589. [PMID: 36038452 PMCID: PMC9375248 DOI: 10.1016/j.burns.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
Introduction Optimal burn care includes fluid resuscitation and early excision and grafting. During the COVID-19 pandemic, resource-constrained environments were susceptible to interruptions in burn care. We sought to characterize pre- and intra-pandemic burn-associated outcomes at a busy tertiary hospital in Malawi. Methods This is a retrospective analysis of burn patients that presented to Kamuzu Central Hospital Lilongwe from 2011 through December 2021. We compared patients based on whether they presented pre- or intra-pandemic, starting on March 11, 2020, the date of official WHO designation. Comparing these cohorts, we used modified Poisson modeling to estimate the adjusted risk of undergoing an operation and the risk of death. Results We included 2969 patients, with 390 presenting during the pandemic. Patient factors were similar between the cohorts. More patients underwent surgery pre-pandemic (21.1 vs 10.3 %, p < 0.001) but crude mortality was similar at 17.3 % vs. 21.2 % (p = 0.08). The RR of undergoing surgery during the pandemic was 0.45 (95 % CI 0.32, 0.64) adjusted for age, sex, % TBSA, flame burns, and time to presentation. During the pandemic, the risk ratio for in-hospital mortality was 1.23 (95 % CI 1.01, 1.50) adjusted for age, sex, % TBSA, surgical intervention, flame burns, and time to presentation. Conclusions During the pandemic, the probability of undergoing burn excision or grafting was significantly lower for patients, independent of the severity. Consequently, the adjusted risk of mortality was higher. To improve patient outcomes, efforts to preserve operative capacity for burn patients during periods of severe resource constraint are imperative.
Collapse
Affiliation(s)
- Jared Gallaher
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Mustafa Abid
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Linda Kayange
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Laura Purcell
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| |
Collapse
|
11
|
Kiyozumi T, Saitoh D, Ogura T, Morino K, Takeda T, Narumi A, Hashimoto I, Sasaki J, Sakurai H. Impact of COVID-19 pandemic on the care of severe burns in Japan: Repeated survey of specialized burn care facilities. Burns 2022; 49:934-940. [PMID: 35787968 PMCID: PMC9225939 DOI: 10.1016/j.burns.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
Background The spread of coronavirus disease 2019 (COVID-19), which began in 2020, has had a major impact on healthcare systems. The spread of COVID-19 has been reported to have affected the readiness to treat patients with burns worldwide. However, the existing reports have evaluated burn care status within a limited time period during the pandemic, and no report clarifies the change in the impact of infection status on burn care from the beginning of the pandemic to the present. Methods Japanese Society for Burn Injuries–accredited burn care facilities were surveyed using questionnaires on April 9–23, 2020; June 23–July 6, 2020; July 9–21, 2021; and January 21–31, 2022. Differences between groups were evaluated using Friedman’s test or Bonferroni’s multiple comparison test, as appropriate. Results From the 103 facilities included in the study, we received 85, 55, 56, and 58 responses in the first, second, third, and fourth surveys, respectively. We could continuously observe 34 facilities. The rate of acceptance of patients with severe burns improved significantly over time (P < 0.05). However, in the second and third surveys, there was an increase in the number of respondents who did not accept patients with burns irrespective of COVID-19 status. Conclusions The number of facilities treating patients with burns who have COVID-19 is increasing; however, COVID-19 care may negatively impact routine burn care. It is necessary to continuously examine medical resource allocation through methods such as information sharing by academic societies.
Collapse
Affiliation(s)
- Tetsuro Kiyozumi
- Department of Defense Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama Prefecture, Japan.
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, Department of Traumatology and Critical Care, Hospital, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, Japan
| | - Takayuki Ogura
- Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation SAISEIKAI, Utsunomiya Hospital, Takebayashi-Machi 911-1, Utsumomiya, Tochigi, Japan
| | - Kazuma Morino
- Yamagata Prefectural Central Hospital, Aoyagi, Yamagata city, Yamagata prefecture 990-2292, Japan
| | - Taichi Takeda
- Koga-Bando Clinical Education and Training Center, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Atsushi Narumi
- Youmeikai Obase Hospital, Aratsu 1589, Miyako-Gun, Fukuoka Prefecture, Japan
| | - Ichiro Hashimoto
- Tokushima University Graduate School of Medicine, Department of Plastic and Reconstructive Surgery, 18-15 3Chome Kuramoto-cho, Tokushima, Japan
| | - Junichi Sasaki
- Department of Emergency & Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
12
|
|
13
|
Miranda AE, Rosadas C, Assone T, Pereira GFM, Vallinoto ACR, Ishak R. Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis of the Implementation of Public Health Policies on HTLV-1 in Brazil. Front Med (Lausanne) 2022; 9:859115. [PMID: 35462992 PMCID: PMC9021745 DOI: 10.3389/fmed.2022.859115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Human T lymphotropic virus 1 (HTLV-1) is a public health issue for most countries and imposes important consequences on patients' health and socioeconomic status. Brazil is one of the global leaders of the public health response to these viruses. The country has challenges to overcome to implement meaningful policies aiming to eliminate HTLV-1/2. An analysis of strengths, weaknesses, opportunities, and threats (SWOT) for the implementation of public health policies on HTLV-1/2 was performed. The strengths identified were the Brazilian Unified Health System (SUS); Brazilian expertise in public health programs successfully implemented; currently available policies targeting HTLV; and strong collaboration with researchers and patient's representative. Lack of awareness about HTLV, insufficient epidemiological data, lack of reference centers for patient care, insufficient availability of confirmatory tests, lack of universal antenatal screening, and absence of cost-effectiveness studies were identified as weaknesses. Some interesting opportunities included the increased interest from international organizations on HTLV, possibility of integrating HTLV into other programs, external funding for research, available online platforms, opportunity to acquire data from HTLV-1/2 surveillance to gather epidemiological information, and HTLV policies that were implemented independently by states and municipalities. In addition to the COVID-19 pandemic, existing demands from different diseases, the country's demography and its marked sociocultural diversity and the volatility of the technical team working with HTLV-1/2 at the Brazilian Ministry of Health are threats to the implementation of public policies on HTLV-1/2. This SWOT analysis will facilitate strategic planning to allow continuous progress of the Brazilian response to HTLV-1/2 infection.
Collapse
Affiliation(s)
- Angelica Espinosa Miranda
- Departamento de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
- Departamento de Medicina Social, Universidade Federal do Espírito Santo, Vitória, Brazil
- *Correspondence: Angelica Espinosa Miranda
| | - Carolina Rosadas
- Section of Virology, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Tatiane Assone
- Departamento de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
- Laboratório de Investigação Médica em Neurologia, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Universidade São Paulo, São Paulo, Brazil
| | - Gerson Fernando Mendes Pereira
- Departamento de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
| | | | - Ricardo Ishak
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| |
Collapse
|