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Francalancia S, Mehta K, Shrestha R, Phuyal D, Bikash D, Yadav M, Nakarmi K, Rai S, Sharar S, Stewart BT, Fudem G. Consumer focus group testing with stakeholders to generate an enteral resuscitation training flipbook for primary health center and first-level hospital providers in Nepal. Burns 2024; 50:1160-1173. [PMID: 38472005 PMCID: PMC11116054 DOI: 10.1016/j.burns.2024.02.008] [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: 10/29/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Enteral resuscitation (EResus) is operationally advantageous to intravenous resuscitation for burn-injured patients in some low-resource settings. However, there is minimal guidance and no training materials for EResus tailored to non-burn care providers. We aimed to develop and consumer-test a training flipbook with doctors and nurses in Nepal to aid broader dissemination of this life-saving technique. MATERIALS AND METHODS We used individual cognitive interviews with Nepali (n = 12) and international (n = 4) burn care experts to define key elements of EResus and specific concepts for its operationalization at primary health centers and first-level hospitals in Nepal. Content, prototype illustrations, and wireframe layouts were developed and revised with the burn care experts. Subsequently, eight consumer testing focus groups with Nepali stakeholders (5-10 people each) were facilitated. Prompts were generated using the Questionnaire Appraisal System (QAS) framework. The flipbook was iteratively revised and tested based on consumer feedback organized according to the domains of clarity, assumptions, knowledge/memory, and sensitivity/bias. RESULTS AND DISCUSSION The flipbook elements were iterated until consumers made no additional requests for changes. Examples of consumer inputs included: clarity-minimize medical jargon, add shrunken organs and wilted plants to represent burn shock; assumptions-use locally representative figures, depict oral rehydration salts sachet instead of a graduated bottle; knowledge/memory-clarify complex topics, use Rule-of-9 s and depict approximately 20% total body surface area to indicate the threshold for resuscitation; sensitivity/bias-reduce anatomic illustration details (e.g. urinary catheter placement, body contours). CONCLUSION Stakeholder engagement, consumer testing, and iterative revision can generate knowledge translation products that reflect contextually appropriate education materials for inexperienced burn providers. The EResus Training Flipbook can be used in Nepal and adapted to other contexts to facilitate the implementation of EResus globally.
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Affiliation(s)
| | - Kajal Mehta
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Raslina Shrestha
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Diwakar Phuyal
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Das Bikash
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Manish Yadav
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Kiran Nakarmi
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Shankar Rai
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Sam Sharar
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA; Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Gary Fudem
- Department of Surgery, University of Washington, Seattle, WA, USA
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Hayavi-Haghighi MH, Alipour J. Applications, opportunities, and challenges in using Telehealth for burn injury management: A systematic review. Burns 2023; 49:1237-1248. [PMID: 37537108 DOI: 10.1016/j.burns.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/18/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Burns are global public health devastating and life-threatening injuries. Telehealth can be an appropriate answer for the effective utilization of health care resources, prevention referrals and reduce socio-economic burden of burns injuries. Thus, this study aimed to systematically evaluate the applications, opportunities, and challenges of using telehealth in burn injuries management. METHODS A structured search was conducted according to PRISMA statement guidelines in the Web of Science, PubMed, Scopus, and Science Direct as well as the Google Scholar for studies published until June 28, 2022. Of the total 2301 yielded studies, 36 articles were included in the final review. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis. RESULTS Patient triage, transfer, and referral (38.9%) follow-up (22%), care (22%), consultation (9%), education (3%), and rehabilitation (3%) were the most prevalent application of telehealth, respectively. Our findings identified 72 unique concepts, eight initial themes, and two clinical and administrative final themes for opportunities of using telehealth in burn injury management. Furthermore, we identified 27 unique concepts, three initial themes, and two clinical and administrative final themes for remaining challenges. CONCLUSIONS Despite providing pivotal opportunities such as improving burn injury diagnosis and quality of care, increasing patient and provider satisfaction, and cost containment using telehealth in burn injuries management, the concept faces challenges such as the impossibility of the physical examination of patients and technological difficulties. Our findings provide valuable information for policymakers and decision-makers infield of burn injuries and effective planning for using telehealth technology.
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Affiliation(s)
- Mohammad Hosein Hayavi-Haghighi
- Department of Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Jahanpour Alipour
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Gacto-Sánchez P, Molina-Morales J, Rodríguez-Vela F, Moreno-Conde J, Sendin-Martin M, Parra-Calderon C, Gomez-Cía T, Pereyra-Rodriguez JJ. Diagnostic accuracy of a telemedicine tool for acute burns diagnosis. Burns 2020; 46:1799-1804. [DOI: 10.1016/j.burns.2020.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
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Cherukupalli A, Duan N, Papp A. A third of referrals are unnecessary: Critical review of burn outpatient clinic data. Burns 2019; 45:805-817. [PMID: 31031020 DOI: 10.1016/j.burns.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/19/2019] [Accepted: 03/26/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study was to establish patterns in types of burns referred to the Outpatient Clinic (OP) at Vancouver General Hospital (VGH). METHODS A 2-year retrospective chart review was conducted of patients presenting to the OP Clinic from June 1, 2016 - June 1, 2018. Data collected included: patient demographics, depth of burn, Total Body Surface Area (TBSA), anatomical location of burn, geographical location of referral, and operative versus non-operative management. RESULTS The OP Clinic served 470 patients for burn injuries with a total of 1852 visits. Of these, 20% were follow-up visits post-admission, and 73.6% were primary referrals from the emergency department (ED) or elsewhere. The vast majority (69.6%) of burns were less than 5% TBSA. Half involved the hands (50.9%), and half were superficial dermal in depth (45.1%). A third of patients attended only one appointment with the OP Clinic before discharge and 15% did not receive any treatment. CONCLUSIONS The results of our study demonstrate gaps in current provincial referral guidelines leading to a significant number of "unnecessary referrals." Further research could correlate the results to current provincial referral guidelines to estimate their current efficacy in practical use.
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Affiliation(s)
- A Cherukupalli
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - N Duan
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - A Papp
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; Division of Plastic Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
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Martinez R, Rogers AD, Numanoglu A, Rode H. The value of WhatsApp communication in paediatric burn care. Burns 2018; 44:947-955. [PMID: 29395403 DOI: 10.1016/j.burns.2017.11.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Telemedicine is increasingly applied in developed settings to facilitate transfer of information to and from burn surgeons across vast geographic areas. WhatsApp is a widely available and extremely user-friendly encrypted smartphone application that does not require the expensive physical and personnel infrastructure that characterizes many of these telemedicine systems. The aim of this study was to review the use of WhatsApp to facilitate paediatric burn injury consultations to a regional burn centre in a developing country, where burn care continues to be thwarted by administrative apathy, poor resource allocation and lack of attention to medical and nursing education at all levels. METHODS A retrospective review was undertaken of all consultations using WhatsApp over an 18-month period, received by the burn centre's two senior medical practitioners. The specific origin and nature of the telemedicine requests for advice, transfer or follow-up were collected, as were data relating to the demographics of the patients, the aetiology, mechanism and extent of the burn injury. The impact of the system of communication in terms of reductions in admissions and clinic visits was assessed, and a cost analysis was undertaken. Feedback was also obtained from those health practitioners regularly using the service. RESULTS 838 communications occurred during the study period, which included 1562 distinct clinical queries. 486 interactions (58%) originated from within the hospital, the majority of which were initiated by surgeons in training or burn nurse practitioners. 352 (42%) consultations were from outside the hospital. Queries related to the full spectrum of burn care, including emergency management and stabilization, triage and transfer, the need for escharotomy, fluid resuscitation, wound care, the timing and nature of surgical intervention, as well as follow-up and rehabilitation. While no significant changes in the number of surgical interventions or admissions were observed when compared to the five years prior to the intervention, outpatient visits reduced significantly during the study period. It was estimated that over 150 unnecessary admissions were also avoided as a result of the triage made possible by WhatsApp, which translated into considerable cost saving for the institution. DISCUSSION Incorporating WhatsApp technology into the daily processes of burn care has significantly improved the quality of paediatric burn care referrals to specialist burn services. Specifically, WhatsApp has contributed to reductions in unnecessary referrals and outpatient visits, facilitated opportunities for continuing medical education, improved the care of major burn injuries through more effective prehospital communication, and enabled greater allocation of scarce specialist resources at the burn centre. This study motivates for the wider application of WhatsApp for burn care referrals, especially in developing countries.
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Affiliation(s)
- R Martinez
- The Burn Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; The Division of Paediatric Surgery, Department of Surgery, University of Cape Town, South Africa
| | - A D Rogers
- The Ross Tilley burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; The Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Canada.
| | - A Numanoglu
- The Burn Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; The Division of Paediatric Surgery, Department of Surgery, University of Cape Town, South Africa
| | - H Rode
- The Burn Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; The Division of Paediatric Surgery, Department of Surgery, University of Cape Town, South Africa
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Kuo LW, Yen CI, Fu CY, Pan CH, Hsu CP, Hsiao YC, Hsieh CH, Hsu YP. The role of preliminary hospitals in the management of a mass burn casualty disaster. Burns 2017; 44:800-806. [PMID: 29258727 DOI: 10.1016/j.burns.2017.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/19/2017] [Accepted: 11/30/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The Formosa Fun Coast explosion is an internationally-known event that occurred in Taiwan on June 27th, 2015. The blast involved 495 casualties in total, with 253 patients receiving 2nd degree or deeper burns on greater than 40% of the total body surface area (TBSA). Questions were raised regarding whether these victims were sent to the appropriate hospitals or not. Therefore, we analyzed the effect of the initial admission destination in this study. MATERIAL AND METHODS We retrospectively reviewed all of the victims from the explosion who were sent to the emergency department of Linkou and Keelung Chang Gung Memorial Hospitals. Patients were divided by direct admission and received via transfer. The basic demographics, the efficacy of the initial resuscitation and the clinical outcomes were analyzed. RESULTS In total, forty-six patients were included. Thirty-five of them were primarily admitted, and eleven of them were received via transfer. Between the two groups, there was no significant difference in the resuscitation outcome. The ratio of delaying intubation was similar (14.3% vs 27.3%, p=0.322). The rate of delayed-detected ischemic events was significantly increased in the referral group (0% vs 27.3%, p=0.001). However, there was no amputation event in either group. No difference in mortality was observed between groups (5.7% vs 9.1%, p=0.692). CONCLUSION Our preliminary findings suggest that local hospitals are capable of providing high-quality acute care to mass casualty burn victims. Our results suggest that patients with suspected limb ischemia should be rapidly transferred to a regional burn center to ensure optimal care. Systemic pre-planning such as employing telemedicine and personnel collaboration, should be considered by the administration to maximize the function of preliminary hospitals in burn care.
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Affiliation(s)
- Ling-Wei Kuo
- Chang Gung Memorial Hospital, Trauma and Critical Care Center, Linkou, Taoyuan, Taiwan
| | - Cheng-I Yen
- Chang Gung Memorial Hospital, Burn Center, Linkou, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Chang Gung Memorial Hospital, Trauma and Critical Care Center, Linkou, Taoyuan, Taiwan.
| | - Chun-Hao Pan
- Chang Gung Memorial Hospital, Department of Plastic & Reconstructive Surgery, Keelung, Taiwan
| | - Chih-Po Hsu
- Chang Gung Memorial Hospital, Trauma and Critical Care Center, Linkou, Taoyuan, Taiwan
| | - Yen-Chang Hsiao
- Chang Gung Memorial Hospital, Burn Center, Linkou, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Chang Gung Memorial Hospital, Trauma and Critical Care Center, Linkou, Taoyuan, Taiwan
| | - Yu-Pao Hsu
- Chang Gung Memorial Hospital, Trauma and Critical Care Center, Linkou, Taoyuan, Taiwan
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Kornhaber R, Rickard G, McLean L, Wiechula R, Lopez V, Cleary M. Burn care and rehabilitation in Australia: health professionals' perspectives. Disabil Rehabil 2017; 41:714-719. [PMID: 29207887 DOI: 10.1080/09638288.2017.1406009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To understand health professionals' perspectives of burn care and rehabilitation. DESIGN Qualitative and semi-structured interviews. SETTING Australian burn and rehabilitation units. PARTICIPANTS Twenty-two clinicians working in burns units across disciplines and healthcare settings. RESULTS The data portrayed the health professionals' perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care. CONCLUSION Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes. Implications for rehabilitation Burn care and rehabilitation remains a complex and challenging area of care. Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase. Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.
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Affiliation(s)
- Rachel Kornhaber
- a Faculty of Health, School of Health Sciences , University of Tasmania, Rozelle Campus , Sydney , Australia
| | - Greg Rickard
- b Faculty of Health , University of Tasmania, Rozelle Campus , Sydney , Australia
| | - Loyola McLean
- c Brain and Mind Centre, The University of Sydney , Sydney , Australia.,d Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School , The University of Sydney , Sydney , Australia.,e Sydney West and Greater Southern Psychiatry Training Network, Cumberland Hospital, Western Sydney Local Health District , Sydney , Australia.,f Consultation-Liaison Psychiatry, Royal North Shore Hospital , Sydney , Australia
| | - Rick Wiechula
- g Adelaide Nursing School, The University of Adelaide , South Australia , Australia.,h Centre for Evidence-Based Practice South Australia: A Joanna Briggs Institute Centre of Excellence , Adelaide , Australia
| | - Violeta Lopez
- i Alice Lee Centre for Nursing Studies, National University of Singapore , Singapore
| | - Michelle Cleary
- a Faculty of Health, School of Health Sciences , University of Tasmania, Rozelle Campus , Sydney , Australia
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Paul MA, Kamali P, Ibrahim AMS, Medin C, Lee BT, Lin SJ. Initial Assessment, Treatment, and Follow-Up of Minor Pediatric Burn Wounds in Four Patients Remotely: A Preliminary Communication. Telemed J E Health 2017; 24:379-385. [PMID: 29028413 DOI: 10.1089/tmj.2017.0115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Close, multidisciplinary collaboration with burn experts is the essential strategy to achieve the best functional and esthetic outcomes in burn wound treatment. Management of minor burn injuries, where no specialized care is available, might be challenging. One concept to achieve a fast and timely result is the application of telemedicine. The objective of this study was to assess and develop a simple telemedicine protocol, which can be applied globally. MATERIAL AND METHODS We present a pilot study based on a pediatric population of four patients with minor burns. Based on the severity and burn area, two cases of ambulant pediatric patients (mean 1% total body surface area, superficial and deep 2° burn) with minor burn injuries met study criteria and were enrolled. A pediatrician performed the initial assessment, followed by plastic surgery video consultation, using telephone's digital camera. Treatment protocols were designed to optimize outcomes. After the initial treatment phase, which took place at a nonteaching local hospital in Poland from January 1, 2014, to December 31, 2014, clinical follow-up was performed by a plastic surgeon via smartphone in the United States. RESULTS We have achieved complete burn wound resolution, in all patients, with no scarring and only minor discoloration. A simple, reproducible treatment protocol was designed to include dressing changes and additional outpatient visits. CONCLUSIONS Implementation of a telemedicine protocol allows for easy access to burn consultations, helps multidisciplinary collaboration, eases follow-ups, and shortens specialists' consult wait times. Real-time evaluation provides fast and flexible treatment, without long distance travels, for patients and their families. Telemedicine increases the frequency of follow-up, contributes to the esthetic outcome, and together with improved cost-effectiveness is beneficial for both the patient and healthcare system.
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Affiliation(s)
- Marek A Paul
- 1 Division of Plastic Surgery, Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, Massachusetts.,2 Department of Plastic Surgery, T. Marciniak Lower Silesian Specialist Hospital , Wroclaw, Poland
| | - Parisa Kamali
- 1 Division of Plastic Surgery, Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, Massachusetts
| | - Ahmed M S Ibrahim
- 3 Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center , New Orleans, Louisiana
| | - Caroline Medin
- 1 Division of Plastic Surgery, Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, Massachusetts
| | - Bernard T Lee
- 1 Division of Plastic Surgery, Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, Massachusetts
| | - Samuel J Lin
- 1 Division of Plastic Surgery, Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, Massachusetts
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Theurer L, Bashshur R, Bernard J, Brewer T, Busch J, Caruso D, Coccaro-Word B, Kemalyan N, Leenknecht C, McMillan LR, Pham T, Saffle JR, Krupinski EA. American Telemedicine Association Guidelines for Teleburn. Telemed J E Health 2017; 23:365-375. [DOI: 10.1089/tmj.2016.0279] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Lou Theurer
- Burn Telemedicine Program, Department of Telemedicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Rashid Bashshur
- School of Public Health, University of Michigan Health System, Ann Arbor, Michigan
| | | | | | | | - Daniel Caruso
- Burn Services, Arizona Burn Center, Phoenix, Arizona
| | | | | | | | | | - Tam Pham
- Harborview Burn Center, Seattle, Washington
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Smart phones make smart referrals. Burns 2017; 43:190-194. [DOI: 10.1016/j.burns.2016.07.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 11/18/2022]
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Hoseini F, Ayatollahi H, Salehi SH. systematized review of telemedicine applications in treating burn patients. Med J Islam Repub Iran 2016; 30:459. [PMID: 28491834 PMCID: PMC5419220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/19/2016] [Indexed: 11/17/2022] Open
Abstract
Background: Telemedicine has been used in different fields of medicine in the past 20 years. The main advantages of this technology include saving costs, improving quality of care, and increasing access to specialists. This study aimed to review telemedicine applications in treating burn patients. Methods: In this systematized review study, related papers were searched using various databases, including PubMed, Scopus, and Science Direct. The time frame was between January 2000 and March 2016; finally, 32 papers were included in the study. Results: The findings revealed that telemedicine was used in burn care in three different ways: Remote patient follow-up, teleconsultation, and patient assessment. Conclusion: It seems that telemedicine can be easily applied in treating burn patients even when there is a limited financial resource. The use of this technology can help reduce possible errors in categorizing burn patients and decrease patients' transportation and treatment costs.
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Affiliation(s)
- Frahang Hoseini
- MSc in Medical Informatics, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Haleh Ayatollahi
- Assistant Professor of Medical Informatics, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed Hamid Salehi
- Associate Professor of General Surgery, Iran University of Medical Sciences, Tehran, Iran.
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Gonçalves N, Ciol MA, Dantas RAS, Farina Junior JA, Rossi LA. A randomized controlled trial of an educational programme with telephone reinforcement to improve perceived health status of Brazilian burn victims at 6-month post discharge. J Adv Nurs 2016; 72:2508-23. [PMID: 27189899 DOI: 10.1111/jan.13003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to compare health status, self-efficacy, symptoms of depression and anxiety and post-traumatic stress between two groups of burn victims receiving information on self-care through routine care or an educational programme with telephone reinforcement. BACKGROUND Self-care post discharge is an important factor on quality of life of burn victims. Reinforcement of self-care programme via telephone follow-up might improve self-efficacy and general health perception in burn victims. DESIGN Randomized, controlled clinical trial. METHOD From 2011-2012, we randomized 108 burn victims either to an educational programme on self-care tailored for burn victims according to the cognitive social theory and reinforcement by telephone every 4-6 weeks for 6 months post discharge, or to the routine instructions given at discharge from the hospital. During hospitalization, at discharge, at 6 and 12 months post discharge, we collected data on socio-demographic characteristics, Burns Specific Health Scale Revised (BSHS-R), Perceived Self-Efficacy Scale (PSE), Hospital Anxiety and Depression Scales (HADS) and Impact of the Event Scale (IES). We analysed data using t-test, Chi-square test and linear regression models. RESULTS Groups were similar regarding clinical and demographic characteristics, except for age. At 6-month follow-up, there were no differences between the groups on BSHS-R, PSE and HADS Depression, while the intervention group showed fewer symptoms of anxiety (HADS Anxiety) and lower IES scores than the control group. CONCLUSION The educational programme, when compared with usual care, reduced anxiety symptoms and post-traumatic stress. Educational programmes with telephone follow-up might be a viable intervention to improve self-care for burn victims.
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Affiliation(s)
| | - Marcia Aparecida Ciol
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Jayme Adriano Farina Junior
- Division of Plastic Surgery and the Burn Unit at Hospital das Clínicas, Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Russell KW, Saffle JR, Theurer L, Cochran AL. Transition from grant funding to a self-supporting burn telemedicine program in the western United States. Am J Surg 2015; 210:1037-42; discussion 1042-4. [DOI: 10.1016/j.amjsurg.2015.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/17/2015] [Indexed: 11/28/2022]
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Finlay V, Phillips M, Allison GT, Wood FM, Ching D, Wicaksono D, Plowman S, Hendrie D, Edgar DW. Towards more efficient burn care: Identifying factors associated with good quality of life post-burn. Burns 2015; 41:1397-404. [PMID: 26233899 DOI: 10.1016/j.burns.2015.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/04/2015] [Accepted: 06/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. METHOD A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. RESULTS AND DISCUSSION Male gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (p<0.001) were significant predictors of good outcome at six months and beyond. A Receiver Operating Curve (ROC) analysis demonstrated excellent (90%) accuracy overall. At 80% probability of good outcome, the false positive risk was 14%. The nomogram was validated by running a second ROC analysis of the model in an independent cohort. The analysis confirmed high (86%) overall accuracy of the model, the risk of false positive was reduced to 10% at a lower (70%) probability. This affirms the stability of the nomogram model in different patient groups over time. An investigation of the effect of missing data on sample selection determined that a greater proportion of younger patients with smaller TBSA burns were excluded due to loss to follow up. CONCLUSION For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery.
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Affiliation(s)
- V Finlay
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia.
| | - M Phillips
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - G T Allison
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - F M Wood
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D Ching
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D Wicaksono
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - S Plowman
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia
| | - D Hendrie
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D W Edgar
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Abstract
The 21st century burn care team epitomises integrated multidisciplinary care. The physical, psychological and socials needs of burn victims necessitates the close collaboration of a broad spectrum of health care professionals. The ultimate aim is to return the patient to the optimal level of physical and psychological health and social function. The modern burn care team must not only consider the staffing and structure of the team, but also the way in which the team is to be delivered to the patient. Furthermore, the 21st century burn care team must be willing to adapt and evolve during the likely NHS re-structuring that will come with the Health and Social Care Act 2012, as well as integrate with the new UK trauma networks. This paper discusses the staffing and structure of the 21st century burn care team along with the future challenges and opportunities it may be presented with.
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Affiliation(s)
- Daniel P Butler
- Department of Plastic and Reconstructive Surgery, Guy's and St Thomas' Hospital, London SE1 7EH, United Kingdom.
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Engrav LH, Heimbach DM, Rivara FP, Kerr KF, Osler T, Pham TN, Sharar SR, Esselman PC, Bulger EM, Carrougher GJ, Honari S, Gibran NS. Harborview burns--1974 to 2009. PLoS One 2012; 7:e40086. [PMID: 22792216 PMCID: PMC3390332 DOI: 10.1371/journal.pone.0040086] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/31/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Burn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess of the Baxter formula began and to identify potential causes, and 4) model mortality over time, during a 36-year period (1974-2009) at the Harborview Burn Center in Seattle, WA, USA. METHODS AND FINDINGS 14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Many changes are highlighted at the end of the manuscript including 1) the large increase in numbers of total and short-stay admissions, 2) the decline in numbers of large burn injuries, 3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, 4) that race/ethnicity and payer status disparity exists, and 5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation and opioids may be involved. CONCLUSIONS 1) The dramatic changes include the rise in short-stay admissions; as a result, the model of burn care practiced since the 1970s is still required but is no longer sufficient. 2) Fluid administration in excess of the Baxter formula with uncomplicated injuries began at least two decades ago. 3) Unadjusted case fatality declined to ∼6% in the mid-1980s and changed little since then. The rBaux mortality model is quite accurate.
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Affiliation(s)
- Loren H Engrav
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, United States of America.
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Wallace D, Hussain A, Khan N, Wilson Y. A systematic review of the evidence for telemedicine in burn care: With a UK perspective. Burns 2012; 38:465-80. [DOI: 10.1016/j.burns.2011.09.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 08/18/2011] [Accepted: 09/21/2011] [Indexed: 01/18/2023]
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A Rationale for Significant Cost Savings in Patients Suffering Home Oxygen Burns. J Burn Care Res 2012; 33:e268-74. [DOI: 10.1097/bcr.0b013e3182504487] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Holt B, Faraklas I, Theurer L, Cochran A, Saffle JR. Telemedicine Use Among Burn Centers in the United States. J Burn Care Res 2012; 33:157-62. [DOI: 10.1097/bcr.0b013e31823d0b68] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vercruysse GA, Ingram WL, Feliciano DV. Overutilization of regional burn centers for pediatric patients—a healthcare system problem that should be corrected. Am J Surg 2011; 202:802-8; discussion 808-9. [DOI: 10.1016/j.amjsurg.2011.06.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 11/16/2022]
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Use of telemedicine and telephone consultation in decision-making and follow-up of burn patients: Initial experience from two burn units. Burns 2011; 37:415-9. [DOI: 10.1016/j.burns.2010.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 10/12/2010] [Accepted: 10/13/2010] [Indexed: 11/23/2022]
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The demographics of modern burn care: should most burns be cared for by non-burn surgeons? Am J Surg 2011; 201:91-6. [DOI: 10.1016/j.amjsurg.2009.12.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 12/01/2009] [Accepted: 12/01/2009] [Indexed: 11/18/2022]
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