Recent alcohol intake impacts microbiota in adult burn patients

Alcohol use is associated with an increased incidence of negative health outcomes in burn patients due to biological mechanisms that include a dysregulated inflammatory response and increased intestinal permeability. This study used phosphatidylethanol (PEth) in blood, a direct biomarker of recent alcohol use, to investigate associations between a recent history of alcohol use and the fecal microbiota, short chain fatty acids, and inflammatory markers in the first week after a burn injury for nineteen participants. Burn patients were grouped according to PEth levels of low or high and differences in the overall fecal microbial community were observed between these cohorts. Two genera that contributed to the differences and had higher relative abundance in the low PEth burn patient group were Akkermansia, a mucin degrading bacteria that improves intestinal barrier function, and Bacteroides, a potentially anti-inflammatory bacteria. There was no statistically significant difference between levels of short chain fatty acids or intestinal permeability across the two groups. To our knowledge, this study represents the first report to evaluate the effects of burn injury and recent alcohol use on early post burn microbiota dysbiosis, inflammatory response, and levels of short chain fatty acids. Future studies in this field are warranted to better understand the factors associated with negative health outcomes and develop interventional trials.

Strategies and Challenges of a Safe Fireplace Program in Rural Kenya: A Qualitative Study

There is a lack of information on effective burn prevention strategies. The objective of this study was to examine a safe fireplace program, as a method of burn prevention, in a resource-limited setting. We conducted a qualitative, phenomenological study at a community health and development program for a rural population in Kenya. Semi-structured, in-depth interviews were conducted with a purposive sample of community health workers involved with the safe fireplace program. Data were reviewed iteratively and coded independently by two researchers using NVivo 12. The study included five participants. Reflections from participants fell into three main domains: (1) effective methods of education, (2) strategies to incorporate stakeholders, and (3) implementation challenges. The results of this study emphasize the importance of community engagement in implementing a successful burn injury prevention program in a resource-limited setting. The participants involved in this study reported that rather than focusing on resources outside the community, effective methods of education and strategies for incorporating stakeholders depended on involving peers and community leaders. The challenges to the program were similarly specific to community concerns about resources and maintenance. These findings provide information to guide future community health programs in creating successful models for burn prevention strategies in resource-limited areas.

Never events in plastic surgery: An analysis of surgical burns and medical malpractice litigation

INTRODUCTION

Burns and fires in the operating room are a known risk and their prevention has contributed to many additional safety measures. Despite these safeguards, burn injuries contribute significantly to the medical malpractice landscape. The aim of the present study is to analyze malpractice litigation related to burn and fire injuries in plastic and reconstructive surgery, identify mechanisms of injury, and develop strategies for prevention.

METHODS

The Westlaw and LexisNexis databases were queried for jury verdicts and settlements in malpractice lawsuits related to burn and fire injuries that occurred during plastic surgery procedures. The Boolean terms included "burn & injury & plastic", "fire & injury & "plastic surg!"" in Westlaw, and "burn & injury & "plastic surg!"", "fire & injury & "plastic surg!"" in LexisNexis.

RESULTS

A total of 46 cases met the inclusion criteria for this study. Overheated surgical instruments and cautery devices were the most common mechanisms for litigation. Plastic surgeons were defendants in 40 (87%) cases. Of the included cases, 43% were ruled in favor of the defendant, while 33% were ruled in favor of the plaintiff. Mishandling of cautery devices 6 (13%), heated surgical instruments 6 (13%), and topical acids 2 (4%) were the most common types of errors encountered.

CONCLUSION

Never events causing burn injury in plastic and reconstructive surgery are ultimately caused by human error or neglect. The misuse of overheated surgical instruments and cauterizing devices should be the focus for improving patient safety and reducing the risk of medical malpractice. Forcing functions and additional safeguards should be considered to minimize the risk of costly litigation and unnecessary severe harm to patients.

PREVALENCE AND TREND OF DEPRESSION IN BURN SURVIVORS: A SINGLE CENTER COHORT STUDY

Burn injuries are frequently disastrous catastrophes that can cause significant skin damage and frequently results in hypertrophic scarring. Recovery from burn injury includes three domains - medical, functional and psychiatric. Psychological concerns affect both the quality of life and the disease recovery. This study assesses the prevalence of major depression or clinically significant symptoms of depression among patients hospitalized for acute burn injury, as well as their persistence once diagnosed. It is a prospective cohort that was studied in 1-40% body surface area burn patients, where Beck Depression Inventory was used as a depressive symptom measures. 108 patients were included in the study, out of which 42 (38.8%) exhibited depressive symptoms. Type of burn did not affect the prevalence of depression, whereas total body surface area had an impact on prevalence rate. The Beck Depression Inventory score assessment during the study revealed that 8.4% of participants exhibited worsening of scores during the study period and only 3.4% showed improvement throughout the study. Patients with mild depressive symptoms at the admission were likely to recover, whereas those with severe depressive symptoms were less likely to recover from the psychological state. To conclude, depression was more prevalent among burn survivors from the Indian community.

Burn Injuries in People Who Used Drug, 2009-2017: A Case-Control Study in Shiraz, Southern Iran

BACKGROUND

Burn injury is a critical health issue, which is associated with several morbidities and mortalities. Substance abuse, which is an important public health problem in Iran, can affect burn injury outcomes and etiologies in victims. This study was aimed to evaluate different aspects of burn injuries in people who used drug (PWUD) in two referral centers in the south of Iran.

METHODS

This Case-Control Study was conducted on burn victims referred to Amir-al Momenin Hospital and Ghotb-al-din Hospital from 2009 to 2017. Patients with a history of drug consumption were selected from the database and compared to randomly selected burn victims with no history of drug use. Demographics, burn etiology, underlying disease, total body surface area, hospitalization duration, and also the outcomes were collected and recorded in both groups. Data analysis was done by SPSS software.

RESULTS

A total of 5,912 inpatients were included in this study, which 2,397 of them (40.54%) were female. The mean age of the patients was 26.12 ± 19.18. Drug history was positive in 659 patients (11.15%). Familial issues and mental disorders were significantly higher in the PWUD group compared to the control group (P<0.001). Explosion etiology was significantly higher in the PWUD group (P<0.001). Psychiatric disorders (P<0.001), total body surface area (P=0.023), and hospital stay (P<0.001) were significantly higher in PWUD; however, the mortality rate had no statistically significant differences between the groups (P=0.583).

CONCLUSION

Substance abuse is a risk factor in burn victims, which can affect burn etiology and burn-related morbidities.

Clinical outcome and comparison of burn injury scoring systems in burn patient in Indonesia

Introduction

The purpose of this study was to explore and compare the performance of four burn injury scoring systems in Indonesia. In a retrospective study, data of all burn patients admitted to the emergency centre (EC) were collected. The following clinical outcome and four burn injury scoring systems were used to assess each patient: Abbreviated Burn Severity Index (ABSI), Belgian Outcome in Burn Injury (BOBI), the Ryan model, and revised Baux Score.

Methods

From April 2017 to April 2018, clinical outcome and burn injury score for every admitted patient were calculated to evaluate burn prognosis. Demographic information, ABSI score, full-thickness total body surface area (TBSA), overall TBSA, hospital stay, and inhalation injury were noted for analysis. Discriminative ability and goodness-of-fit of the prediction models were determined by receiver operating characteristic curve analysis and Hosmer–Lemeshow tests.

Results

We included 72 patients (mean age: 40.79 ± 16.30 years, average TBSA: 23.59% ± 24.84). Only 1 (1.4%) of them was diagnosed with inhalation injury. Mortality rate was 25%. Deceased patients had significantly higher mean age, %TBSA, and number of inhalation injuries. The ABSI model with sensitivity was 81.6, specificity was 92.5, accuracy was 87.3 and under the Receiver Operator Characteristics curve (AUC) was 0.93 (SE = 0.03).

Conclusions

The best estimation of predicted mortality was obtained with the ABSI model.

Temperature sensitivity after burn injury: A Burn Model System National Database Hot Topic

BACKGROUND

People living with burn injury often report temperature sensitivity. However, its epidemiology and associations with health-related quality of life (HRQOL) are unknown. We aimed to characterize temperature sensitivity and determine its impact on HRQOL to inform patient education after recovery from burn injury.

METHODS

We used the multicenter, longitudinal Burn Model System National Database to assess temperature sensitivity at 6, 12 and 24 months after burn injury. Chi-square and Kruskal-Wallis tests determined differences in patient and injury characteristics. Multivariable, multi-level generalized linear regression models determined the association of temperature sensitivity with Satisfaction with Life Scale (SWL) scores and Veterans RAND 12 (VR-12) physical (PCS) and mental health summary (MCS) component scores.

RESULTS

The cohort comprised 637 participants. Two thirds (66%) experienced temperature sensitivity. They had larger burns (12% TBSA, IQR 4-30 vs 5% TBSA, IQR 2-15; p<0.0001), required more grafting (5% TBSA, IQR 1-19 vs 2% TBSA, IQR 0-6; p<0.0001), and had higher intensity of pruritus at discharge (11% severe vs 5% severe; p=0.002). After adjusting for confounding variables, temperature sensitivity was strongly associated with lower SWL (OR -3.2, 95% CI -5.2, -1.1) and MCS (OR -4.0, 95% CI -6.9, -1.2) at 6-months. Temperature sensitivity decreased over time (43% at discharge, 4% at 24-months) and was not associated with poorer HRQOL at 12 and 24 months.

CONCLUSION

Temperature sensitivity is common after burn injury and associated with worse SWL and MCS during the first year after injury. However, temperature sensitivity seems to improve and be less intrusive over time.

Development of the School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) Profile: A Conceptual Framework

Pediatric burn injuries can alter the trajectory of the survivor's entire life. Patient-centered outcome measures are helpful to assess unique physical and psychosocial needs and long-term recovery. This study aimed to develop a conceptual framework to measure pediatric burn outcomes in survivors aged 5 to 12 years as a part of the School-Aged Life Impact Burn Recovery Evaluation Computer Adaptive Test (SA-LIBRE5-12 CAT) development. This study conducted a systematic literature review guided by the WHO International Classification of Functioning - Child and Youth and domains in the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire5-18. Interviews with eight parents and seven clinicians were conducted to identify important domains in child recovery. One clinician focus group with four clinicians was completed to identify gaps in the preliminary framework, and semi-weekly expert consensus meetings were conducted with three experts to solidify the framework. Qualitative data were analyzed by grounded theory methodology. Three major thematic outcome domains emerged: 1) Physical Functioning: fine motor and upper extremity, gross motor and lower extremity, pain, skin symptoms, sleep and fatigue, and physical resilience; 2) Psychological Functioning: cognitive, behavioral, emotional, resilience, and body image; and 3) Family and Social Functioning: family relationships, and parental satisfaction, school, peer relations and community participation. The framework will be used to develop item banks for a CAT-based assessment of school-aged children's health and developmental outcomes, which will be designed for clinical and research use to optimize interventions, personalize care, and improve long-term health outcomes for burned children.

Smartphone apps on burns first aid: A review of the advice

AIMS

Many websites giving first aid advice are disappointingly inaccurate and at times dangerous in regard to burn injuries. With more patients relying on their smart phones to obtain online information the aim of this study was to compare first aid applications (apps) burn advice against those guidelines set by the British Burns Association (BBA).

METHOD

A content analysis of all freely available English written first aid apps from Google Play and the Apple Store was performed. The information was compared against BBA guidance which was split into 12 domains and scored appropriately.

RESULTS

61 of the 103 first aid apps included in the study, had information on the treatment of burn injuries. The mean score for all apps was 3.3 out of 12. 85% of apps postulated the need to cool the burn. However, only 11% of apps stipulated the need for 20min of cooling, while 3% suggested the burn can be cooled up to 3h post injury. Disappointingly even apps produced by reputable first aid charities scored poorly.

CONCLUSION

Burns first aid is documented as being poorly given in the community. With easy access to the internet and specifically smart device apps, more needs to be done to improve burn first aid information online.