Burn Research Research Articles

Abstracts

Abstracts Get access Journal of Burn Care & Research, Volume 32, Issue suppl_2, March 2011, Pages S51–S180, https://doi.org/10.1097/BCR.0b013e3182109aea Published: 01 March 2011

Burn Rehabilitation and Research: Proceedings of a Consensus Summit

Burn Rehabilitation and Research: Proceedings of a Consensus Summit

Methods and Tools Used for the Measurement of Burn Scar Contracture

After burn injury, scar contracture can cause significant impairment and functional deficit. Many studies have investigated the treatment and prevention of burn scar contracture, but few studies have focused on the methods for measuring contracture. The purpose of this study was to determine whether consistent and objective methods of measurement are used to quantify scar contracture in the clinical evaluation of burn patients and in burn research. A survey was administered to 407 burn therapists to determine the methods and tools used clinically to measure scar contracture, while a review of recent burn literature was conducted to determine the methods and tools used in burn research. The results of the survey indicate that there is a lack of consensus in the methods and tools used for the measurement of scar contracture, both clinically and in research. Instead, a variety of measurement methods was reported, each with varying degrees of objectivity. Clinically, the methods are rarely checked for reliability or performance competency. In burn research, the methods and tools vary, and contracture data obtained are often reported in an inconsistent manner. If the measurement of scar contracture is not done objectively and consistently, then it is difficult to determine reliability, validity, and responsiveness of the measurement methods. Development of standard protocols with reliable measures of scar contracture would improve the quality of burn care and research.

Note From the Editor-in-Chief

As 2010 comes to a close, I would like to thank the Editorial Board members who again have given their time and talent to review the ever-increasing number of manuscripts that have been submitted to the Journal of Burn Care and Research (JBCR). The members of the board and the guest referees have continued to submit thoughtful reviews in a timely manner. This process continues to enhance the quality of the Journal. This past year, the Journal received more than 356 new submissions, and 147 articles were published in 2010. Thanks to John Krichbaum and Susan Browning and the American Burn Association Board for their continued support of the Journal. Thank you to the following guest referees who assisted in the review process during the past 12 months: David Ahrenholz, MD; Samam Arbabi, MD; Alexis Armour, MD; Brett Arnoldo, MD; George Babcock, PhD; John Bailey, MD; Henry...

Research in burns - Present and future

ABSTRACTThere have been tremendous advances in burns care over the past 50 years. Much of this, but not all, can be attributed to basic science and clinically related research. Out of the best centres in the world, centres that are fully funded and richly resourced, best practice guidelines result in impressive outcomes not only in terms of survival but also in terms of a quality of survival. Indeed the remaining clinical challenges in these centres are the elderly, the inhalational burns, and the very extensive burns. There are however other challenges when looking at burns care in a global context and in particular is the provision of even minimal standards of acceptable care for burns patients in many parts of the world. Whilst the justification for research funding in the wealthy countries becomes increasingly esoteric, for example looking at the immunology of face transplantation, the global health challenges of burns care still remain. Perhaps, the greatest research challenge in burns care in the 21st century lies not in furthering our understanding of the phenomenon we observe but the global application of the knowledge we already possess.

Systematic Care Management: A Comprehensive Approach to Catastrophic Injury Management Applied to a Catastrophic Burn Injury Population—Clinical, Utilization, Economic, and Outcome Data in Support of the Model

The new standard for successful burn care encompasses both patient survival and the burn patient's long-term quality of life. To provide optimal long-term recovery from catastrophic injuries, including catastrophic burns, an outcome-based model using a new technology called systematic care management (SCM) has been developed. SCM provides a highly organized system of management throughout the spectrum of care that provides access to outcome data, consistent oversight, broader access to expert providers, appropriate allocation of resources, and greater understanding of total costs. Data from a population of 209 workers' compensation catastrophic burn cases with a mean TBSA of 27.9% who were managed under the SCM model of care were analyzed. The data include treatment type, cost, return to work, and outcomes achieved. Mean duration of management to achieve all guaranteed outcomes was 20 months. Of the 209 injured workers, 152 (72.7%) achieved sufficient recovery to be released to return to work, of which 97 (46.8%) were both released and competitively employed. Assessment of 10 domains of functional independence indicated that 47.2% of injured workers required total assistance at initiation of SCM. However, at termination of SCM, 84% of those injured workers were fully independent in the 10 functional activities. When compared with other burn research outcome data, the results support the value of the SCM model of care.

Consensus Statement on the Adoption of the COPE Guidelines

Journal Article Consensus Statement on the Adoption of the COPE Guidelines Get access Journal of Burn Care & Research, Volume 31, Issue 4, July-August 2010, Page 509, https://doi.org/10.1097/BCR.0b013e3181ebec22 Published: 01 July 2010

Evidence-based burn care—An assessment of the methodological quality of research published in burn care journals from 1982 to 2008

Introduction The quantity and quality of research evidence in peer-reviewed burn care journals have never been evaluated. The aim of this study was to empirically assess the evidence available in this literature. Methods All studies published in Burns and Journal of Burn Care and Research between 1st January 1982 and 31st December 2008 were reviewed. Articles were tabulated according to their study design into the following groups: meta-analyses; randomised controlled trials; controlled trials; comparative studies and case series/reports. Results A total of 2215 original articles were evaluated, of which 67.0% were from Burns and 33.0% were from Journal of Burn Care and Research. There were 3 meta-analyses (0.1%), 179 (8.1%) randomised controlled trials, 56 (2.5%) controlled clinical trials, 715 (32.3%) comparative studies and 1262 (57.1%) case series/reports. Journal of Burn Care and Research published a higher proportion of randomised controlled trials than Burns (11.9% vs. 6.2%; p < 0.001). There was no significant difference in the proportion of published controlled trials between the two journals (3.0% vs. 2.3%; p = 0.333). Journal of Burn Care and Research published a higher proportion of comparative studies than Burns (27.9% vs. 41.4%; p < 0.001). Case series/reports made up the highest proportion of articles in both Burns (63.6%) and Journal of Burn Care and Research (43.7%), with Burns publishing a higher proportion of these than Journal of Burn Care and Research ( p < 0.001). From 1982 to 2008, when articles from both journals were considered together there were significant increases in the proportion of randomised controlled trials (0 (0%) to 10 (9%); p < 0.001) and controlled clinical trials (0 (0%) to 1 (1%); p < 0.001). There were no significant changes in the proportion of comparative studies (11 (44%) to 28 (16%); p = 0.846) or case series/reports (14 (56%) to 71 (65%); p = 0.448). Discussion The burn care literature suffers from a relative shortage of high-quality evidence. More randomised controlled trials are warranted.

Healthcare Resource Utilization and Epidemiology of Pediatric Burn-Associated Hospitalizations, United States, 2000

Our study, “Healthcare Resource Utilization and Epidemiology of Pediatric Burn-Associated Hospitalizations, United States, 2000,” published in the Journal of Burn Care & Research, November/December 2007, is an analysis of the Kids' Inpatient Sample, a large, restricted access, publicly available dataset that is maintained by the Agency for Healthcare Research and Quality (AHRQ). One of the provisions of the Kids' Inpatient Sample data use agreement, which I signed when purchasing the dataset, is that no data involving ≤10 observations are to be published. This measure was put in place by AHRQ to protect individual patients' privacy and to prevent the potential disclosure of personal information. We were notified by AHRQ that our article violated this agreement by having some tabulated cells that contain ≤10 observations. This represents an oversight on my part and an inadvertent failure to comply with the data use agreement. For this, I apologize. Although I am fully confident that nothing in our article could be used to identify individuals or their personal information, the fact remains that the reporting of small numbers of observations is in violation of the AHRQ guidelines. The corrections are as follows.

Yeast from burn patients at a major burn centre of China

Aim This study presents fungi and their characteristics identified from burn patients at a major Chinese burn centre. Methods All burns patients admitted to our Burn Research Institute from 2003 to 2006 inclusive were included in this study. Once fungal infection was suspected clinically, samples including wound tissue, blood, urine, stool and sputum were harvested for the culture of yeast. The sensitivities of the identified yeast were determined and the positive samples and cases were analysed. Results Out of a total of 3909 cases, 467 patients were clinically suspected of fungal infection, of which 1970 samples were taken for yeast culture. A total of 38 samples and 36 patients tested positive. The three most positive samples were urine, blood and catheter. Candida tropicalis was identified as the most common yeast type (42.1%), followed by Candida albicans (31.6%), Candida famata (T. Famata) (10.5%) and Candida glabrata (T. Glabrata) (7.9%). Except for C. galbrata, most of the yeast strains found in the study were sensitive to the routine antimycotic agents. There were eight deaths in the 36 positive patients. As much as 83.3% of the positive cases suffered burns of more than 50% total body surface area (TBSA) and half of the positive cases were greater than 80% TBSA. A total of 78.95% of the positive samples were taken from patients after 2 weeks post-burn injury. Conclusion A profile of the fungi isolated from burn patients in a major Chinese burn centre is presented.

Author Index

Author Index Journal of Burn Care & Research, Volume 31, Issue suppl_2, March 2010, Pages S161–S168, https://doi.org/10.1097/01.bcr.0000368438.05456.59 Published: 01 March 2010

Abstracts

Abstracts Get access Journal of Burn Care & Research, Volume 31, Issue suppl_2, March 2010, Pages S44–S160, https://doi.org/10.1097/01.bcr.0000368437.89133.01 Published: 01 March 2010

Correction: A Computer Simulation of Progesterone and Cox2 Inhibitor Treatment for Preterm Labor

The affiliations of the fifth author, Charles F. Simmons, are incorrect. He is affiliated only with #1, Department of Pediatrics, Steven Spielberg Pediatric Research Center, Burns and Allen Research Institute, Cedars-Sinai Medical Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America

Research in burns - Present and future

There have been tremendous advances in burns care over the past 50 years. Much of this, but not all, can be attributed to basic science and clinically related research. Out of the best centres in the world, centres that are fully funded and richly resourced, best practice guidelines result in impressive outcomes not only in terms of survival but also in terms of a quality of survival. Indeed the remaining clinical challenges in these centres are the elderly, the inhalational burns, and the very extensive burns. There are however other challenges when looking at burns care in a global context and in particular is the provision of even minimal standards of acceptable care for burns patients in many parts of the world. Whilst the justification for research funding in the wealthy countries becomes increasingly esoteric, for example looking at the immunology of face transplantation, the global health challenges of burns care still remain. Perhaps, the greatest research challenge in burns care in the 21st century lies not in furthering our understanding of the phenomenon we observe but the global application of the knowledge we already possess.

Combat Casualty Care Research at the U.S. Army Institute of Surgical Research

The Institute of Surgical Research is the US Army’s lead research laboratory for improving the care of combat casualties. The Institute follows a rigorous process for analyzing patterns of injury...

When is it time to go? The difficulty of intensive care unit discharge decisions at times of high census or admission demand*

Department of Intensive Care Medicine, Burns, Trauma and Critical Care Research Centre, University of Queensland, Royal Brisbane and Women's Hospital, Queensland, Australia The author has not disclosed any potential conflicts of interest.

Saving the zone of stasis in burns with activated protein C: An experimental study in rats

Salvage of the zone of stasis is a major subject of focus in burn research. Use of various antithrombotic, anti-inflammatory and antioxidant drugs have been studied experimentally, with reports of favourable results; however, none became popular in clinical practice. Activated protein C (APC) is a well-known physiologic anticoagulant. Recent studies revealed that APC contributes not only to systemic anticoagulant activities but also to anti-inflammatory activities by inhibiting leucocyte activation associated with TNF production. The likely favourable effects of APC on salvage of the zone of stasis were investigated on a well-described experimental rat burn model representing the zone of stasis according to the ‘burn comb model’. Twenty Sprague-Dawley rats were used and randomly separated into experimental and control groups. Two hours after inducing injury, 100 μg kg −1 APC (Sigma, Boehringer Ingelheim, Germany) was administered to the experimental group through the caudal vein while 0.9% saline was injected through the same route in the control group. Laser Doppler flowmetry measurements and autoradiography were used for evaluation of perfusion and viability in the zone of stasis. At day 3, the differences between the results obtained from the treatment and the control groups were found to be statistically significant ( p < 0.05). Our experimental study revealed that APC improved tissue perfusion and decreased the area of skin necrosis in the zone of stasis in rats. The dual effect of APC, each of which has been shown to be favourable in saving the zone of stasis, may make this agent effective with a single effect in treatment of burn injury.

Involving burn survivors in agenda setting on burn research: An added value?

Background and aim The role of burn survivors in burn research is usually restricted to being objects of study and beneficiaries of research results, while decision-making on research is traditionally the domain of a small group of experts, mainly scientists. In this article we compare the research priorities of burn survivors and professionals and investigate to what extent it is possible to come to a joint research agenda. Methodology The project followed the Dialogue Model for research agenda setting. Initially burn survivors and professionals were consulted separately and group-specific lists of research priorities were established, using a literature survey, exploratory interviews ( n = 10), focus groups ( n = 58), a questionnaire ( n = 224) and Delphi rounds ( n = 12). Subsequently, in a dialogue meeting burn survivors and professionals presented and discussed their priorities, developed one integrated list, and prioritized the 15 most important topics on this list. Results Considerable overlap was observed between the research priorities of burn survivors and professionals, particularly with respect to biomedical and clinical research on wound healing and scar management. However, differences were also observed, e.g. treatment of itching and oedema on scars and donor places. Conclusion The model proved useful in eliciting research priorities from both professionals and burn survivors, and in stimulating a meaningful dialogue between these groups. The involvement of burn survivors identified burn research areas that are currently not the focus of research in The Netherlands.

Burn Rehabilitation and Research: Proceedings of a Consensus Summit

Burn rehabilitation is an essential component of successful patient care. In May 2008, a group of burn rehabilitation clinicians met to discuss the status and future needs of burn rehabilitation. Fifteen topic areas pertinent to clinical burn rehabilitation were addressed. Consensus positions and suggested future research directions regarding the physical aspects of burn rehabilitation are shared.

Descriptive and inferential statistical methods used in burns research

Background Burns research articles utilise a variety of descriptive and inferential methods to present and analyse data. The aim of this study was to determine the descriptive methods (e.g. mean, median, SD, range, etc.) and survey the use of inferential methods (statistical tests) used in articles in the journal Burns. Methods This study defined its population as all original articles published in the journal Burns in 2007. Letters to the editor, brief reports, reviews, and case reports were excluded. Study characteristics, use of descriptive statistics and the number and types of statistical methods employed were evaluated. Results Of the 51 articles analysed, 11(22%) were randomised controlled trials, 18(35%) were cohort studies, 11(22%) were case control studies and 11(22%) were case series. The study design and objectives were defined in all articles. All articles made use of continuous and descriptive data. Inferential statistics were used in 49(96%) articles. Data dispersion was calculated by standard deviation in 30(59%). Standard error of the mean was quoted in 19(37%). The statistical software product was named in 33(65%). Of the 49 articles that used inferential statistics, the tests were named in 47(96%). The 6 most common tests used (Student's t-test (53%), analysis of variance/co-variance (33%), χ 2 test (27%), Wilcoxon & Mann–Whitney tests (22%), Fisher's exact test (12%)) accounted for the majority (72%) of statistical methods employed. A specified significance level was named in 43(88%) and the exact significance levels were reported in 28(57%). Conclusion Descriptive analysis and basic statistical techniques account for most of the statistical tests reported. This information should prove useful in deciding which tests should be emphasised in educating burn care professionals. These results highlight the need for burn care professionals to have a sound understanding of basic statistics, which is crucial in interpreting and reporting data. Advice should be sought from professionals in the fields of biostatistics and epidemiology when using more advanced statistical techniques.