Journal of Burn Care & Research最新文献

This study aimed to investigate the effects of Individual Cognitive Stimulation Therapy (ICST) on the cognition, quality of life, and family relationships of caregivers of burn patients. A total of 98 caregivers of burn patients were randomly divided into a control group and a study group. The control group received routine interventions, while the study group underwent ICST, focusing on psychological diagnosis, comprehension, communication, and re-education phases. Burn awareness levels, quality of life, social support utilization, and psychological resilience were assessed before and after the intervention. Before intervention, there were no significant differences in burn awareness levels, quality of life, social support utilization, or psychological resilience between the two groups. After the intervention, caregivers in the study group exhibited significantly higher scores in burn awareness levels, quality of life dimensions, social support utilization, and psychological resilience compared to the control group (P < 0.05). Individual Cognitive Stimulation Therapy can improve the burn awareness level, quality of life, and social support utilization of caregivers of burn patients, highlighting its significant clinical implications in enhancing caregiver well-being and patient care.

Hypergranulated wounds from thermal injury remain a complex and debilitating problem for burn patients. Currently, there is no standard therapy to prevent or treat hypergranulation following burn injury. Many centers use topical corticosteroids; however, their use seems to be geographically dependent and controversial. The primary aim of this study was to quantify the current use of topical corticosteroids for post-burn hypergranulation in North America (NA) and Europe, while secondarily assessing for perceptions of safety and efficacy. We designed a survey that was distributed to the members of the European and American Burn Associations. Data was extracted and analyzed using SPSS software. A total of 165 respondents completed the survey (90 and 75 for the European and NA members, respectively). Seventy-one of the 90 (78.9%) European respondents reported they routinely use topical steroids for suppression of hypergranulation tissue in burns, versus 25 of the 75 (33.3%) NA respondents (p<0.001). European respondents, compared to NA respondents, were significantly more likely to consider topical steroid use safe (100% vs. 74.4%, p <0.001) and effective (98.6% vs. 66.7%, p < 0.001) for treatment of hypergranulated burn wounds. There was no significant difference in reported systemic effects seen after topical steroid use when comparing NA respondents and European respondents (6.5% vs. 6.9%, p > 0.10). The results of this study suggest that the use of steroids for hypergranulation tissue in burn care is more prevalent in Europe than NA, which may be due to discordant views on safety and efficacy despite minimal reported adverse effects.

Burn survivors are involved in burn research, but typically in the role of research subject. We believe that the outcomes and impact of burn research can be improved by engaging survivors as collaborators in the planning, implementation, and dissemination of burn research. The goal of this work was to produce the first burn research agenda generated and prioritized by burn survivors and other stakeholders from the burn community. A series of structured focus groups covering five topics (Patient and Family Education, Aftercare, Navigating the Healthcare System, Recovery: Physical and Psychosocial, and Barriers to Research) were held with burn survivors and their family members. Specific research questions/topics were identified from the transcripts and prioritized via an anonymous survey of burn survivors, their caregivers, and other stakeholders from the burn community. From these sessions, 37 specific research questions/topics were identified and ranked. In addition, 19 research barriers were identified and ranked. This work presents an innovative approach to burn research through co-production with survivors and other stakeholders. Burn survivors and their caregivers are experts in their lived experiences. By involving them in burn research as collaborators and contributors from the very first steps of research and throughout the continuum of the research planning, conducting projects, and distributing findings, we believe that the research will be both more successful and more impactful. We have taken the first steps in burn research co-production with this novel stakeholder-generated research agenda for the burn community.

Research is one of the American Burn Association's (ABA) strategic priorities. Advocacy is required not only to promote burn research, but also, the ABA's other strategic priorities (Prevention, Quality, and Education). The ABA convened a two-day Research and Advocacy (R&A) Summit in September 2023, to develop a roadmap for the organization's research and advocacy efforts. The in-person summit identified fourteen key R&A initiatives. A multidisciplinary workgroup then developed strategies to achieve each initiative. The initiatives and strategies were then approved by the ABA's Board of Trustees as our organization's roadmap for research and advocacy. The next task will be to implement the initiatives. This will require not only oversight from the ABA's Board of Trustees, but also, effort from and collaboration between several of the ABA's committees and panels, including the Burn Science Advisory panel (BSAP), the Research Committee, the Prevention Committee, The Governmental Affairs Committee, The Organization and Delivery of Burn care Committee, the Quality and Burn Registry Committee, the ad hoc Coding Committee, and the ABA's Central Office.

Glucagon-like peptide-1 (GLP-1) agonists mimic the action of GLP-1, a hormone that regulates blood glucose levels via stimulation of insulin release and inhibition of glucagon secretion. After burn, the current literature suggests that the use of GLP-1 agonists results in less insulin dependence with similar glucose control and hypoglycemic events to patients receiving a basal-bolus insulin regimen. GLP-1 agonists may also promote wound healing through various mechanisms including angiogenesis and improved keratinocyte migration. Despite the potential benefits, GLP-1 agonists reduce gastrointestinal motility which impacts their widespread adoption in burn care. This dysmotility can result in inadequate nutrition delivery, unintentional weight loss, and is a potential aspiration risk. The net impact of these medications on burn patients is unclear. Given their potential to demonstrate the safety, efficacy, and optimal dosing of various GLP-1 agonists in acute burn management.

Older adults are at a higher risk of complications after burn injuries since many physical and mental changes are compounded by increasing age. Few studies have targeted the long-term effects of burns on older adults. Therefore, this study will investigate the long-term physical and mental health outcomes in older adults. 3129 participants from the Burn Model System Database were divided into 3 cohorts based on their age at injury (18-54, 55-64, and 65+). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were derived from the 12-item Short Form (SF-12) and the Veterans RAND 12-item (VR-12) health surveys and analyzed to measure recovery at preinjury, discharge, 2-year follow-up, and 5-year follow-up. ANOVA, T-score analysis, and linear mixed-effects models were utilized to assess for significant differences in outcome scores. PCS scores were significantly different between the 18-54 cohort and 65+ cohorts at the preinjury and 2-year time intervals (p<0.001 and p<0.001, respectively), but not at the 5-year follow up (P=0.28). MCS scores were significantly different between the 18-54 cohort and 65+ cohorts at all time intervals measured (p=0.001, p<0.001, P<0.001, and p=0.005 respectively), though the change in MCS scores over time were not significantly different between age cohorts across time (p=0.088). This supports that patients 65 years and older have a different physical function recovery trajectory when compared to patients under 64 years. These findings underscore the belief that for physical recovery after a burn injury, individualized physical rehabilitation plans will provide the most benefit for patients across all ages.

Previous iterations of burn severity (mild, moderate, and severe) were not data-driven and were outdated. Clustering analyses have gained popularity for identifying homogenous subgroups from heterogeneous medical conditions, such as asthma, sepsis, and lung disease. There is no consensus in burn literature regarding what constitutes massive burns. The current classification includes a 20% total body surface area (TBSA) burn and a 95% TBSA burn as severe. Latent class and hierarchical clustering analyses were applied to the American Burn Association National Burn Research Dataset. Cluster variables included length of stay, length of stay, intensive care unit length of, number and type of procedures, and number and type of complications. Non-clustering variables were evaluated after clustering, including burned TBSA, inhalation injury, mortality, discharge disposition, age, sex, and race. Latent class analysis suggested three clusters. Hierarchical clustering analysis was applied to the most severe latent class, creating four total burn severity groups. In total, 112,297 patients were included in the final analysis. The mean TBSA burned for each class is 4.26±4.91 for minor, 8.07±8.39 for moderate, 22.76±17.31 for severe and 36.72±21.61 for massive. The age and sex proportions were similar among all clusters. The clustering variables steadily increased for each severity cluster. Mortality was the highest in the massive cluster (18.2%). Data informed categories of burn severity were formed using clustering analyses, which will be helpful for triage, data-benchmarking, and class-specific research.

Burn injury can have a lasting impact on quality of life beyond the initial injury. The aim of this study was to examine the recovery process through analyzing the relationship between body image, physical function, and return to work. This study uses data from the Burn Model System (BMS) National Longitudinal Database and includes 1,001 participants injured between 2015 and 2023 who were measured using Patient-Reported Outcomes Measurement Information System (PROMIS-29) Physical Function, Employment Status, and the Body Image subscale. Associations were explored using multivariate linear and logistic regression analyses. Physical function was positively associated with body image and negatively associated with burn size, age, and amputation. Employment was positively correlated with body image and employment at injury, while negatively correlated with age. Other variables including burn etiology, burn center site, race, and ethnicity were significant at different time points. By understanding how these factors change and are associated with outcomes across recovery, the healthcare team can make more tailored efforts to improve the psychosocial and physical well-being of burn survivors.