Medicine and Health Sciences Commons^™

Is Music Therapy Intervention Effective In Decreasing Pain After Standard Wound Care In Hospitalized Burn Patients?, Lindsay King

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective evidence based medicine review is to determine whether or not music therapy intervention is effective in decreasing pain after standard wound care in hospitalized burn patients.

STUDY DESIGN: Systematic review compiling data from three randomized controlled trials in 2016, all in the English language.

DATA SOURCES: After a thorough search of PubMed and Cochrane, three pertinent studies were found to include in this review. The selected studies were evaluated to assess the effectiveness of music therapy in decreasing pain after wound care in hospitalized burn patients.

OUTCOMES MEASURED: Decrease in pain symptoms were measured …

Efficacy Of Acupuncture In Treating Scars Following Tissue Trauma, Cathy Tuckey, Susan Kohut, Dale Edgar

Physiotherapy Papers and Journal Articles

Introduction: Anecdotally, acupuncture is used in the treatment of scar tissue in order to improve scar quality and reduce symptoms of pain and pruritus. Unlike conditions such as lower back pain, knee osteoarthritis and migraines, there are no systematic reviews to confirm treatment efficacy. This systematic literature review aims to assess the current level of evidence for the use of acupuncture for treating abnormal scars such as hypertrophic or other symptomatic scars.

Methods: A comprehensive database search was performed followed by reviewing reference lists, grey literature databases and Google Scholar. Study quality was assessed using the Oregon CONSORT STRICTA instrument …

Management In Paediatric Burns: A Case Report, Sangeetha Priyadarshini Ms, Pramod Kumar Dr, Elsa Sanatombi Devi Dr, Anice George Dr

Manipal Journal of Nursing and Health Sciences

Burns are common childhood injuries among children, mainly caused by scald, fire or abuse. The authors presented the case of a one-year child who presented with second degree thermal burns due to fall of hot liquid on the child. Most of the burn injuries, which occur in the early ages of life, are mostly due to the negligence or lack of supervision of the child during the growing period. So, proper management of burn injury and adequate education of parents should be considered as an important aspect in prevention of burns in children. Further, the classification of burns injury helps …

Genetic Influence On Scar Height And Pliability After Burn Injury In Individuals Of European Ancestry: A Prospective Cohort Study, Hilary J. Wallace, Gemma Cadby, Phillip E. Melton, Fiona M. Wood, Sian Falder, Margaret M. Crowe, Lisa J. Martin, Karen Marlow, Sarah V. Ward, Mark W. Fear

Medical Papers and Journal Articles

After similar extent of injury there is considerable variability in scarring between individuals, in part due to genetic factors. This study aimed to identify genetic variants associated with scar height and pliability after burn injury. An exome-wide array association study and gene pathway analysis were performed on a prospective cohort of 665 patients treated for burn injury. Outcomes were scar height (SH) and scar pliability (SP) sub-scores of the modified Vancouver Scar Scale (mVSS). DNA was genotyped using the Infinium^® HumanCoreExome-24 BeadChip. Associations between genetic variants (single nucleotide polymorphisms) and SH and SP were estimated using an additive genetic …

Increased Risk Of Blood Transfusion In Patients With Diabetes Mellitus Sustaining Non-Major Burn Injury, Linda Mai, Katrina Spilsbury, Dale W. Edgar, Aaron Berghuber, Fiona M. Wood

Health Sciences Papers and Journal Articles

Background: Due to the increased mortality and morbidity associated with blood transfusion, identifying modifiable predictors of transfusion are vital to prevent or minimise blood use. We hypothesised that burn patients with diabetes mellitus were more likely to be prescribed a transfusion. These patients tend to have increased age, number of comorbidities, infection risk and need for surgery which are all factors reported previously to be associated with blood use.

Objective: To determine whether patients with diabetes mellitus who have sustained a burn ≤20% total body surface area (TBSA) are at higher risk of receiving red blood cell transfusion compared to …

Cold Burn Injury After Treatment At Whole-Body Cryotherapy Facility, Mackenzie O'Connor, Jordan V. Wang, Anthony Gaspari

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

The Impact Of Diabetes Mellitus On Burns And Standard Burn Treatments, Emma Shepard

Senior Honors Theses

Burns are complex injuries that trigger the stress response and result in increased blood glucose. Diabetes mellitus, an endocrine disorder with abnormal glucose regulation, can significantly alter the risk for burns and the treatment of burns. Pre-existing diabetes mellitus complicates burn treatments and healing ability. Diabetes mellitus may also develop directly from an unregulated stress response to the burn. The consideration of diabetes mellitus affects wound care, medications, and nutrition for burn patients. As patient advocates, nurses are responsible for caring for burn patients with awareness of endocrine complications. This paper provides a detailed overview of the pathophysiology, complications, and …

Serum Albumin And Base Deficit As Prognostic Factors For Mortality In Major Burn Patients, Mohamed A. Megahed, Mohamed M. Mansour, Rana H. El-Helbawy, Shawky S. M. Gad

Menoufia Medical Journal

Objective The objective of this study was to assess serum albumin and base deficit as prognostic factors for mortality in major burn patients. Background Hypoalbuminemia is a common clinical deficiency in burn patients and is associated with complications related to increased extravascular fluid, including edema, abnormal healing, and susceptibility to sepsis. Base deficit is routinely calculated on blood gas analysis, and it provides the best estimate of the degree of tissue anoxia and shock at the whole body level, particularly in hemorrhagic shock. A rising base deficit indicates increasing metabolic acidosis, and may stratify mortality in patients after major trauma. …

Is Virtual Reality An Effective Pain Management Treatment During Wound Care Of Pediatric Burn Patients?, Angelica Mcgowan

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not “Is virtual reality an effective pain management treatment during the wound care of pediatric burn patients?”

Study Design: Systematic review of three randomized controlled trials (RCTs) published, in English, in peer-reviewed journals between 2008-2014.

Data Sources: The three RCTs were found using the PubMed and Ovid databases.

Outcomes measured: All three studies measured pain perception and intensity using self-reporting questionnaires, and visual analogue scales.

Results: Jeffs et al. and Miller et al. both showed that patients using the virtual reality (VR) or augmented reality (AR) mechanisms …

Grip And Muscle Strength Dynamometry In Acute Burn Injury: Evaluation Of An Updated Assessment Protocol, Paul M. Gittings, Dana A. Hince, Benedict M. Wand, Fiona M. Wood, Dale W. Edgar

Physiotherapy Papers and Journal Articles

External stabilization is reported to improve reliability of hand held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry.

Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to four weeks. Within session reliability was assessed using intraclass correlations calculated for within session data grouped prior to surgery, immediately after surgery and in the sub-acute phase of injury. Minimum …

Safety And Effectiveness Of Propranolol In Severely Burned Patients: Systematic Review And Meta-Analysis, Ramiro Manzano-Nunez, Herney Andrés García-Perdomo, Paula Ferrada, Carlos Alberto Ordoñez Delgado, Diego Andrés Gomez, Jorge Esteban Foianini

Surgery Publications

Background

The objective of this systematic review was to determine the effectiveness and safety of propranolol compared to placebo or usual care for improving clinical relevant outcomes in severely burned patients (TBSA >20%).

Methods

Relevant articles from randomized controlled trials were identified by a literature search in MEDLINE, EMBASE, and CENTRAL. We included trials involving patients with a severe burn (>20% of total body surface area affected). Trials were eligible if they evaluated propranolol and compared to usual care or placebo. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for the final analysis. We …

Resistance Training For Rehabilitation After Burn Injury: A Systematic Literature Review And Meta-Analysis, P Gittings, T Grisbrook, Dale Edgar, F Wood, B Wand, N O'Connell

Physiotherapy Papers and Journal Articles

Background/aim: Resistance training is beneficial for rehabilitation in many clinical conditions, though this has not been systematically reviewed in burns. The objective was to determine the effectiveness of resistance training on muscle strength, lean mass, function, quality of life and pain, in children and adults after burn injury.

Methods: Medline & EMBASE, PubMed, CINAHL and CENTRAL were searched from inception to October 2016. Studies were identified that implemented resistance training in rehabilitation. Data were combined and included in meta-analyses for muscle strength and lean mass. Otherwise, narrative analysis was completed. The quality of evidence for each outcome was summarised and …

Evidence Based Nutritional Management Of Adult Patients With Severe Burns, Ashley Lazarz, Samantha Waller

Interprofessional Research and Innovations Council

Clinical Scholars Abstract 2017

Title: Evidence based nutritional management of adult patients with severe burns.

Presenters: Ashley Lazarz RD, LD and Samantha Waller MS, RD, LD

Background/Literature: It is estimated that more than 2 million people suffer burns in the United States annually, resulting in approximately 3400 deaths. Burns cause pathological alterations in nearly every system of the body and changes in both metabolism and immunity in the burned patient contribute to adverse outcomes. (1) Hyper-metabolism leads to severe catabolism and loss of lean body mass in the severely burned patient making nutrition intervention critical. (2) Literature indicates that enteral …

Increased Burn Healing Time Is Associated With Higher Vancouver Scar Scale Score, Vidya Finlay, Sally Burrows, Maddison Burmaz, Hussna Yawary, Johanna Lee, Dale Edgar, Fiona M. Wood

Physiotherapy Papers and Journal Articles

Increased burn wound healing time has been shown to influence abnormal scarring. This study hypothesized that scar severity increases commensurate to the increase in time to healing (TTH) of the wound. Wound healing and scar data from burn patients treated by the Burn Service of Western Australia at Royal Perth Hospital were examined. The relationship between TTH and scar severity, as assessed by the modified Vancouver Scar Scale (mVSS), was modelled using regression analysis. Interaction terms evaluated the effect of surgery and total body surface area – burn (TBSA) on the main relationship. Maximum likelihood estimation was used to account …

Bioimpedance Spectroscopy - Can It Be Used As A Tool For Monitoring Fluid Shifts In Burns?, Pippa Kenworthy

Theses

Large fluid shifts and oedema are features of burn injuries. Oedema hampers burn wound healing and is directly related to the size and depth of the burn. The degree of oedema in burns covers a broad spectrum: Minor burns cause localised or peripheral oedema, whilst major burns may result in a systemic inflammatory response which can be life threatening and necessitates formal fluid resuscitation. Acute burn fluid resuscitation is paramount in decreasing patient morbidity and mortality but can contribute to already large amounts of oedema. There is currently no single clinically applicable, non-invasive and accurate outcome measure to titrate fluid …

The Development And Impact Of Heterotopic Ossification In Burns: A Review Of Four Decades Of Research, Rachel Kornhaber, Nichola Foster, Dale Edgar, Denis Visentin, Elad Ofir, Josef Haik, Moti Harats

Physiotherapy Papers and Journal Articles

Introduction: Heterotopic ossification (HO) is the formation of lamellar bone within connective and other tissue where bone should not form and is a rare complication after burn injury. However, it leads to severe pain and distress, marked reduction in joint range of motion (ROM), impaired function and increased hospital length of stay. The pathophysiology, incidence and risk factors of HO remain poorly understood in burns and other traumas and the management, controversial. The aim of this comprehensive review, therefore, was to synthesise the available evidence on the development and treatment of HO after acute burn injury.

Methods: The review was …

Uchunguzi (Journal Watch/Montre De Journal) June 2016, Benjamin Wachira

Emergency Medicine, East Africa

When someone telephones for an ambulance, an interaction ensues which should be efficient and effective to facilitate a speedy dispatch of the appropriate level of vehicle, equipment and personnel to where it is needed. The process in South Africa begins with a three-part opening sequence which typically identifies the organisation, introduces the call-taker (CT) and invites the caller to proceed with the business of the call. In a recent project conducted in a South African emergency service, the researchers aimed to ascertain the impact of the CT’s identification sequence on the progression of the call and to determine whether there …

Medical Student Competency In Wound Care Guidelines, Sophia Akhiyat, Sean Mcnish, Kara S. Couch, Victoria K. Shanmugam

GW Research Days 2016 - 2020

Chronic wounds that have failed to heal after 3 months of appropriate wound care affect approximately 6.5 million people in the US with a prevalence of 1% and costs estimated at $25 billion per year. Medical students currently receive limited wound care training, yet to effectively manage chronic wounds, providers must both understand the biology of healing, and also remain up-to-date with wound care guidelines published by the Agency for Healthcare Research and Quality (AHRQ). The purpose of this student-led project was to investigate medical students' knowledge and comfort with wound care guidelines.

The Evidence-Based Topical Therapies For Management Of Minor Burns In Outpatient Clinic, Siphora Dien, Eliza Miranda, Erdina Hardiono D Pusponegoro, Aditya Wardhana

Journal of General - Procedural Dermatology & Venereology Indonesia

Burns are often seen in clinics or hospitals. Majority of burns are minor burns, which can be managed in outpatient setting with satisfactory result. The healing outcome depends on physician’s knowledge and competencies in burn pathogenesis and basic principles of burn care. Initial treatment of burns consists of emergency evaluation, assessment of depth and severity of burns and considerations for referral. The principles of minor wound therapy include cooling, cleansing, pain management, and topical therapy. Recently, many topical agents are available and indicated for first to second degree burn. Silver sulfadiazine (SSD) is the standard treatment; however, it has some …

Burn Injury Alters The Intestinal Microbiome And Increases Gut Permeability And Bacterial Translocation, Zachary M. Earley, Suhail Akhtar, Stefan J. Green, Ankur Naqib, Omair Khan '15, Abigail R. Cannon, Adam M. Hammer, Niya L. Morris, Xiaoling Li, Joshua M. Eberhardt, Richard L. Gamelli, Richard H. Kennedy, Mashkoor A. Choudhry

Student Publications & Research

Sepsis remains one of the leading causes of death in burn patients who survive the initial insult of injury. Disruption of the intestinal epithelial barrier has been shown after burn injury; this can lead to the translocation of bacteria or their products (e.g., endotoxin) from the intestinal lumen to the circulation, thereby increasing the risk for sepsis in immunocompromised individuals. Since the maintenance of the epithelial barrier is largely dependent on the intestinal microbiota, we examined the diversity of the intestinal microbiome of severely burned patients and a controlled mouse model of burn injury. We show that burn injury induces …

Brother, Have You Got A Light? Assessing The Need For Intubation In Patients Sustaining Burn Injury Secondary To Home Oxygen Therapy., Hamed Amani, Daniel Lozano, Sigrid Blome-Eberwein

Sigrid A Blome-Eberwein MD

Home oxygen therapy use has steadily increased for the past 30 years. A majority of these patients suffer from chronic obstructive pulmonary disease secondary to smoking. Although warned of the danger of smoking while on oxygen, patients continue to do so, potentially resulting in cutaneous burns and suspected inhalation injury. Those suspected of inhalation injury are intubated for airway control. In the English literature, there is a paucity of data discussing the need for intubation. To date, this is the largest study to determine whether intubated patients had inhalation injury as observed by bronchoscopy and whether intubation was necessary. All …

How Long Does That 10-Year Smoke Alarm Really Last? A Survival Analysis Of Smoke Alarms Installed Through The Saife Program In Rural Georgia, Haresh Rochani, Valamar Malika Reagon, Steve Davidson

Biostatistics Faculty Publications

Background: When functioning properly, a smoke alarm alerts individuals in the residence that smoke is near the alarm. Smoke alarms serve as a primary prevention mechanism to abate morbidity and mortality related to residential fires.

Methods: Using survival analysis, we examined the length of operability of 10-year lithium battery powered smoke alarms installed through the Georgia Public Health/CDC SAIFE program in Moultrie, Georgia. Attempts were made to reach all homes in the city limits. The premise of the study is that geographic clusters (in the case of Moultrie city quadrants) are associated with decreases in the length of time that …

The Telehealth Skills, Training, And Implementation Project: An Evaluation Protocol, Andrew Bonney, Patricia Knight-Billing, Judy Mullan, Michelle Moscova, Stephen Barnett, Don Iverson, Daniel Saffioti, Elisabeth Eastland, Michelle Guppy, Kathryn Weston, Ian Wilson, Judith Nicky Hudson, Dimity Pond, Gerard Gill, Charlotte Hespe

Medical Papers and Journal Articles

External stabilization is reported to improve reliability of hand held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry.

Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to four weeks. Within session reliability was assessed using intraclass correlations calculated for within session data grouped prior to surgery, immediately after surgery and in the sub-acute phase of injury. Minimum …

Accuracy Of Predictive Formulas To Estimate Resting Energy Expenditure Of Thermally Injured Patients, Roland N. Dickerson, Jane M. Gervasio, Marti L. Riley, James E. Murrell, William L. Hickerson, Kenneth A. Kudsk, Rex O. Brown

Jane M. Gervasio

Abstract from the 25th Clinical Congress of the American Society for Parenteral and Enteral Nutrition, Chicago, IL, January 21-24, 2001.

A Comparison Of Renal Phosphorus Regulation In Thermally-Injured And Multiple Trauma Patients Receiving Specialized Nutrition Support, Roland N. Dickerson, Jane M. Gervasio, Justin J. Sherman, Kenneth A. Kudsk, William L. Hickerson, Rex O. Brown

Jane M. Gervasio

To compare phosphorus intake and renal phosphorus regulation between thermally injured patients and multiple trauma patients, 40 consecutive critically ill patients, 20 with thermal injury and 20 with multiple trauma, who required enteral tube feeding were evaluated. Phosphorus intakes were recorded for 14 days from the initiation of tube feeding which was started 1 to 3 days post-injury. Serum for determination of phosphorus concentrations was collected at days 1, 3, 7, and 14 of the study period. A 24-hour urine collection was obtained during the first and second weeks of nutrition support for urinary phosphorus excretion, fractional excretion of phosphorus, …

Accuracy Of Predictive Methods To Estimate Resting Energy Expenditure Of Thermally-Injured Patients, Roland N. Dickerson, Jane M. Gervasio, Marti L. Riley, James E. Murrell, William L. Hickerson, Kenneth A. Kudsk, Rex O. Brown

Jane M. Gervasio

Background The purpose of this study was to evaluate the bias and precision of 46 methods published from 1953 to 2000 for estimating resting energy expenditure (REE) of thermally injured patients. Methods Twenty-four adult patients with ≥20% body surface area burn admitted to a burn center who required specialized nutrition support and who had their REE measured via indirect calorimetry (IC) were evaluated. Patients with morbid obesity, human immunovirus, malignancy, pregnancy, hepatic or renal failure, neuromuscular paralysis, or those requiring a FiO2 >50% or positive end expiratory pressure (PEEP) ≥10 cm H2O were excluded. One steady-state measured REE measurement (MEE) …

Trends And Costs Of Industry-Related Injuries In The United States [1998 - 2009], Delphine Fontcha

USF Tampa Graduate Theses and Dissertations

In order to describe the trend, characteristics, and cost of occupational injuries that occurred in industrial settings across the United States between 1998 and 2009, a cross sectional analysis based on hospital discharge data was conducted. The National Inpatient Sample (NIS) data from the Healthcare and Cost Utilization Project (HCUP)(1) was used. Identification of relevant injuries from the sample was performed using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) code E849.3 (industrial place and premises)(8).

A total of 307,586 (weighted) patients with industrial related injuries were discharged from hospitals in the United States during the period …

Pediatric Medical Traumatic Stress : The Impact On Children, Parents And Staff, Sarah Mcgarry

Theses: Doctorates and Masters

Burns are one of the most painful and traumatising injuries an individual can sustain and constitute a serious global health threat to children. Despite the magnitude of this public health problem, little research has examined the psychological burden of these injuries. This study used a mixed-methods approach to investigate the effect of paediatric medical trauma on children who have sustained a burn, their parents and the healthcare professionals caring for these patients. The paediatric medical traumatic stress model provided a theoretical framework for this study.

Firstly, this study aimed to gain an understanding of the lived experience of children who …

The Long-Term Impact Of Physical And Emotional Trauma: The Station Nightclub Fire, Jeffrey C. Schneider, Nhi-Ha T. Trinh, Elizabeth Selleck, Felipe Fregni, Sara S. Salles, Colleen M. Ryan, Joel Stein

Physical Medicine and Rehabilitation Faculty Publications

BACKGROUND: Survivors of physical and emotional trauma experience enduring occupational, psychological and quality of life impairments. Examining survivors from a large fire provides a unique opportunity to distinguish the impact of physical and emotional trauma on long-term outcomes. The objective is to detail the multi-dimensional long-term effects of a large fire on its survivor population and assess differences in outcomes between survivors with and without physical injury.

METHODS AND FINDINGS: This is a survey-based cross-sectional study of survivors of The Station fire on February 20, 2003. The relationships between functional outcomes and physical injury were evaluated with multivariate regression models …

Trends In Maternal And Infant Health: An Analysis Of Births In Montgomery County, Ohio, 2000-2010, Abby Burns

Master of Public Health Program Student Publications

The demographic characteristics of women who give birth are continually changing. Age, education, use of assisted reproductive technology, BMI before pregnancy, and weight gain during pregnancy are maternal factors that play a role in maternal and fetal health. Other factors including induction, route of delivery, calculated gestational age, and birthweight help determine and identify complications of pregnancy. The purpose of this study is to analyze trends of maternal demographics, risk factors, and birth outcomes associated with poor health outcomes. This research is a secondary analysis of Ohio Natality Statistical Files collected by the Ohio Department of Health, Center for Vital …