Burns Current Awareness Newsletter

July 2015

Outreach Your Outreach Librarian can help facilitate evidence-based practise for all members of staff, as well as assisting with academic study and research. We can help with literature searching, obtaining journal articles and books, and setting up individual current awareness alerts.

Literature Searching We provide a literature searching service for any library member. For those embarking on their own research it is advisable to book some time with one of the librarians for a 1 to 1 session where we can guide you through the process of creating a well-focused literature research and introduce you to the health databases access via NHS Evidence.

Critical Appraisal Training We also offer one-to-one or small group training in literature searching, accessing electronic journals, and critical appraisal/Statistics. These are essential courses that teach how to interpret clinical papers.

For more information, email: [email protected]

Books Books can be searched for using SWIMS our online catalogue at www.swims.nhs.uk. Books and journals that are not available on site or electronically may be requested from other locations. Please email requests to: [email protected]

Contents

1: Tables of Contents from July’s Burns journals

2: Latest relevant Systematic Reviews from the Cochrane Library

3: Quick Exercise

4: Current Awareness database articles Tables of Contents from Burns journals

If you require full articles please email: [email protected]

Burns 2015 (Elsevier) August 2015, Volume 41, Issue 3

Journal of Care & Research (LWW) May/June 2015, Volume 36, Issue 3

Injury Prevention (BMJ) June 2015, Volume 21, Issue 3

Plastic and Reconstructive (LWW) July 2015, Volume 136, Issue 1

Journal of Plastic, Reconstructive & Aesthetic Surgery (Elsevier) July 2015, Volume 68, Issue 7

Archives of Disease in Childhood (BMJ) July 2015, Volume 100, Issue 7

Pediatrics (HighWire) July 2015, Volume 136, Issue 1

Injury (Elsevier) July 2015, Volume 46, Issue 7

Trauma (Sage) July 2015, Volume 17, Issue 3

To access electronic resources you need an NHS Athens username and password

To register, click on the link: https://openathens.nice.org.uk/

You need to register using an NHS PC and an NHS email address.

Registration is a quick, simple process, and will give you access to a huge range of online subscription resources, including:

UpToDate Dynamed NHS Evidence Anatomy.tv E-journals E-books

For more information or help with setting up your Athens account, email: [email protected]

Latest relevant Systematic Reviews from the Cochrane Library

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness Bronwen Connolly, Lisa Salisbury, Brenda O'Neill, Louise Geneen, Abdel Douiri, Michael PW Grocott, Nicholas Hart, Timothy S Walsh, Bronagh Blackwood, for the ERACIP Group

Hyperbaric oxygen for chronic wounds Peter Kranke, Michael H Bennett, Marrissa Martyn-St James, Alexander Schnabel, Sebastian E Debus, Stephanie Weibel

Transcutaneous electrical nerve stimulation for acute pain Mark I Johnson, Carole A Paley, Tracey E Howe, Kathleen A Sluka

Quick Exercise

Confounding Bias in research methodology

A confounder is a factor that is:  Linked to the outcome of interest, independent of the exposure  Linked to the exposure but not the consequence of the exposure

What is the confounding factor in the following relationships:

 People who carry matches are more likely to develop lung cancer

 People who eat ice-cream are more likely to drown

 Training in anaesthesia is more likely to make doctors commit suicide

To find out more about bias in research methodology, sign up for one of our Critical Appraisal training sessions. For more details, email [email protected]

UpToDate is the leading evidence-based clinical decision support system, designed for use at the point of care.

It contains more than 9,500 searchable topics across the following specialities:

 Adult and paediatric emergency and  Cardiovascular medicine   Drug therapy  and diabetes mellitus  and  Haematology   Infectious diseases  and hypertension  and  Paediatrics  Primary care  Pulmonary, critical care and

How to access UpToDate

You can access UpToDate from any computer via www.uptodate.com. You will need your NHS Athens username/password (register through http://openathens.nice.org.uk/). Current Awareness database articles

If you require full articles please email: [email protected]

Title: Diagnostic criteria for cutaneous injuries in child abuse: classification, findings, and interpretation.

Citation: Forensic science, medicine, and , Jun 2015, vol. 11, no. 2, p. 235-242 (June 2015)

Author(s): Tsokos, Michael

Abstract: Physical abuse of children has many manifestations. Depending on the type of force involved, specific injury patterns are produced on the body of the child, the morphology and localization of which are forensically relevant in terms of diagnostic classification as child abuse. Typical patterned bruising includes, for example, tramline bruises resulting from blows with oblong, stick-like objects. In addition to rounded or one- sided horseshoe-shaped bite injuries, injuries of different ages, clustered injuries (e.g., three or more individual injuries in the same body region), and thermal injuries are typical results of abuse. Abusive scalds are usually characterized by a symmetrical impression and localization with sharp delineation of the scald wound edges, in contrast to accidental scalding injuries with radiating splash patterns ending in tapered points. The coloration of a hematoma can help indicate the time when the injury occurred. Lack of a coherent and comprehensible explanation for accidental injury constitutes grounds for suspecting abuse. Suspicions should be raised in cases of a delayed visit to a doctor, waiting for an unusually long period before summoning emergency medical help for serious injuries to a child, and when differing versions of a purported accident are provided. Documentation of the findings is highly relevant in later reviews of the diagnosis, for instance, when new relevant facts and investigative results come to light in subsequent criminal proceedings.

Source: Medline

Title: Too hot to handle? Hot water bottle injuries in Sydney, Australia.

Citation: Burns : journal of the International Society for Burn Injuries, Jun 2015, vol. 41, no. 4, p. 770-777 (June 2015)

Author(s): Goltsman, David, Li, Zhe, Bruce, Eleanor, Darton, Anne, Thornbury, Kelly, Maitz, Peter K M, Kennedy, Peter

Abstract: Hot water bottles are frequently used in the community as a source of warmth, and to alleviate a number of medical symptoms. In Australia it is believed that over 500,000 water bottles are sold annually (Whittam et al., 2010). This simple treatment is known to result in significant burns and has led to mandatory labeling requirements on hot water bottles in Australia. Despite this, few published studies have documented the incidence and nature of burns sustained through their use. This study aimed to assess the incidence, causation and outcome of hot water bottle burns presenting to a major burn trauma unit in Sydney (Australia). The New South Wales Agency for Clinical Innovation Statewide Burn Injury database and admission data to the Concord Hospital Burns Injury Unit (major treatment unit) provided information on hot water bottle burns occurring between 2005 and 2013. Demographic details, cause of burn, burn depth, total burn surface area (%TBSA), and outcome of burn were ascertained. In order to assess the burn potential of hot water bottles, a separate study examined the thermic properties of hot water bottles in 'real life' scenarios. There were 155 hot water bottle burn presentations resulting in 41 admissions and 24 grafts. The majority of patients were female, and most burns resulted from appliance rupture when used for local pain relief. Patients had an average TBSA of 2.4%. Burns patients were slightly more likely to reside in areas with greater socio-economic disadvantage. In real life scenarios, hot water bottles were shown to retain heat over 50°C for at least 3 hours (h). Hot water bottles are a source of common and preventable burns in the community, with women being more at risk than men. Hot water bottles may retain harmful levels of heat over an extended period of time. Additional labeling requirements pertaining to the longevity of hot water bottles and their use among people especially at risk of burns (i.e. children, the elderly, patients who have undergone recent surgery and/or those with conditions associated with sensory impairment) may further reduce the incidence and severity of hot water bottle burns in the community. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Source: Medline

Title: Increased wound pH as an indicator of local wound infection in second degree burns.

Citation: Burns : journal of the International Society for Burn Injuries, Jun 2015, vol. 41, no. 4, p. 820-824 (June 2015)

Author(s): Ono, Sayaka, Imai, Ryutro, Ida, Yukiko, Shibata, Dai, Komiya, Takako, Matsumura, Hajime

Abstract: Wound pH affects a number of important factors in wound healing. It is known that the pH of the skin surface of healthy adults and children is 4.2-5.6 and that it decreases with the lapse of epithelialization. We measured the pH of the exudates from second degree burns in 26 cases. Among these, local burn wound infection developed in 6 cases. The causative organisms were Staphylococcus aureus in 2 cases and Staphylococcus epidermidis in 4 cases. The maximum pH value measured was 10.0 and the minimum was 5.0 for all samples. There were no differences in the initial measurements of pH between the non-infected cases and the local-infected cases. In cases of local infection, the pH rose prior to the onset of clinical signs of local burn infection. By consecutive measurement of pH, early detection of local wound infection can be achieved and this is very beneficial in clinical practice. Moreover, measurement is very easy and results are available immediately. In conclusion, consecutive pH measurement of exudates is considered to be a useful indicator in the treatment of second degree burns. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Source: Medline

Title: Surgical treatment of severe or moderate axillary burn contracture with transverse island scapular flap and expanded transverse island scapular flap in adult and pediatric patients--A clinical experience of 15 cases.

Citation: Burns : journal of the International Society for Burn Injuries, Jun 2015, vol. 41, no. 4, p. 872-880 (June 2015)

Author(s): Chen, Baoguo, Xu, Minghuo, Chai, Jiake, Song, Huifeng, Gao, Quanwen

Abstract: Axillary burn scar contracture is common and troublesome. With the aim of restoring the function of the upper extremities, a proper local flap with minor damage and preclusion from recurrence should be developed to guarantee satisfactory results. A minor webbed scar contracture was rectified by Z-plasty. However, severe or moderate contracture must be constructed by a local flap. An island scapular flap has been used in pediatric patients for repairing axillary contracture. However, no detailed description of the use of a transverse island scapular flap (TISF) was reported to correct the deformity. Moreover, an expanded transverse island scapular flap (ETISF) used for increasing the volume of skin for severe axillary contracture in adults and developing children was also not presented. From 2006 to 2013, TISFs were harvested for 12 pediatric patients (5-12 years of age) with 15 sides of severe or moderate axillary burn scar contractures. Four ETISFs were designed for two adult patients (38 and 32 years of age). The flap size was between 10 cm×5 cm and 20 cm×10 cm. In one pediatric patient, a cicatrix was observed on the surface of the flap's donor site. Handheld Doppler was applied to detect the pedicle. The patients were required to lift their upper arms regularly each day after the operation. All 19 flaps survived completely. Axillary burn scar contractures were corrected successfully in 11 patients with no expander implantation. The lifting angle was enhanced considerably with 1-3 years of follow- up in the 11 patients. Only one pediatric patient with cicatrix on the donor site displayed tight skin on the back and a little restraint on the shoulder. The patient's parents were told to intensify the chin-up movement on the horizontal bar. She was in the process of a 3-month follow-up. The lifting angle was also improved significantly in the latter three cases of expander implantation although they were followed up for a short duration of 3 months. Due to poor flap design, the donor site of one adult patient was not closed directly with the help of skin grafting on the left side of her back. Considering the flap's negligible level of later contracture and minimal trauma, local TISF based on the transverse branch of the circumflex scapular artery is a good choice for reconstruction of axillary burn scar contractures. If the TISF is not able to meet the demand, the expander implanted in advance can be more beneficial. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Source: Medline

Title: Measuring the impact of a burns school reintegration programme on the time taken to return to school: A multi-disciplinary team intervention for children returning to school after a significant burn injury.

Citation: Burns : journal of the International Society for Burn Injuries, Jun 2015, vol. 41, no. 4, p. 727-734 (June 2015)

Author(s): Arshad, Sira N, Gaskell, Sarah L, Baker, Charlotte, Ellis, Nicola, Potts, Jennie, Coucill, Theresa, Ryan, Lynn, Smith, Jan, Nixon, Anna, Greaves, Kate, Monk, Rebecca, Shelmerdine, Teresa, Leach, Alison, Shah, Mamta

Abstract: Returning to school can be a major step for burn-injured children, their family, and staff and pupils at the receiving school. Previous literature has recognised the difficulties children may face after a significant injury and factors that may influence a successful reintegration. A regional paediatric burns service recognised that some patients were experiencing difficulties in returning to school. A baseline audit confirmed this and suggested factors that hindered or facilitated this process, initiating the development of a school reintegration programme (SRP). Since the programme's development in 2009, it has been audited annually. The aim of this paper was to evaluate the impact of the SRP by presenting data from the 2009 to 2011 audits. For the baseline audit, the burn care team gathered information from clinical records (age, gender, total body surface area burned (TBSA), skin grafting and length of stay) and telephone interviews with parents and teachers of the school returners. For the re-audits, the same information was gathered from clinical records and feedback questionnaires. Since its introduction, the mean length of time from discharge to return to school has dropped annually for those that opted into the programme, when compared to the baseline by 62.3% (53 days to 20 days). Thematic analysis highlights positive responses to the programme from all involved. Increased awareness and feeling supported were amongst the main themes to emerge. Returning to school after a significant burn injury can be challenging for all involved, but we hypothesise that outreach interventions in schools by burns services can have a positive impact on the time it takes children to successfully reintegrate. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Source: Medline

Title: Chemical burns in children: Aetiology and prevention.

Citation: Burns : journal of the International Society for Burn Injuries, Jun 2015, vol. 41, no. 4, p. 764-769 (June 2015)

Author(s): D'Cruz, Rachel, Pang, Tony C Y, Harvey, John G, Holland, Andrew J A

Abstract: Chemical burns account for a small proportion of total burns in children, but may require specific first aid and different modes of prevention. A retrospective study between 2006 and 2012 of children ≤16 years treated with chemical burns at a specialist paediatric burn centre. Data were extracted from a prospectively maintained database. 56 episodes of chemical burns occurred during the study period. The majority (54%) occurred in boys. There were 39 (72%) patients <10 years and 17 (39%) ≥10 years. Median total body surface area burnt was 1% with nine (16%) patients requiring skin grafting. Only 24 (45%) had adequate first aid. The majority (n=46, 82%) of chemical burns occurred in the domestic setting, especially in the <10 years age group (P=0.052). Non-intentional exposure of chemicals by an unattended child accounted for half of all (n=22, 49%) chemical burns <10 years of age. Eight (47%) burns in patients ≥10 years resulted from self-harm. The most common aetiological agents were household cleaners and aerosols in the younger and older age groups respectively. Chemical burns remain infrequent but potentially preventable. These burns mainly occur in the domestic setting due to non-intentional exposure of household chemicals in children <10, and due to deliberate self-harm in children ≥10. The use of child-resistant packaging, similar to that used for medications, and improved parental practices could help decrease the incidence of burns in children <10. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Source: Medline

Title: [Burns and scalds in children].

Citation: Medizinische Klinik, Intensivmedizin und Notfallmedizin, Jun 2015, vol. 110, no. 5, p. 346-353 (June 2015)

Author(s): Landsleitner, B, Keil, J

Abstract: Since pediatric emergencies and burn injuries are rare in prehospital , emergency teams can hardly develop routine in emergency care. How to effectively treat burn injuries and avoid common errors? A simple and severity-based therapy concept based on the current literature using the example of a case report is presented. About 80 % of burns and scalds in children are not severe cases-in these patients an effective analgesia by intranasal administration is important and further invasive treatments are generally not necessary. The emergency care of children with severe burn injuries should start with intranasally administered analgesia and/or sedation. After an intravenous or intraosseous access is gained, moderate fluid therapy is started, which should be complemented by a fluid bolus only if signs of a shock are present. Additional administration of analgesia and/or sedation may be necessary. Estimation of the burned body surface area is best determined with the palm rule; the severity of the burn appears after a latency period. Induction of anesthesia and intubation are not required in the majority of cases. By applying a modified ABCDE scheme, all emergency teams can provide effective emergency care in children with burn injuries.

Source: Medline

Title: Review of "From Baghdad to Boston: International Transfer of Burned Children in Time of War" by Schmidt PM, Sheridan RL, Moore CL, Scuba SC, King BT, Morrissey PM, Cancio LC, in J Burn Care Res 35:369-373, 2014.

Citation: The Journal of craniofacial surgery, Jun 2015, vol. 26, no. 4, p. 1413-1414 (June 2015)

Source: Medline

Title: Recent developments in the management of common childhood skin infections.

Citation: The Journal of infection, Jun 2015, vol. 71 Suppl 1, p. S76. (June 2015)

Author(s): Oranje, Arnold P, de Waard-van der Spek, Flora B

Abstract: A literature review and clinical commentary on diagnosis and treatment of common childhood bacterial, fungal and viral skin infections is presented including impetigo, folliculitis, staphylococcal scalded skin syndrome, tinea capitis, warts and molluscum contagiosum. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Source: Medline

Title: Multidrug-Resistant Acinetobacter baumannii Bacteremia Treated with Tigecycline in Two Pediatric Burn Patients.

Citation: The Pediatric infectious disease journal, Jun 2015, vol. 34, no. 6, p. 677. (June 2015)

Author(s): Kank-Yüksek, Saliha, Tezer, Hasan, Ozkaya-Parlakay, Aslnur, Gulhan, Belgin, Sayed-Oskovi, Hülya, Kara, Ateş, Şenel, Emrah

Source: Medline

Title: Propofol-ketamine or propofol-remifentanil for deep sedation and analgesia in pediatric patients undergoing burn dressing changes: a randomized clinical trial.

Citation: Paediatric anaesthesia, Jun 2015, vol. 25, no. 6, p. 560-566 (June 2015)

Author(s): Seol, Tai-Kyung, Lim, Jin-Kyu, Yoo, Eun-Kyung, Min, Seong-Won, Kim, Chong-Soo, Hwang, Jin- Young

Abstract: In this study, we compared the propofol-ketamine and propofol-remifentanil combinations for deep sedation and analgesia during pediatric burn wound dressing changes. Fifty pediatric patients aged 12-36 months, undergoing burn wound dressing changes, were randomly assigned to receive propofol-remifentanil (group PR) or propofol-ketamine (group PK) for deep sedation and analgesia. Patients in the group PR received 2 mg·kg(-1) propofol and 0.1 μg·kg(-1) remifentanil, and 0.05 μg·kg(-1) ·min(-1) remifentanil was infused continuously until the end of the procedure. Patients in the group PK received 2 mg·kg(-1) propofol and 1 mg·kg(-1) ketamine, and the same volume of isotonic saline was infused continuously until the end of the procedure. Additional propofol with remifentanil or ketamine was administered when required. Hemodynamic variables, drug requirements, occurrence of patient movement, surgeon's satisfaction score, recovery time, and the incidence of adverse events were recorded throughout the procedure and recovery. Recovery time was significantly shorter in the group PR compared to that in the group PK (10.3 [9.1-11.5] min vs 22.5 [20.3-25.6] min, median [interquartile range], respectively; P < 0.001). No significant hypotension or bradycardia occurred throughout the procedure. No significant differences were observed in terms of drug requirements, occurrence of patient movement, surgeon's satisfaction, incidence of respiratory depression, hypoxia, or nausea and vomiting The combinations of propofol-ketamine and propofol-remifentanil were effective for sedation and analgesia in pediatric patients undergoing burn dressing changes, but the propofol-remifentanil combination provided faster recovery compared to the propofol-ketamine combination. © 2014 John Wiley & Sons Ltd.

Source: Medline

Title: Inpatient Rehabilitation Experience of Children with Burn Injuries: A 10-yr Review of the Uniform Data System for Medical Rehabilitation.

Citation: American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, Jun 2015, vol. 94, no. 6, p. 436-443 (June 2015)

Author(s): Luce, John C, Mix, Jacqueline, Mathews, Katie, Goldstein, Richard, Niewczyk, Paulette, DiVita, Margaret A, Gerrard, Paul, Sheridan, Robert L, Ryan, Colleen M, Kowalske, Karen, Zafonte, Ross, Schneider, Jeffrey C

Abstract: This study aimed to describe the pediatric burn inpatient rehabilitation population and short-term functional outcomes using the Uniform Data System for Medical Rehabilitation. This is a secondary analysis of data from the Uniform Data System for Medical Rehabilitation database between 2002 and 2011 included children younger than 18 yrs at time of admission to inpatient rehabilitation with primary diagnosis of burn injury. Demographic, medical, and functional data were evaluated. Function was assessed with the Functional Independence Measure or the WeeFIM. A total of 509 children were included, of whom 124 were evaluated with Functional Independence Measure and 385 with WeeFIM. The mean age of the population was 8.6 yrs and most were boys (72%). The mean length of stay for the population was 35 days. Functional status improved significantly from admission to discharge; most gains were in the motor subscore. Most patients were discharged home (95%). Of those discharged home, most (96%) went home with family. Children receiving multidisciplinary inpatient rehabilitation make significant functional improvements in total functional scores and in both motor and cognitive subscores. Most patients are discharged home with family. This study advances understanding of pediatric burn post-acute care outcomes.

Source: Medline

Title: Clinical and forensic signs related to chemical burns: a mechanistic approach.

Citation: Burns : journal of the International Society for Burn Injuries, Jun 2015, vol. 41, no. 4, p. 658-679 (June 2015)

Author(s): Dinis-Oliveira, Ricardo Jorge, Carvalho, Félix, Moreira, Roxana, Proença, Jorge Brandão, Santos, Agostinho, Duarte, José Alberto, Bastos, Maria de Lourdes, Magalhães, Teresa

Abstract: This manuscript highlights and critically analyses clinical and forensic signs related to chemical burns. Signs that may lead to suspicion of a particular chemical are thoroughly discussed regarding its underlying mechanisms. Burns due to sulfuric, hydrofluoric, nitric, hydrochloric (muriatic) and acetic (including derivatives) acids, hydrogen sulphide, sodium (caustic soda) and calcium (cement) hydroxides, paraquat, burns after inflation and rupture of airbags, povidone-iodine, chlorhexidine/alcohol (in preterm infants), laxatives, and vesicants (warfare agents), will be reviewed since these are the most common agents found in daily practice, for which relevant and timed information may be helpful in formulating an emergency treatment protocols and toxicological analysis. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Source: Medline

Title: Comparison of long-term quality of life of pediatric burn survivors with and without inhalation injury.

Citation: Burns : journal of the International Society for Burn Injuries, Jun 2015, vol. 41, no. 4, p. 721-726 (June 2015)

Author(s): Rosenberg, Marta, Ramirez, Maribel, Epperson, Kathy, Richardson, Lisa, Holzer, Charles, Andersen, Clark R, Herndon, David N, Meyer, Walter, Suman, Oscar E, Mlcak, Ronald

Abstract: To examine the long-term quality of life of pediatric burn survivors with and without inhalation injuries. We hypothesized that patients with inhalation injury would report more disability and lower quality of life. We examined 51 patients with inhalation injury and 72 without inhalation injury who had burns of ≥10% total body surface area, were age ≥16 years at time of the interview, and were greater than 5 years from injury. Subjects completed the World Health Organization Disability Assessment Scale II (WHODAS II) and the Burn Specific Health Scale-Brief (BSHS-B). Multiple regression analyses were used to measure the effects of inhalation injury while controlling for age at burn and TBSA. The mean age of burn of participants with inhalation injury was 11.7±3.6 years, mean TBSA 55%±18, and mean ventilator days 8.4±9. The mean age of burn of participants without inhalation injury was 10.3±34.1 years, mean TBSA 45%±20, and mean ventilator days 1.3±5.2. Inhalation injury did not appear to significantly impact participants' scores on the majority of the domains. The WHODAS II domain of household activities showed a significant relation with TBSA (p=0.01). Increased size of burn was associated with difficulty completing tasks for both groups. The BSHS-B domain of treatment regimen showed a relation with age at burn (p=0.02). Increased age was associated difficulty in this area for both groups. Overall the groups were comparable in their reports of disability and quality of life. Inhalation injury did not affect long-term quality of life. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Source: Medline

Title: Keeping kids sun safe: Exploring parents' beliefs about their young child's sun‐protective behaviours.

Citation: Psycho-Oncology, Jun 2015, (Jun 23, 2015), 1057-9249 (Jun 23, 2015)

Author(s): Hamilton, Kyra, Cleary, Catherine, White, Katherine M., Hawkes, Anna L.

Abstract: Abstract Objectives Melanoma of the skin is the third most commonly diagnosed cancer in Australia. Given the high incidence of sunburn in children and the level of sun protection provided by parents is often infrequent and/or insufficient, this research employed qualitative methodology to examine parents' beliefs about their young child's sun safe behaviour. Methods Parents (N = 21; n = 14 mothers, n = 7 fathers) of children aged 2–5 years participated in focus groups to identify commonly held beliefs about their decision to sun protect their child. Data were analysed using thematic content analysis. Results Parents generally had knowledge of the broad sun safe recommendations; however, the specific details of the recommendations were not always known. Parents reported adopting a range of sun‐protective measures for their child, which depended on the time of year. A range of advantages (e.g. reducing the risk of skin cancer, developing good habits early and parental peace of mind), disadvantages (e.g. false sense of safety and preventing vitamin D absorption), barriers (e.g. child refusal) and facilitators (e.g. routine and accessibility) to performing sun safe practices were identified. Normative pressures and expectations also affected parents' motivation to be sun safe for their child. Conclusions These identified beliefs can be used to inform interventions to improve sun safe behaviours in young children who reside in a region that has the highest skin cancer incidence in the world. Copyright © 2015 John Wiley & Sons, Ltd. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)

Source: PsycInfo

Title: The past 25 years of pediatric burn treatment in Graz and important lessons been learned. An overview.

Citation: Burns : journal of the International Society for Burn Injuries, Jun 2015, vol. 41, no. 4, p. 714-720 (June 2015)

Author(s): Trop, Marija, Herzog, Sereina A, Pfurtscheller, Klaus, Hoebenreich, Angelika M, Schintler, Michael V, Stockenhuber, Andrea, Kamolz, Lars-Peter

Abstract: The aim of this study was to characterize the epidemiology of pediatric and adolescent burns admitted to the Children's Burns Unit at the Department of and , Medical University of Graz, Austria, between January 1st 1988 and December 31st 2012. This is a retrospective review over the past 25-years and describes admission rate by gender and age groups, causes of burns, anatomical sites of burns, extent and depth of injury, length of hospital stay, child abuse and in-hospital mortality. In the studied 25 year-period, 1586 pediatric burn patients were admitted. 1451 patients were "acute" admissions, 64 "secondary" admissions and 71 patients did not fulfill the inclusion criteria. Of the 1451 patients, 930 (64%) were male and 521 (36%) female. The majority of patients - 880 or 60.6% - were children from 1 to 5 years of age. Domestic burns occurring at home resulted in 1164 (80.2%) of injuries and scalds were the most common type of thermal trauma with 945 (65.1%) patients. According to the extent of injury 1106 (76.2%) patients suffered burns of <10% with an median length of hospital stay of 3 days. 14 children (0.98%) - 8 girls and 6 boys - were confirmed victims of abuse and 4 patients (0.3%) died. The study provides a good opportunity to review changes in burn care over a long time period, at a single center, including children and adolescents, with stable surgical and rehabilitation staff. The data is also important for the design of prevention programs and establishment of burn care capacities, since the analysis showed no change in the incidence of burn related admissions over the time period studied. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Source: Medline

Title: Evaluation of 2 novel devices for calculation of fluid requirements in pediatric burns.

Citation: Annals of , Jun 2015, vol. 74, no. 6, p. 658-664 (June 2015)

Author(s): Dingley, John, Cromey, Catherine, Bodger, Owen, Williams, David

Abstract: The Parkland formula for maintenance and resuscitation fluid requirements in the first 24 hours after pediatric burns is widely used, but calculation errors frequently occur. Two different novel aids to calculation, a dedicated electronic device and a mechanical disc calculator, are described and compared with the conventional method of calculation (pen and paper, assisted by a general purpose calculator). In a blinded randomized volunteer study, 21 participants performed a total of 189 calculations using simulated patient data to compare the accuracy and speed of 3 different methods for calculating resuscitation fluid requirements based on the pediatric Parkland formula. Bespoke software generated the simulated patient data and recorded accuracy and speed of all participant responses. Sixty-five percent of calculations with the electronic device, 35% using the disc and 44% using the pen/paper methods were within ±5% of the correct value and considered "correct" for clinical purposes. The method used strongly affected the tendency to make errors (logistic regression). With thresholds of error magnitude classed as very small (>5%), small (>25%), medium (>50%) and large (>100%) of the correct value respectively, the electronic method produced fewer errors than both disc and pen/paper methods at all error thresholds. Disc produced more errors than pen/paper at the greater than 5% threshold but fewer at the greater than 25%, greater than 50%, and greater than 100% thresholds. Both novel devices provide safer and faster alternatives to conventional methods for calculation of fluid requirements in pediatric burns.

Source: Medline

Title: Paediatric burns patients: Reasons for admission at a tertiary centre.

Citation: Burns : journal of the International Society for Burn Injuries, Jun 2015, vol. 41, no. 4, p. 708-713 (June 2015)

Author(s): Marino, M J, Kimble, R M, Stockton, K A

Abstract: The aim of this study was to determine the reasons why children with burns are admitted upon primary presentation to a tertiary burns centre. The study was a retrospective chart review of all children admitted to the Stuart Pegg Paediatric Burns Centre with a burns injury over an 18 month period. A total of 159 children with an overall median age of 25 months were included in the study. The reason for admission was able to be determined in all but two of these patients, and categorised into either severity, region of body burnt, social reasons, timing of presentation, geographical reasons, age and other. The majority of children (45%) were admitted for severity, followed by region of body burnt (24%) and social reasons (11%). One third of children were admitted because of reasons other than the biology of the burn itself (severity or body region). The findings of this study demonstrate that it is not just children with severe burns who are admitted. One third of children are admitted because of the impact of the burn injury on the family, not because of a need for immediate management of the burns injury itself. The full impact of paediatric burns on our healthcare system is not solely determined by the physical characteristics of the burn itself. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Source: Medline

Title: Prospective, randomised controlled trial comparing VersajetTM hydrosurgery and conventional debridement of partial thickness paediatric burns.

Citation: Burns : journal of the International Society for Burn Injuries, Jun 2015, vol. 41, no. 4, p. 700-707 (June 2015)

Author(s): Hyland, Ela J, D'Cruz, Rachel, Menon, Seema, Chan, Queenie, Harvey, John G, Lawrence, Torey, La Hei, Erik, Holland, Andrew J A

Abstract: Conventional surgical debridement of burn wounds consists of tangential excision of eschar using a knife or dermabrasion until viable dermis or punctate bleeding occurs. The VersajetTM (Smith and Nephew, St. Petersburg, FL, USA) hydrosurgery system has also been advocated for burn wound debridement, with the suggestion that enhanced preservation of dermal tissue might reduce subsequent scarring. A prospective randomised controlled trial was undertaken comparing VersajetTM to conventional debridement. After excluding those with facial burns, 61 children ≤16 years of age undergoing debridement and skin grafting for partial thickness burns were recruited. Adequacy of debridement was assessed by 2mm punch biopsies taken pre- and post-debridement. Surgical time, percentage graft take at day 10, time to healing, post-operative infection and scarring at 3 and 6 months were assessed. Thirty-one children underwent conventional debridement and 30 debridement using VersajetTM. There was a significant difference in the amount of viable dermal preservation between the two groups (p=0.02), with more viable tissue lost in the conventional group (median 325 μm) versus the VersajetTM group (median 35 μm). There was no significant difference between graft take at day 10 (p=0.9), post-operative wound infection (p=0.5), duration of surgery (p=0.6) or time to healing after grafting (p=0.6). Despite better dermal preservation in the VersajetTM group, there was no significant difference between scarring at 3 or 6 months (p=1.0, 0.1). These findings suggest that VersajetTM hydrosurgery appears a more precise method of burn wound debridement. Although dermal preservation may be a factor in reducing subsequent hypertrophic scarring, there were no significant differences found between scarring at 3 or 6 months after-injury. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Source: Medline

Title: Influence of burn injury on activity participation of children.

Citation: Journal of burn care & research : official publication of the American Burn Association, May 2015, vol. 36, no. 3, p. 414-420 (2015 May-Jun)

Author(s): Grice, Kimatha Oxford, Barnes, Karin J, Vogel, Kimberly A

Abstract: Children with physical disabilities show limitations in the frequency of participation in activities and in the range of activities, such as play and recreation, chores, and social involvement, compared to their able- bodied peers. The Children's Assessment of Participation and Enjoyment (CAPE) is a standardized assessment which evaluates a child's participation in, enjoyment of, and preferences for formal and informal activities other than school activities. In this study, the CAPE was used to evaluate activity participation of children with burns to provide an understanding of the impact of the injury on their participation in activity. The results provided preliminary information that burn injury can affect the activity participation of children. The children in this study were found to participate more in informal domain activities than formal domain, yet enjoyment scores were higher for formal domain activities. It was found that children with burn injury do not participate in social activities as much as children with other physical limitations, but they scored highest in these for enjoyment. In addition, they participate more in activities at home than outside the home. Increased awareness of activity participation of children with burns can guide healthcare professionals toward appropriate interventions and help parents increase participation in desired activities to improve the children's positive adjustment and quality of life. Intervention needs to address all aspects of activity participation, particularly for domain, types of activities, and where they are done. These considerations add another dimension to the care required for children with burn injury.

Source: Medline

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