Translation of SCAR-Q into Finnish and psychometric validation of the Finnish version.

BACKGROUND: An effective patient-reported outcome measure for scars is needed to assess scar treatments and thus improve scar management. The recently developed SCAR-Q questionnaire for all scar types, which consists of the Appearance, Symptom, and Psychosocial impact scales, has been developed with patients' input. The aim of this study was to translate the SCAR-Q into Finnish and to assess its psychometric properties in burn patients. METHODS: The translation protocol followed the International Society for Pharmacoeconomics and Outcomes Research guidelines. Participants for the psychometric validation of the Finnish SCAR-Q were adults with deep second or third degree burns treated with skin grafting in the Helsinki Burn Centre between 2006 and 2017. Internal consistency was assessed by using Crohnbach's alpha and reliability by using ICC, SEM, R values, and Mann-Whitney U-test. The internal structure of each SCAR-Q subscale was investigated by using exploratory factor analysis. RESULTS: 190 burn patients participated in the psychometric validation of the Finnish SCAR-Q. 135 (71.1 %) of the participants were male. Ceiling effect was present in all subscales. Internal consistency was excellent with all subscales, Crohnbach's alpha 0.97, 0.91, and 0.94. Reliability was good in all subscales, ICC 0.84, 0.88, and 0.91. The parallel analysis suggested inclusion of one factor into factor analysis for the Appearance scale and the Psychosocial impact scale, whereas two factors for the Symptom scale. CONCLUSION: The Finnish version of the SCAR-Q is equivalent with the original scale, showed excellent internal consistency, factor analysis confirmed it for the Appearance and Psychosocial impact scale, and demonstrated good reliability with all subscales when used in assessing burn scars.

Translation and psychometric validation of the Finnish version of the Patient Scar Assessment Scale for use in patients with burn scars.

BACKGROUND: The aim of this study was to create a Finnish scar assessment scale by translating and evaluating the psychometric properties of the Patient Scar Assessment Scale (PSAS), a part of the Patient and Observer Scar Assessment Scale (POSAS), with burn patients to enable its use in burn care. METHODS: The translation process followed international guidelines with forward and backward translations and cognitive debriefing with patients. Psychometric validation was performed with adult patients with burns who had been treated at the Helsinki Burn Centre between 2006 and 2017 with skin grafting following the excision of deep second- or third-degree burns. To ensure reproducibility, the PSAS was sent to the study participants twice. The correlation between the PSAS and health-related quality of life (HRQL) was also tested. RESULTS: In total, 192 patients, of whom 71 % were male, participated in this study. The mean (SD) age of the participants was 57 (17) years. The internal consistency of the PSAS was good, Cronbach's α 0.89 (95 % CI: 0.86-0.91). The reproducibility was also good concerning all items and the total score, ICC from 0.77 to 0.89. As expected, the total PSAS score correlated negatively with HRQL. CONCLUSION: The PSAS was successfully translated and culturally adapted into Finnish and the newly translated version has good validity and reproducibility for assessing mature burn scars.

ATMP-classified, scalable, autologous cell spray for the treatment of skin wounds and assessment of its effects on wound healing clinically and on a molecular level.

BACKGROUND: Autologous split-thickness skin grafts (STSGs) are the standard of care for closure of deep and large burns. However, perforation and extensive fishnet-like expansion of the grafts to achieve greater area wound coverage can lead to treatment failures or esthetically poor healing outcomes and scarring. The purpose of this study was to validate an autologous advanced therapy medicinal product (ATMP)-compliant skin cell suspension and evaluate its efficacy to promote epithelialization. METHODS: Cells isolated from a piece of STSG according to ATMP classification requirements were sprayed onto 20 patients during a single operation in a validation study. Comparative evaluation of treatment efficacy was carried out using side-by-side skin graft donor site wounds that were standardized in depth. Firstly, we characterized wound healing transcriptomes at 14 and 21 days from serial wound biopsies in seven patients. Then, side-by-side wounds in four patients were treated with or without the skin cells. The wounds were photographed, clinical outcomes assessed, and the treatment and control wound transcriptomes at 14 days were compared to the untreated wounds' healing transcriptomes. RESULTS: The average cell yield after isolation from the STSG was 2.4 × 106 cells/cm2 with 96 % viability. The product contained mainly keratinocytes and their precursors but also other skin cells such as fibroblasts were present. As compared to vehicle-treated donor site wounds, the wounds treated with cells demonstrated improved epithelialization by both direct comparison and machine learning analysis of the transcriptomes. CONCLUSIONS: We showed that rapid and scalable ATMP-classified processing of skin cells is feasible, and application of the skin cells effectively promotes healing and epithelization of donor site wounds.

The CARe Burn Scale-Adult Form: Translation and linguistic validation into Finnish.

BACKGROUND: Burn injury can dramatically deteriorate health-related quality of life. Effective burn care may minimize the impact of the burn injury and ensure optimal functional outcome. This requires continuous improvement in burn care and assessment of treatment results. The aim of this study was to translate, culturally adapt and linguistically validate the CARe Burn Scale-Adult Form, a burn-specific patient-reported outcome measure, into Finnish. METHODS: The translation process followed the International Society for Pharmacoeconomics and Outcomes Research guidelines consisting of forward and backward translations, pilot-testing and cognitive debriefing interviews of five burn patients, and proofreading before finalizing. The process involved expert panel meetings and continuous discussion between the developers of the Scale and the research group. RESULTS: In the forward translation 10 amendments were required. After the backward translation, 12 items were reworded. Cognitive debriefing interviews led to three alterations enhancing the comprehensiveness and accuracy of the translation. The translation was reviewed by burn occupational therapists for practicality, resulting in 12 modifications. Minor grammatical changes were made after proofreading. CONCLUSION: The Finnish version is the first foreign translation of the CARe Burn Scale. It is equivalent to the original Scale and ready for psychometric validation with burn patients in Finland.

Inpatient costs of fire-related injuries in Finland.

The aim of this study was to approximate the direct health care costs of fire-related injuries in inpatient care in Finland. Using the PERFECT costing method, cost data from both Finnish burn centres were linked to the fire-related injury patient data from the Finnish National Hospital Discharge Register (FHDR, 2001-2009). Additionally, a sample of 168 patients from the Helsinki Burn Centre was linked to the FHDR to examine the relation of %TBSA. Burn was involved in approximately 77% of the cases, the remainder consisting mainly of combustion gas poisonings. Burns were generally much more expensive to treat. Fire-related injuries incurred EUR 6.2 million per year in inpatient costs for the whole country. Mean cost per burn patient was EUR 25,000 and for combustion gas poisoning it was EUR 3600. As expected there was a strong relationship between %TBSA and cost. Older age had a strong effect on costs. The most severe injuries cost over EUR 400,000 to treat. Approximately 7-8% of the most expensive cases constitute 50% of the total costs. Successful prevention of extreme cases would yield considerable savings in relation to total annual inpatient care costs. However, a cost-benefit analysis would be needed.

Psychiatric consultation and care after acute burn injury: a 6-month naturalistic prospective study.

OBJECTIVE: To prospectively investigate proportions of burn patients receiving psychiatric consultation or care, and whether care actually received relates to estimated psychiatric need or burn severity. METHOD: Consecutive acute hospitalized adult burn patients were examined with the Structured Clinical Interview for DSM IV-TR (SCID-I) at baseline and six months after injury. During follow-up, 55% (51/92) suffered from some mental disorder. Estimated need for psychiatric care was classified as unequivocal, probable or nonexistent. The proportions of patients receiving psychiatric consultation and/or different levels of psychiatric care and specific psychiatric interventions during follow-up and predictors for care were investigated. RESULTS: During the follow-up, 21% of acute burn patients received psychiatric care, and 20%, psychiatric consultation. Of patients with unequivocal need, 48% (12/25) received psychiatric care, and 28%, psychiatric consultation; with probable need, 21% received psychiatric care, and 37%, consultation. Pre-burn psychiatric history (OR=7.54), severe burns (OR=6.76) and estimated need for psychiatric care (OR=6.23) significantly predicted psychiatric care. CONCLUSIONS: After hospitalized burn injury, only half of the patients with mental disorders and unequivocal need for psychiatric care actually received such care. Psychiatric consultations and care follow the course of acute burn treatment, not of later emerging mental disorders. Previous psychiatric history strongly influences care decisions.