A comparison of parent-reported and self-reported psychosocial function scores of the PedsQL for children with non-severe burn.

BACKGROUND: Quality of life of paediatric patients after burn injury is often assessed through parents who may score differently to their child. Non-severe burns are the most common type of burn injury in Western Australia, however, despite low severity and high survival rates, they can cause long term physical and psychosocial problems which need to be detected early in order to provide patients with optimal holistic care. METHODS: Demographic and clinical data were collected from paediatric patients (5-16-year-old) with non-severe burns (<20% total body surface area), and Paediatric quality of life (PedsQL) questionnaires were collected from both the patient and their parent. Two cohorts of patients were assessed: first, those at approximately six months after burn, and second, those more than one-year after burn. Differences between parent-scores and self-scores were analysed using multivariate linear regression to assess the relationship between risk factors and observed differences in PedsQL scores. RESULTS: Parents reported poorer Psychosocial Function (PSF) for younger children (p = 0.01) and for patients from higher socioeconomic status areas (p = 0.05) compared to their children. In the 'Early Recovery Cohort', female patients had significantly different scores to their parents (p < 0.01). In the 'Late Recovery Cohort', parents rated older patients lower than they rated themselves (p = 0.03). CONCLUSION: Age at burn, socioeconomic status, and female gender may increase the discrepancy in quality-of-life assessments between parents and patients.

'There's more to life than money and health': Family caregivers' views on the role of Power of Attorney in proxy decisions about research participation for people living with dementia.

People living with dementia may experience difficulties when making decisions for themselves in the later stages of the condition. While there are mechanisms in England and Wales for appointing an attorney to make decisions about welfare and finances on their behalf, there are no provisions for appointing an attorney to make future decisions about research participation. This is despite a growing focus on Advanced Care Planning and other processes that provide opportunities to discuss future preferences and ensure that decisions are made in line with those preferences. This qualitative study with 15 family caregivers who had acted as research proxies explored the role of Power of Attorney in their decisions about research, and their views about extending current legal arrangements to include research. Five themes were identified: the holistic nature of decision-making; the 'power' of attorney; making decisions by putting yourself in their shoes; support for bringing research under the umbrella of attorney arrangements and a unifying theme of trusting relationships. Legal provisions for prospectively appointing a research proxy may encourage discussion about future wishes and so enable decisions about research to be made that are in accordance with the person's preferences and wishes. However, further consultation with the public including people living with dementia and their families, and a range of stakeholders is needed. Providing guidance to families, people living with dementia and the wider research community may provide greater clarity and improve decision-making in the meantime.

"This is not just a little accident": a qualitative understanding of paediatric burns from the perspective of parents.

PURPOSE: To describe the experiences of parents of children admitted to hospital for a burn. METHODS: In-depth interviews were conducted with 21 parents (14 mothers and seven fathers) of children who had sustained a burn requiring hospitalisation. Face-to-face interviews were conducted six months post-burn, in rural, remote and metropolitan areas. The interview guide explored the overall experience of parents and included probing questions exploring the perceptions, thoughts and feelings of participants. Interviews were digitally recorded and transcribed verbatim. Transcripts were analysed according to the seven-step Coliazzi method. Relationships between themes were explored to identify core concepts. RESULTS: Analysis of interview transcripts revealed three phases that describe the parents' journey: experiencing the accident, the in-patient phase and the return to community. Within these phases, themes were identified. Themes represented subthemes of stressors, behavioural and emotional responses and coping factors. CONCLUSION: Findings from this research will allow health professionals to optimise a holistic clinical service from a consumer's perspective at all stages of the burn journey. These research conclusions could be used for the development of protocols to underpin a comprehensive information and social support management plan for families that would complement and support the surgical, medical and therapeutic treatment plan, providing direction for comprehensive service delivery. Implications for Rehabilitation Health professionals should optimise a holistic clinical service from a consumer's perspective taking into consideration all stages of the burn journey. Therapeutic supports are required to target each phase of the burn journey and address changes in coping strategies and behavioural responses. There is a need for the development of protocols to underpin a comprehensive information and social support management plan for families that will complement and support the surgical and medical treatment plan.

The effect of nano-scale topography on keratinocyte phenotype and wound healing following burn injury.

Topographic modulation of tissue response is an important consideration in the design and manufacture of a biomaterial. In developing new tissue therapies for skin, all levels of architecture, including the nanoscale need to be considered. Here we show that keratinocyte phenotype is affected by nanoscale changes in topography with cell morphology, proliferation, and migration influenced by the pore size in anodic aluminum oxide membranes. A membrane with a pore size of 300 nm, which enhanced cell phenotype in vitro, was used as a dressing to cover a partial thickness burn injury in the pig. Wounds dressed with the membrane showed evidence of advanced healing with significantly less organizing granulation tissue and more mature epidermal layers than control wounds dressed with a standard burns dressing. The results demonstrate the importance of nanoscale topography in modulating keratinocyte phenotype and skin wound healing.

Thiamine supplementation increases serum thiamine and reduces pyruvate and lactate levels in burn patients.

The importance of vitamins for optimal metabolism is well established. However, currently little is known about the optimal vitamin levels required for burn patients. As a consequence, current practice both for macronutrient supplementation and vitamin supplementation varies widely between burn units. A better understanding of the effects of vitamins on metabolism may lead to better nutrition and subsequently improved outcomes for burn patients. Thiamine is an important co-factor required for multiple enzymes involved in carbohydrate metabolism. We have examined the levels of thiamine (B1) in burn patients as well as the effects of thiamine supplementation on the levels of serum thiamine, pyruvate and lactate. Twenty patients had blood samples taken on the day of admission, then on days 1, 3, and 7 post-admission and weekly thereafter until discharge. Of these, nine received enteral feeding. Six patients received thiamine supplementation. Serum thiamine, pyruvate and lactate levels were measured at each time point. Serum thiamine levels increased significantly with thiamine supplementation (p<0.001). Serum thiamine levels also increased with time of supplementation (p<0.001). Serum thiamine level was closely associated with pyruvate and lactate levels, with a decrease in both pyruvate and lactate associated with increased serum thiamine. Lastly, pyruvate and lactate levels appear closely associated in a linear relationship. This study suggests thiamine supplementation increases serum thiamine and that this increase is associated with a decrease in pyruvate and lactate levels. Further study of changes in metabolic flux associated with thiamine supplementation and a randomised control trial of thiamine supplementation are required to establish whether thiamine supplementation is beneficial to burn patients' metabolism and recovery.

The potential of nanoporous anodic aluminium oxide membranes to influence skin wound repair.

Cells respond to changes in the environment by altering their phenotype. The ability to influence cell behavior by modifying their environment provides an opportunity for therapeutic application, for example, to promote faster wound healing in response to skin injury. Here, we have modified the preparation of an aluminium oxide template to generate large uniform membranes with differing nano-pore sizes. Epidermal cells (keratinocytes) and dermal cells (fibroblasts) readily adhere to these nanoporous membranes. The pore size appears to influence the rate of cell proliferation and migration, important aspects of cell behavior during wound healing. The suitability of the membrane to act as a dressing after a burn injury was assessed in vivo; application of the membrane demonstrated adherence and conformability to the skin surface of a pig, with no observed degradation or detrimental effect on the repair. Our results suggest that keratinocytes are sensitive to changes in topography at the nanoscale level and that this property may be exploited to improve wound repair after tissue injury.

Assessing the effectiveness of two round neonatal resuscitation masks: study 1.

BACKGROUND: Positive pressure ventilation (PPV) via a face mask is an important skill taught using manikins. There have been few attempts to assess the effectiveness of different face mask designs. AIM: To determine whether leak at the face mask during simulated neonatal resuscitation differed between a new round mask design and the current most widely used model. METHOD: 50 participants gave PPV to a modified manikin designed to measure leak at the face mask. Leak was calculated from the difference between the inspired and expired tidal volumes. RESULTS: Mask leak varied widely with no significant difference between devices; mean (SD) percentage leak for the Laerdal round mask was 55% (31) and with the Fisher & Paykel mask it was 57% (25). CONCLUSION: We compared a new neonatal face mask with an established design and found no difference in leak. On average the mask leak was >50% irrespective of operator experience or technique.

Improved techniques reduce face mask leak during simulated neonatal resuscitation: study 2.

BACKGROUND: Techniques of positioning and holding neonatal face masks vary. Studies have shown that leak at the face mask is common and often substantial irrespective of operator experience. AIMS: (1) To identify a technique for face mask placement and hold which will minimise mask leak. (2) To investigate the effect of written instruction and demonstration of the identified technique on mask leak for two round face masks. METHOD: Three experienced neonatologists compared methods of placing and holding face masks to minimise the leak for Fisher & Paykel 60 mm and Laerdal size 0/1 masks. 50 clinical staff gave positive pressure ventilation to a modified manikin designed to measure leak at the face mask. They were provided with written instructions on how to position and hold each mask and then received a demonstration. Face mask leak was measured after each teaching intervention. RESULTS: A technique of positioning and holding the face masks was identified which minimised leak. The mean (SD) mask leaks before instruction, after instruction and after demonstration were 55% (31), 49% (30), 33% (26) for the Laerdal mask and 57% (25), 47% (28), 32% (30) for the Fisher & Paykel mask. There was no significant difference in mask leak between the two masks. Written instruction alone reduced leak by 8.8% (CI 1.4% to 16.2%) for either mask; when combined with a demonstration mask leak was reduced by 24.1% (CI 16.4% to 31.8%). CONCLUSION: Written instruction and demonstration of the identified optimal technique resulted in significantly reduced face mask leak.

Should your GP be an osteopath? Patients' views of an osteopathy clinic based in primary care.

BACKGROUND: Spinal pain is a common reason for consulting general practitioners (GPs), and complementary therapists such as osteopaths and chiropractors. Patients express greater satisfaction with the care from chiropractors and osteopaths, because they are perceived as having more empathy, diagnostic skill and effective treatment, but their attitude to a GP providing an osteopathy service is unknown. AIM: To explore patients' views of receiving osteopathy in contrast with usual GP care, to provide insight into the psychological benefit of treatment, and to explore their views on how such a service should be provided and funded. DESIGN OF STUDY: Qualitative study using semi-structured interviews preceded by short questionnaires. SETTING: Primary care osteopathy clinic treating patients from Llanfairfechan Health Centre, which also accepted referrals from neighbouring practices in North West Wales in a randomised controlled trial. METHOD: Short questionnaires followed by semi-structured interviews with 20 participants. The interview transcripts were analysed by open coding into categories, axial coding to define the categories' properties and selective coding for the final thematic account. RESULTS: Traditional GP skills were valued, but GP care for spinal pain was perceived as limited and ineffective. Osteopathy was attractive because it did not involve drugs, but it had short-term painful side effects, and some found it frightening. Physical benefits included increased mobility and reduced pain; psychological benefits included removal of fear and improved understanding. Provision of osteopathy by a GP was welcomed, so long as the GP was properly qualified, and had sufficient time. CONCLUSION: A GP run osteopathy clinic provided additional physical and psychological benefit. GP consultation might be improved by adopting some features from the osteopathic consultation.