ABSTRACT
Objective: To develop a core outcome set for international burn research. Design: Development and international consensus, from April 2017 to November 2019. Methods: Candidate outcomes were identified from systematic reviews and stakeholder interviews. Through a Delphi survey, international clinicians, researchers, and UK patients prioritised outcomes. Anonymised feedback aimed to achieve consensus. Pre-defined criteria for retaining outcomes were agreed. A consensus meeting with voting was held to finalise the core outcome set. Results: Data source examination identified 1021 unique outcomes grouped into 88 candidate outcomes. Stakeholders in round 1 of the survey, included 668 health professionals from 77 countries (18% from low or low middle income countries) and 126 UK patients or carers. After round 1, one outcome was discarded, and 13 new outcomes added. After round 2, 69 items were discarded, leaving 31 outcomes for the consensus meeting. Outcome merging and voting, in two rounds, with prespecified thresholds agreed seven core outcomes: death, specified complications, ability to do daily tasks, wound healing, neuropathic pain and itch, psychological wellbeing, and return to school or work. Conclusions: This core outcome set caters for global burn research, and future trials are recommended to include measures of these outcomes.
ABSTRACT
INTRODUCTION: 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. AIM: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.
Subject(s)
Burns/rehabilitation , Schools , Adolescent , Body Surface Area , Burns/psychology , Burns/surgery , Child , Clinical Audit , Female , Humans , Male , Patient Discharge , Skin Transplantation , Social Adjustment , Surveys and Questionnaires , Time FactorsABSTRACT
School reintegration programmes provide support to both children absent from school as a result of a serious health problem and their teachers, but little is known regarding their efficacy, or the impact of the situation on teachers. This qualitative study explored the experience of primary school teachers who were involved in a school reintegration programme, following a burn injury to a child in their class. Data was collected using semi-structured interviews with four primary school teachers. Transcripts were analysed using interpretative phenomenological analysis. The findings indicated that participants were positive regarding the programme, but detailed aspects which could be improved, for example better communication before the child's return. They discussed their fears and concerns, including a strong need to protect the child from further harm. Implications of this study include the need to provide adequate support to teachers in similar positions, and further develop school reintegration programmes to best facilitate the child's return to school.
Subject(s)
Attitude , Burns/rehabilitation , Faculty , Schools , Body Surface Area , Child , Child, Preschool , Female , Humans , Male , Qualitative ResearchABSTRACT
Childhood burns are painful and traumatic and impact the child and their family. For the child, part of the returning to wellness process involves successfully returning to school, a process in which parents play a vital role. This qualitative research aimed to examine how influential parental and other factors were in the return to school process. Data was collected through semi-structured interviews and was analysed using a social-constructivist Grounded Theory approach. The analysis revealed that parental confidence-in themselves, their children and their children's schools; role adaptation, skill acquisition and flexibility; and school receptivity, were pivotal in the return to school process.
Subject(s)
Adaptation, Psychological , Burns/psychology , Burns/rehabilitation , Parents/psychology , Schools , Social Adjustment , Adolescent , Adult , Child , Emotions , Female , Humans , Male , Qualitative Research , Self Concept , Surveys and QuestionnairesABSTRACT
PURPOSE: We assessed the results from a single exstrophy center of salvage continence surgery after failed staged reconstruction for bladder exstrophy. MATERIALS AND METHODS: A total of 32 patients with bladder exstrophy had undergone salvage continence procedures. Indications for surgery included incontinence due to poor bladder capacity or failed bladder neck repair, and upper tract deterioration. Continence was defined according to the International Children's Continence Society as continent, intermittently incontinent and continuously incontinent. RESULTS: A total of 29 patients (91%) are continent, 3 (9%) are intermittently incontinent and none is continuously incontinent. One patient is continent after bladder augmentation and urethral clean intermittent catheterization. Two patients are continent and 1 is intermittently incontinent after bladder augmentation and modified Young-Dees bladder neck repair using urethral clean intermittent catheterization. One patient is continent using clean intermittent catheterization through a continent cutaneous diversion into a bladder substitution. A total of 19 patients are continent after bladder neck closure, bladder augmentation and continent cutaneous diversion using clean intermittent catheterization. Four patients are continent after cutaneous urinary diversion. Two are continent and 2 are intermittently incontinent after a Mainz II pouch. CONCLUSIONS: The majority of patients can still achieve continence following failed staged repair. Patients who have a low bladder leak pressure and who tolerate urethral catheterization can be consistently dry with bladder augmentation and bladder neck repair, which is a viable alternative to bladder neck closure, bladder augmentation and continent cutaneous diversion. Cutaneous urinary diversion has a role in selected patients. Mainz II pouch has not yielded consistent results. With better patient selection and increasing experience within specialist exstrophy centers fewer patients should require salvage continent surgery in the future.
Subject(s)
Bladder Exstrophy/complications , Bladder Exstrophy/surgery , Urinary Incontinence/etiology , Urinary Incontinence/surgery , Child, Preschool , Female , Humans , Infant , Male , Retrospective Studies , Salvage Therapy , Treatment FailureABSTRACT
Specialized holidays for burn-injured children are currently considered an important part of their rehabilitation. These holidays, or Camps, aim to help children face the challenges of their burn injury and treatment in a fun and supportive environment. Manchester Children's Burns Camps have been run by professionals from the Burns Unit at Booth Hall Children's Hospital together with volunteers since 1983. Formal evaluation has been a crucial component of these Camps since 1999. The purpose of this study was to summarize the findings of the evaluation process over the last 5 years, and to discuss any issues raised by the results. Standardized measures were administered to 97 children and their parents over this time period. These measures, designed to assess self-esteem, social relationships and general emotional and behavioural well-being, were completed before and after the children attended the Camp. The quantitative data showed little consistent evidence of change on these measures over the 5 years. However, the qualitative data shows consistent themes of increased confidence and improved coping with the burn injury, amongst others. The discrepancy between the quantitative and qualitative results is discussed, and implications and challenges for further evaluation of Burns Camps are raised.