Prevalence and Risk Factors for Hypertrophic Scarring of Split Thickness Autograft Donor Sites in a Pediatric Burn Population.

TITLE: Prevalence and Risk Factors for Hypertrophic Scarring of Split Thickness Autograft Donor Sites in a Pediatric Burn Population. OBJECTIVE: The split-thickness autograft remains a fundamental treatment for burn injuries; however, donor sites may remain hypersensitive, hyperemic, less pliable, and develop hypertrophic scarring. This study sought to assess the long-term scarring of donor sites after pediatric burns. METHODS: A retrospective review of pediatric burn patients treated at a single institution (2010-2016) was performed. Primary outcomes were prevalence of donor site hypertrophic scarring, scarring time course, and risk factor assessment. RESULTS: 237 pediatric burn patients were identified. Mean age at burn was 7 yrs., mean %TBSA was 26% with 17% being Full Thickness. Mean follow-up was 2.4 yrs. Hypertrophic scarring was observed in 152 (64%) patients with 81 (34%) patients having persistent hypertrophic scarring through long-term follow-up. Patient-specific risk factors for hypertrophic scarring were Hispanic ethnicity (P=0.03), increased %TBSA (P=0.03), %Full Thickness burn (P=0.02) and total autograft amount (P=0.03). Donor site factors for hypertrophic scarring were longer time to epithelialization (P<0.0001), increased donor site harvest depth (P<0.0001), autografts harvested in the acute burn setting (P=0.008), and thigh donor site location (vs. all other sites; P<0.0001). The scalp, arm, foot, and lower leg donor sites (vs. all other sites) were less likely to develop HTS (P<0.0001, 0.02, 0.005, 0.002, respectively), along with a history of previous donor site harvest (P=0.04). CONCLUSIONS: Hypertrophic scarring is a prominent burden in donor site wounds of pediatric burn patients. Knowledge of pertinent risk factors can assist with guiding management and expectations.

Pilot Feasibility Study of an Oncology Financial Navigation Program.

BACKGROUND: Few studies have reported on interventions to alleviate financial toxicity in patients with cancer. We developed a financial navigation program in collaboration with our partners, Consumer Education and Training Services (CENTS) and Patient Advocate Foundation (PAF), to improve patient knowledge about treatment costs, provide financial counseling, and to help manage out-of-pocket expenses. We conducted a pilot study to assess the feasibility and impact of this program. METHODS: Patients with cancer received a financial education course followed by monthly contact with a CENTS financial counselor and a PAF case manager for 6 months. We measured program adherence, self-reported financial burden and anxiety, program satisfaction, and type of assistance provided. RESULTS: Thirty-four patients (median age, 60.5 years) were consented (85% white and 50% commercially insured). Debt, income declines, and loans were reported by 55%, 55%, and 30% of patients, respectively. CENTS counselors assisted most often with budgeting, retirement planning, and medical bill questions. PAF case managers assisted with applications for appropriate insurance coverage, cost of living issues (eg, housing, transportation), and disability applications. High financial burden and anxiety about costs (4 or 5 on a Likert scale) were reported at baseline by 37% and 47% of patients, respectively. Anxiety about costs decreased over time in 33% of patients, whereas self-reported financial burden did not substantially change. CONCLUSION: Implementing an oncology financial navigation program is feasible, provides concrete assistance in navigating the cost of care, and mitigates anxiety about costs in a subset of patients. Future work will focus on measuring the program's impact on financial and clinical outcomes.

Palliative care consultation in the ICU #253.

Specialist palliative care consultations, together with integration of palliative care principles into the care of all ICU patients, can improve the patient/family experience, reduce length of stay, improve ICU throughput without increasing mortality, and lower health care costs.

Worry about ovarian cancer risk and use of screening by high-risk women: how you recruit affects what you find.

Several studies have described the characteristics of women at high-risk for ovarian cancer who are participating in registry studies and high-risk screening programs. These studies have found high-risk women to report high levels of perceived risk and worry about their risk for ovarian cancer. In contrast, population based studies have found that while high-risk women did report high levels of perceived risk, they did not report high levels of worry about their risk. In this study, we examine reports of perceived risk, worry about ovarian cancer, and use of screening by high-risk women recruited to participate in a survey from several recruitment sources. These sources include self-, physician-, and affected patient relative-referral, a fundraising mailer, and a mass mailing to a commercial mailing list. High-risk women recruited via mass mailing were less likely than those recruited via physicians or affected relatives to report either worry about their risk or use of ovarian cancer screening tests.

Compliance of average- and intermediate-risk women to semiannual ovarian cancer screening.

OBJECTIVE: To report rates of compliance with an ovarian cancer screening protocol using serum CA125 and transvaginal sonography (TVS), performed semiannually on an alternating schedule, among participants at average or intermediate risk for developing ovarian cancer. METHODS: Two hundred ninety-two women at average or intermediate risk for developing ovarian cancer were randomly assigned to arms of a controlled clinical trial in which they received ovarian cancer screening consisting of serum CA125 alternating with TVS performed semiannually over 18 months, either alone or in combination with ovarian cancer risk education. A computerized tracking system generated screening appointment reminder letters and monitored adherence to scheduled screening. Participants overdue for scheduled screens received follow-up telephone calls consisting of up to four reminder messages left at 1-week intervals, and one to two interim attempts to reach participants between messages. The compliance rate for each screen was calculated as a ratio of the number of participants successfully completing the screen relative to the number expected to attend. Compliance rate by screen was: screen 1 (CA125) (97.3%), screen 2 (TVS) (82.5%), screen 3 (CA125) (79.0%), and screen 4 (TVS) (64.5%). One hundred seventy-two women completed all four screens and were classified as adherent to the screening protocol. Analysis by screening modality suggests that participants were more compliant to screens involving CA125. Age, educational background, distance from screening center, personal or family history of cancer, perceived risk of ovarian cancer, pre-enrollment ovarian cancer screening behavior, receiving an abnormal screen test result, and participation in ovarian cancer risk education sessions were not associated with adherence to the screening protocol or compliance to any of the screens. CONCLUSIONS: Despite extensive follow-up, compliance of average- and intermediate-risk women to an ovarian cancer screening protocol requiring semiannual screening diminishes rapidly. We propose that a semiannual ovarian cancer screening protocol, particularly one including TVS, may be too intensive for use in this population.

Food preferences, dieting behaviors, and body image perceptions of elite figure skaters.

The objectives of this study were to determine food preferences, body image perceptions, dieting behaviors, and nutrient intakes of elite male and female figure skaters. Male (n = 23) and female (n = 26) figure skaters completed a food preference checklist, a questionnaire examining their demographics, dieting behaviors and body image perceptions, and 3-d food records. Male skaters had a higher preference (score > or = 6) for grains, fruit, meat, dairy, fats, and sweets. Female skaters had higher preference for grains and fruits. Of the female skaters, 30% considered themselves overweight and indicated a preference for a thinner body contour. Both male and female skaters expressed a preference for leaner body contours for members of the opposite gender. Total energy intake, total fat (females) and dietary fiber were below the dietary recommendations. Vitamin E, vitamin D, folate (females), pantothenic acid (females), calcium (females), magnesium, potassium, and phosphorus (females) were less than two-thirds of the dietary recommendations. Macronutrient intake of male skaters was associated with preferences for the grain group, although no association was observed among female skaters. Results suggest that these behaviors and attitudes need to be assessed and addressed among figure skaters, given their impact on dietary intakes and overall well-being.

Use of dietary supplements by elite figure skaters.

The present study examined the prevalence of dietary supplement use among elite figure skaters, gender differences in supplement use, and differences in nutrient intake of supplement users versus non-users. Male (n = 46) and female (n = 59) figure skaters completed a supplement survey and 3-day food records. Descriptive analysis, chi-square test, and independent t tests were used to analyze the data. Sixty-five percent of male (n = 30) and 76% of female (n = 45) figure skaters reported use of supplements. Forty-seven percent of males and 55% of females reported daily use of supplements. Multivitamin-mineral supplements were the most popular dietary supplements consumed by figure skaters. Significant gender differences were observed in the use of multivitamin-mineral supplements (61% males vs. 83% females, p < .05). Echinacea and ginseng were popular herbal supplements used by these skaters. The 3 main reasons given by male figure skaters for taking supplements were: to provide more energy (41%), to prevent illness or disease (34%), and to enhance performance (21%). Among female figure skaters, the 3 main reasons given were: to prevent illness or disease (61%), to provide more energy (39%), and to make up for an inadequate diet (28%). Significant differences (p < .05) were observed in protein, total fat, saturated fat, polyunsaturated fat intakes, and % energy from carbohydrate and total fat of male supplement users versus non-users, with supplement users having higher intakes except for percent energy from carbohydrate. Sodium was the only nutrient significantly different (p < .05) among female supplement users versus non-users, with supplement users having lower intakes. Given the popularity of dietary supplements, it is important to understand the factors influencing athletes' use of supplements, their knowledge and attitudes regarding supplements, dosage of supplements used, and the effectiveness of these dietary supplements in meeting the goals of the athletes.

Contribution of meals and snacks to nutrient intake of male and female elite figure skaters during peak competitive season.

OBJECTIVE: To examine the contribution of breakfast, lunch, dinner and snack to the macronutrient and micronutrient intake of elite male and female figure skaters during their competitive season. SUBJECTS: Male (n = 46) and female (n = 48) figure skaters who participated in the 1999 U.S. National Figure Skating Championships completed the study. METHODS: Each athlete completed three-day food records, during the athlete's competitive season. Food records were analyzed using Nutritionist V software. Macronutrient and micronutrient contributions from meals were assessed. RESULTS: Lunch and dinner meals were the main contributors to the total calorie intake of these skaters (27% and 32%, respectively). Likewise, lunch and dinner were the main contributors to the total protein (27% and 41%), carbohydrate (26% and 29%), fat (30% and 32%), saturated fat (29% and 32%) and polyunsaturated fat (31% and 32%) intakes. Dinner was the main source of the monounsaturated fat (34%), cholesterol (40%) and dietary fiber (34%). Breakfast was the main source of dietary folate (36%), whereas iron and calcium intakes were mainly contributed by breakfast and dinner (29% and 32%, 27% and 29%, respectively). CONCLUSION: These elite figure skaters appear to be starting their day with low energy reserves and therefore need to be educated about the benefits of consuming breakfast. These athletes also need to be educated about consuming adequate calories throughout the day in order to meet the energy needs of their activity. It is thus important to monitor eating patterns throughout the day to ensure adequate energy intake to sustain the physical and mental aspects of the athletes' training and performance.