Surgical training for burns care in low-income countries: A literature review and critical appraisal.

INTRODUCTION: Low- and middle-income countries account for over 90% of burns worldwide. Though mission trips, public health interventions and educational strategies have been introduced in recent years, a disparity remains in treatment provided between high- and low -income countries. This analysis aims to review available literature pertaining to strategies for training in burns management, with a focus on those applicable to low-income countries. METHODOLOGY: Mesh terms including "burns", "burns care", "burns management", "training", "teaching" and "education" were inputted into Medline and EMBase. Studies were included on the basis that they include an educational intervention to train doctors to provide surgical burns care in low-income countries. Included literature was analysed using scoring tools then a critical appraisal was performed. RESULTS: Fourteen studies were included in this analysis. These describe e-learning (n = 1), video-based teaching (n = 1), lecture-based teaching (n = 1), simulation training (n = 8) and hospital-based training achieved through collaborative efforts between high and low-income countries such as mission trips and fellowship programmes (n = 3). The strategies described have been summarised and presented. CONCLUSION: Burns care training should be accessible at a global scale and so, involve training methods including simulation, courses and fellowship programmes that are affordable and accessible to surgeons in low-income countries.

Where to from here? A quality improvement project investigating burns treatment and rehabilitation practices in India.

OBJECTIVE: To describe the capacity of the Indian healthcare system in providing appropriate and effective burns treatment and rehabilitation services. RESULTS: Health professionals involved in burns treatment or rehabilitation at seven hospitals from four states in India were invited to participate in consultative meetings. Existing treatment and rehabilitation strategies, barriers and enablers to patient flow across the continuum of care and details on inpatient and outpatient rehabilitation were discussed during the meetings. Seventeen health professionals from various clinical backgrounds were involved in the consultation process. Key themes highlighted (a) a lack of awareness on burn first aid at the community level, (b) a lack of human resource to treat burn injuries in hospital settings, (c) a gap in burn care training for medical staff, (d) poor hospital infrastructure and (e) a variation in treatment practices and rehabilitation services available between hospitals. A number of opportunities exist to improve burns treatment and rehabilitation in India. Improvements would most effectively be achieved through promoting multidisciplinary care across a number of facilities and service providers. Further research is required to develop context-specific burn care models, determining how these can be integrated into the Indian healthcare system.

Purpose-built national burns center: The Israeli experience.

The opening of the National Burns Center (NBC) in Sheba Medical Center (SMC) in 2014 was a keystone point in the development of specialized burns trauma services for Israel to ensure burn care and disaster planning at international standards. The NBC is a purpose-built, level 1 burns trauma center that receives patients from Israel, Gaza, West Bank, and abroad. Hosting six intensive care and four step-down burns beds, the center serves as a referral center for patients in other health-care facilities with indication for hospitalization. In the present study, we describe the planning, design, and organization of the NBC at the SMC with reference to some of the key areas and considerations in its conception and development. With the improved survival rates of patients with extensive burns and the demographics and characteristics among burn-injury patients in Israel, the NBC has the capacity to be the center of excellence in burns care, teaching, and research within the Middle East.

Bioresources in the pharmacotherapy and healing of burns: A mini-review.

The present mini-review actualizes the pharmacy of botanical, animal, and fungal sources of potential value in the management of burns wounds. It also highlights the importance of applying contemporary imaged-based sciences such as radiology in the assessment and prognosis of wounds and burns.

Research in burns - Present and future.

There have been tremendous advances in burns care over the past 50 years. Much of this, but not all, can be attributed to basic science and clinically related research. Out of the best centres in the world, centres that are fully funded and richly resourced, best practice guidelines result in impressive outcomes not only in terms of survival but also in terms of a quality of survival. Indeed the remaining clinical challenges in these centres are the elderly, the inhalational burns, and the very extensive burns. There are however other challenges when looking at burns care in a global context and in particular is the provision of even minimal standards of acceptable care for burns patients in many parts of the world. Whilst the justification for research funding in the wealthy countries becomes increasingly esoteric, for example looking at the immunology of face transplantation, the global health challenges of burns care still remain. Perhaps, the greatest research challenge in burns care in the 21st century lies not in furthering our understanding of the phenomenon we observe but the global application of the knowledge we already possess.