Patient Reported Experiences of their Treatment and Recovery at the Severe Burn Injury Unit, Royal North Shore Hospital

Julia Kwiet,1 Anne Darton2 ,Dale Forbes3, Peter Hawkins1, Loyola McLean4

1 NSRHS Social Work Department, Royal North Shore Hospital, NSW, 2075 juliakwiet@health.nsw.gov.au 2 Agency for Clinical Innovation Statewide Burn Injury Service (SBIS), NSW 2065 3 SBIS Consumer Representative. NSW 4 Academic Psychiatry, Royal North Shore Hospital, NSW, 2075 

Abstract:

Engaging patients and families is acknowledged as a key component to achieving high quality health care as it will affect their recovery and overall outcome. For this reason it is important to look specifically at our patient’s experiences and bring their voices and needs to the forefront.
This project seeks to capture patient’s reported experiences of their treatment and recovery. This information can help the burns team understand the needs of their patients more fully and assist with improving service delivery and recovery.
A burns specific patient reported experience measure (PREM) will be designed and used to capture burn patient’s perceptions of their health care experience. In particular to understand more about what facilitated and aided recovery and what could be improved upon.
This project was initiated by the SBIS consumer representative and will develop in close collaboration between burns clinicians and consumers. The main objectives are to collect data on what patients and family found helpful in their recovery and foster closer partnerships between consumers and clinicians. This is particular important given the highly complex and chronic condition of severe burn injuries.


Biography:

BQIP: Driving Improved Burn Care Through Registry Data

Ms Yvonne Singer

Abstract:

In recent decades, research and advances in treatment have contributed to significant improvements to burn care, and the quality of life following injury. Nevertheless, significant evidence gaps and high variations in clinical practice remain; the effects of which are largely unknown. The Burn Registry of Australia and New Zealand (BRANZ) collects data on patients admitted to all 17 Australian and New Zealand specialist burns units regarding burn injury, pre-existing conditions, clinical quality indicators, and in-hospital outcomes. As such, the BRANZ is an ideal platform to close knowledge gaps and inform best practices.
A successful 2017 HCF Research Grant has provided the opportunity to use the BRANZ data to quantify practice variation and establish if, and how this variation impacts patient outcomes. This important piece of work sets the standard for the future, and will drive quality improvement initiatives and the development of best practice guidelines, which have great potential to improve the quality of burn care and patient outcomes in the region.
This project is relevant to all Australian and New Zealand burn units and clinicians, whose commitment and collaboration have contributed significantly to the substantial successes of BRANZ thus far, and is reliant on them in the future. Stage one of this multi-centre study is currently underway. This presentation will summarise key findings from Stage one data analysis, discuss its implications, and lay out a plan for the future regarding the use of BRANZ data and the binational Burn Quality Improvement Program as quantitative bases to drive improvements in burn care and patient outcomes.


Biography:

Advances in the assessment of burn scars

Prof Roy Kimble1,2, Dr Megan Simons1,3, Dr Zephanie Tyack1

1Centre for Children’s Burns and Trauma Research, UQ Child Health Research Centre, Centre for Children’s Health Research, South Brisbane, Australia, 2Department of Paediatric Surgery, Urology, Neonatal Surgery, Burns and Trauma, Lady Cilento Children’s Hospital, South Brisbane, Australia, 3Department of Occupational Therapy, Lady Cilento Children’s Hospital, South Brisbane, Australia

Abstract:

Background:This paper aims to provide an overview of advances in the assessment of burn scars over the last 5-years.  This will include recent evidence regarding the content and psychometric properties of patient-reported outcome measures, risk factors for burn scarring, and objective measures that assess individual or multiple scar characteristics. Assessments of the dose of scar interventions delivered such as pressure beneath pressure garments will also be reviewed.

Method: Data will be reported from published systematic reviews and the authors’ own work from three longitudinal cohort studies. Work will be presented from the field of burns as well as from the broader fields of scar and chronic disease where evidence in burns is not available.

Results:Comprehensive burn scar assessment should go beyond the assessment of physical scar characteristics to include sensory, social and emotional outcomes as well as the burden of treatment and adherence. Assessments from multiple perspectives may be appropriate (i.e., families, patients, clinicians). Assessments that focus on predicting and evaluating scar outcomes over time have received little attention with further research required in these areas. As clinicians working in burn care have indicated they choose assessments based on the ease of use and speed of completion feasibility of translating scar assessments into practice is an important consideration.

Discussion: Advances in the future are likely to include assessments that are better targeted to the needs of patients and tailored to patients. Future directions in scar assessment from a methodological perspective will also be discussed.


Biography:

 

 

Results from a National Burn Prevention and First aid Treatment Education Campaign

Dr Leila Cuttle1, Dr Belinda  Wallis2,3, Ms Jacquii Burgess3, Ms Erin Meyers1, Dr Cate Cameron4,5, Prof Roy Kimble1,3,6, Mr Steve Huff7

1Centre for Children’s Burns and Trauma Research, Queensland University of Technology, Institute of Health and Biomedical Innovation at Centre for Children’s Health Research, South Brisbane, Australia, 2Larchill Consulting, Hawthorne, Australia, 3Centre for Children’s Burns and Trauma Research, University of Queensland, Centre for Children’s Health Research, South Brisbane, Australia, 4Jamieson Trauma Institute, Royal Brisbane & Women’s Hospital, Herston, Australia, 5Menzies Health Institute Queensland, Griffith University, Logan, Australia, 6Children’s Health Queensland, Lady Cilento Children’s Hospital, South Brisbane, Australia, 7iPug (Injury Prevention Using Gamification), Maroochydore, Australia

Abstract:

Public knowledge of correct burn first aid treatment is poor and burn injury preventative behaviours need to be promoted. Over the past year, we have utilised a smartphone app-based campaign to provide burn prevention and treatment messages and resources to the Australian public. Animations and infographics were developed to target the most common mechanisms of burn injury for adults and children. These were delivered to the public by several different methods: an app (Cool Runnings) which could be downloaded onto participant’s phones, media releases, dissemination by partner organisations, Facebook marketing and public events. Different strategies were trialled to increase reach and public knowledge. The impact of the campaign was measured by: the number of interactions with the app or the messages, extra sharing and promotion of the materials within participant social networks and changes in knowledge, assessed by surveys. Social media-based strategies reached more people than other methods. Marketing strategies which generated the most public support and changes in knowledge will be reported, to enable other effective burn education campaigns to be developed in the future.


Biography:

Dr Leila Cuttle is an NHMRC Career Development Fellow and biomedical researcher, based at the Centre for Children’s Health Research, Queensland University of Technology and Lady Cilento Children’s Hospital. She has been conducting burn research for the past 16 years and is passionate about burn prevention and developing better evidence-based burn treatments. Leila is an expert at facilitating biological research at the clinical interface and has lead clinical trials, laboratory work and public health/injury prevention projects.

Characterisation of Burn Blister Fluid Using Quantitative Proteomics to Aid Clinical Diagnosis

Mr Tuo Zang1,2,3, Dr Leila Cuttle1,2,4, Dr Daniel Broszczak1,2,5, Dr James Broadbent1,2,6, Ms Catherine  Tanzer1,2,4, Dr Tony Parker1,2

1Institute of Health and Biomedical Innovation, Kelvin Grove, Australia, 2Queensland University Of Technology, Kelvin Grove, Australia, 3Wound Management Innovation Co-operative Research Centre, Brisbane, Australia, 4Institute of Health and Biomedical Innovation at the Centre for Children’s Health Research, South Brisbane, Australia, 5Australian Catholic University, Banyo, Australia, 6Sciex P/L, Brisbane, Australia

Abstract:

Blister fluid (BF) is a sample matrix that can reflect both systemic and local microenvironment responses to burn injury. Our aim was to investigate the proteome of burn blister fluid using liquid chromatography tandem mass spectrometry (LC-MS/MS), which provides an objective and quantitative measurement of biomolecules in the wound site. This enables a non-invasive investigation of the cutaneous biological response to different burn severities, which may aid in the clinical diagnosis and monitor the response of treatment.

In order to generate a comprehensive peptide spectral library for quantitative information acquisition, a subset of BF samples were pooled according to burn depth (12 superficial, 12 deep-partial thickness, and 4 full thickness) and fractionated by four different methods, prior to LC-MS/MS analysis. Subsequently, all individual BF samples (n=87) were analysed using LC-MS/MS in quantitative mode (SWATH) to obtain the protein abundance. More than 800 individual proteins were identified and formed the basis of a BF protein library. Finally, more than 600 proteins in each individual sample was quantitatively profiled. This proteomic data was correlated with different clinical parameters, such as burn depth, time to re-epithelialisation, first aid, and burn size.

The statistical analysis of these data revealed the key biochemical differences that stratify sub-groups within the clinically relevant parameters. We have shown that the blister fluid proteome could be used to assist the classification of paediatric burn wounds by different burn depths and prognose time to re-epithelialisation at an earlier stage. Interestingly differences in the application of first aid may also be reflected in the burn wound protein profile. This may help deepen our understanding of the biological effect of first aid treatment.


Biography:

Tuo Zang is a PhD student of the Tissue Repair and Translational Physiology Program (TRTP) at the Institute of Health and Biomedical Innovation (IHBI) at the Queensland University of Technology. His research has focused on proteomics and metabolomics, especially quantitative proteomics analysis of clinical samples. His PhD study characterised blister fluid from paediatric burn injury using LC-MS/MS based proteomics and NMR based metabolomics.

Ablative fractional resurfacing for burn scar management: Does the depth of laser penetration matter?

Dr Andrea C Issler-Fisher1,4, Dr Oliver M Fisher2,3, Dr Shivani Aggarwala1,4, A/Prof Peter Haertsch1,4, Dr Zhe Li1,4,5, Prof Peter KM Maitz1,4,5

1Burns Unit, Concord Repatriation General Hospital, Concord, Australia, 2Department of Surgery, St George Hospital , Kogarah , Australia, 3Department of Surgery, University of Notre Dame, School of Medicine, Sydney , Australia, 4University of Sydney, Camperdown, Australia, 5ANZAC Research Institute, Concord Repatriation General Hospital, Concord, Australia

Abstract:

Purpose. To investigate whether the maximum depth of ablative factional CO2 laser (AFL) penetration in pathological burn scars influences patient outcomes after one treatment.
Methods. All patients presenting to the Concord Repatriation General Hospital (CRGH) Scar Clinic received ultrasound measurement at the thickest point of their burn scars. Subsequently, the effect of various AFL settings (energy which correlates to penetration depths) on different outcome parameters was analysed. Patients were divided into 5 groups depending on maximal scar penetration depth.
Results. 78 patients (158 scars) had complete data allowing for analysis. Median scar thickness was 3400 micrometers and median laser scar penetration depth was 900 micrometers. Scar penetration categories were as follows: 0-25% (n=40), 25-50% (n=67), 50-75% (n=31), 75-100% (n=8), >100% (n=3). Median reduction in maximum scar thickness was 800 micrometers following one treatment (p<0.001). However, this effect depended on scar penetration depth, whereby scars that were penetrated 75% showed no significant improvement in scar thickness and those penetrated >100% showed a tendency to become worse. Despite this, the Vancouver Scar Scale improved significantly over all groups up to 100%, although no significant improvement was seen if the scar was penetrated >100%. Similar results were seen with the Patient and Observer Scar Assessment Scale. Likewise, neuropathic pain scores only showed significant improvement in scars penetrated up to 75%. Intriguingly however, pruritus scores showed significant improvement over all penetration categories.
Conclusion. AFL scar penetration depth significantly influences subjective and objective pathologic burn scar modulation. This presentation will further elucidate factors contributing to the identified changes.


Biography:

Following training in general surgery, burns & plastic surgery in Switzerland, Dr Issler-Fisher joined the Sydney University Burns Unit of Concord Repatriation General Hospital (CRGH) in Sydney in 2013, where she established and now runs the Burns Scar Clinic in 2015.

Exercise training for improving outcomes post burns: a systematic review and meta-analysis

Mr Orlando Flores1, Dr. Zephanie Tyack2, Dr. Kellie  Stockton3, Dr. Robert Ware4, Dr. Jennifer Paratz1,5

1Burns, Trauma & Critical Care Research Centre. The University of Queensland, Brisbane, Australia, 2Centre for Children’s Burns and Trauma Research, Child Health Research Centre. The University of Queensland, Brisbane, Australia, 3Physiotherapy Department, Children’s Health Queensland, Brisbane, Australia, 4Menzies Health Institute Queensland, Griffith University, Brisbane, Australia, 5Rehabilitation Science, Griffith University, Brisbane, Australia

Abstract:

Introduction: A systematic review and meta-analysis was performed to determine the effectiveness of different modalities of exercise and to evaluate the safety of exercise-based interventions post-burns.

Methods: Six databases were searched from inception to December 2016. Relevant authors, key journals and reference lists of included studies were hand searched. Articles reporting on exercise interventions in patients post-burn, and considering physical, physiological or psychological outcomes were considered. Two authors independently screened 2,253 records with 19 articles meeting inclusion criteria. The quality of the evidence was assessed at the study level and at the outcome level.

Results: There were no significant differences post exercise training in VO2 peak (g=0.99; 95% CI -0.4 to 2.4: p=0.18), resting energy expenditure (g=-0.51; 95% CI -1.99 to 0.97: p=0.5) and muscle strength (g=0.51; 95% CI -0.03 to 1.05: p=0.07) between the groups. Evidence suggested exercise had a beneficial effect on body composition (g=0.59; 95% CI 0.05 to 1.14: p=0.03), need for surgical release of contractures (Risk Ratio=0.34; 95% CI 0.2 to 0.7; p=0.004) and health-related quality of life. However, a lack of evidence existed regarding the safety of exercise training post-burns. Unbiased effect size estimators (pooled Hedges’s g) with 95% confidence intervals were calculated if there were two or more trials with homogenous outcomes.

Conclusions: Limited evidence suggests that exercise has a beneficial effect on physical and physiological outcomes in patients post-burn. Further trials using high quality methodology are required, with focus on reporting of adverse events, health-related quality of life and psychological outcomes.


Biography:

Orlando Flores is a PhD candidate in the last stage of his doctoral research project.
His thesis aimed to understand the role of different interventions in the management of metabolic changes occurring post burn injuries.

The use of exercise in burn rehabilitation. A worldwide survey of practice

Mr Orlando Flores1, Dr. Zephanie Tyack2, Dr. Kellie  Stockton3, Dr. Jennifer Paratz1,4

1Burns, Trauma and Critical Care Research Centre. The University of Queensland, Brisbane, Australia, 2Centre for Children’s Burns and Trauma Research, Child Health Research Centre. The University of Queensland, Brisbane, Australia, 3Physiotherapy Department, Children’s Health Queensland, Brisbane, Australia, 4Rehabilitation Science, Griffith University, Brisbane, Australia

Abstract:

Introduction: Exercise interventions have been used to enhance recovery of burn patients affected by hypermetabolism, muscle wasting and contractures. Although the benefits of exercise in burn population have been previously reported, the actual extent of the use of exercise in burn patients worldwide remains unknown. The purpose of this study was to identify the extent and characteristics of exercise use in specialised and non-specialised burn centres worldwide.

Methods: A web-based survey of 47 questions was developed and translated into Spanish and Chinese languages. Distribution of the surveys was made via email using personal contacts of the authors and through six scientific societies related to burn care. Data was analysed using descriptive statistics and comparisons of frequencies were analysed using Chi-square.

Results: One hundred and twenty nine surveys from 25 countries were completed (n = 96, 20 and 13 from the English, Chinese and Spanish versions respectively). The majority of the surveyed professionals worked in cities of 1 million inhabitants or more, and 93.8% worked in hospital-based burn centres. The majority of the surveyed professionals used exercise for rehabilitation of patients following burn injuries (94.58%). The extent of the use of exercise, type of interventions, and comparisons by region will be presented.

Conclusion: The criteria used for prescription and monitoring exercise in burns is variable and exercise programs offered are difficult to standardize. Further investigation is required to elucidate the access to exercise interventions post burns in remote areas and in less developed countries.


Biography:

Orlando Flores is a PhD candidate in the last stage of his doctoral research project. His thesis aimed to understand the role of different interventions in the management of metabolic changes occurring post burn injuries.

How Bad is My Child’s Burn? Differences in Blister Fluid Biochemistry to Assess Paediatric Burn Wounds

Mr Tuo Zang1,2,3, Dr Leila Cuttle1,2,4, Dr Daniel Broszczak1,2,5, Dr James Broadbent1,2,6, Dr Catherine Tanzer1,2,4, Dr Tony Parker1,2

1Tissue Repair and Translational Physiology Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia, 2School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia, 3Wound Management Innovation Co-operative Research Centre, Brisbane, Australia, 4Centre for Children’s Burns and Trauma Research, Queensland University of Technology, Institute of Health and Biomedical Innovation at the Centre for Children’s Health Research, South Brisbane, Australia, 5School of Science, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia, 6Sciex P/L, Brisbane, Australia

Abstract:

Burn blister fluid analysis provides an opportunity to non-invasively investigate the biology of the initial response to burn injury; uncover novel diagnostics or prognostics to assist in clinical decision making and enable the identification of new therapeutic approaches to enhance healing.

We performed a proteomic analysis of 87 paediatric burn blister fluid samples using liquid chromatography – tandem mass spectrometry with SWATH (data independent) acquisition, which allows for the large scale relative quantification of multiple proteins between samples. The blister fluid proteomes of all samples were compared to the key clinical features of burn depth classification and time-to-reepithelialisation. Both of these clinical parameters are critical for enabling accurate clinical decisions regarding early burn treatment options.

Subsequent analyses revealed significant differences in the biochemistry associated with both burn depth and time-to-reepithelialisation. Interestingly, the protein profiles provided evidence of potential clinical misclassification of some burn wounds examined in this study. Importantly, this highlights the utility of diagnostic markers for burn depth and / or prognostic markers of time-to-reepithelialisation. While full-thickness burns are often grafted and superficial-partial thickness burns are often not, it is more difficult to determine if deep-partial thickness burns should be grafted or not. Thus, utilisation of the results of this study could translate to aid in clinical decision making. Overall, this study provides new insights into the early stages of burn wound biology in children and may help with the development of diagnostic or prognostic tools to assist with clinical decisions regarding burn treatment options.


Biography:

Dr Tony Parker is the program leader of the Tissue Repair and Translational Physiology (TRTP) Program at the Institute of Health and Biomedical Innovation (IHBI) at the Queensland University of Technology. He is also a Senior Lecturer within the School of Biomedical Sciences at QUT. Dr Parker’s research has focused on the biochemical implications of musculoskeletal and skin tissue injury and recovery processes. In particular his team has utilized 2D and 3D in vitro skin wound models and developed the workflows required for the proteomic and metabolomic investigation of wound and tissue fluids. To achieve this he played a key role in the establishment of the world class proteomics and metabolomics capability at QUTs Central Analytical Research Facility (CARF). Dr Parker’s team also has an interest in the health promoting effects of physical activity wherein his team found that moderate levels of exercise in healthy individuals induces the systemic release of the neuroprotective / neurorepairative protein known as the LG3 peptide. This finding may have implications for stroke prevention and rehabilitation and his team is currently exploring the effect of exercise on the release of circulating LG3 peptide in a small clinical cohort.

Understanding burn injuries in Aboriginal and Torres Strait Islander children: baseline results from the Coolamon Study

Dr Kate Hunter1, Professor Rebecca Q.  Ivers1,2, Dr Tamara Mackean1,3, Ms  Julieann Coombes1,4, Professor Kathleen Clapham5, Professor Roy Kimble6, Professor Andrew J.A. Holland7

1The George Institute For Global Health, Newtown, Australia, 2Southgate, Flinders University, Adelaide, Australia, 3The Southgate Institute for Health, Society and Equity, Flinders University , Adelaide, Australia, 4The University of Technology, Sydney, Australia, 5Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia, 6Lady Cilento Children’s Hospital; Centre of Children’s Burns & Trauma Research, Queensland Children’s Medical Research Institute, University of Queensland, Brisbane, Australia, 7The University of Sydney School of Medicine, The Children’s Hospital at Westmead, The Faculty of Medicine and Health, Sydney, Australia

Abstract:

Background: Aboriginal and Torres Strait Islander (First Nations) children are over-represented in burn injury hospitalisations, yet little is understood about the burn injury, care received and access to services. This study aims to describe the burden of burns, access to care, and outcomes in First Nations children with serious burns. This paper presents the baseline data.
Methods: In 2015-2017, First Nations children aged under 16 years (and their families) presenting with a burn to one of five tertiary paediatric burn services in Australia were recruited. Data were collected via participant interviews and medical records and includes sociodemographic data, burn injury and first aid treatment, mode and timing of transportation to hospital, health related quality of life and impact of the injury on family. The study is governed by an advisory group comprising representatives from the investigators, Aboriginal community members, and Aboriginal health organisation.
Results: Of 204 children recruited, 64% were male, 45% were aged less than two years, children were more likely to have received first aid at the site of the injury if it was a scald burn compared with a flame burn (95% vs 79%).
Discussion: Burns sustained by children in this cohort were largely scald and contact burns in boys. Although first aid was applied in most cases, timing to first aid differed by burn type.


Biography:

Dr Kate Hunter is a Senior Research Fellow at The George Institute for Global Health and a conjoint senior lecturer at the University of NSW. She leads a large body of work in Aboriginal and Torres Strait Islander health research. In her current research in burn care Dr Hunter draws on her earlier career as an RN working in burn units in both Australia and the US. Her research interests include assessing equitable access to health services for Aboriginal and Torres Strait Islander people. Dr Hunter is supported by a NSW Health Early Mid-Career Fellowship.

1238