Abstract Introduction The incidence of unintentional burn injuries provides a natural condition that induces guilt and other emotions, such as blame, in the parents of the inflicted child. Empirical evidence generated has suggested that the consequences of guilt include both prosocial behaviors and antisocial behaviors. Therefore, the effects of guilt on parental behavioral and emotional outcomes have long-term implication. The purposes of this study were to examine guilt and its representation in parental responses to a child’s burn, and to look for the immediate consequences that guilt for parents. Methods Semi-structured interviews were conducted with 20 parents or caregivers in the hospital during their child’s clinical visit in a regional burn center in eastern China. We used a combination of deductive and inductive content analysis to analyze the interview data. Results Parents expressed feelings of guilt using both the word “guilt” or sentences that conveyed the manifest meaning, which reflected the definition of guilt. Analysis of the data produced three conceptual domains of the consequence of guilt. Reappraisal of guilt toward the self included eight categories: regret, blaming myself, thinking about why, not wanting to talk, wanting to be punished, blaming others, having trouble sleeping and feeling irresponsible. Motivational reactions toward the child were sorted into four categories: paying more attention to prevent injuries, feeling sorry for the child, providing the best care, and placating the child. Other reported accompanying emotions included upset, anger and heartache. Conclusions Guilt and its consequences are correlated but have distinct semantic representation. However, guilt and its related emotions were often expressed within one parent’s account of his or her emotional experience. Blaming has been a significant reaction among parents and family caregivers, including self-blaming and blaming others. The results of this study suggest that guilt appears to promote both prosocial and antisocial emotions and behaviors in parents. Applicability of Research to Practice This paper’s findings help to extend our theoretical understanding of the guilt and its effects on the development and persistence of emotional distress in parents facing their child’s unintentional burn injury. What’s more, these results have practical implications for professionals caring for parents or family caregivers who are in greater need of professional mental health support and interventions, given the long-term recovery period in children with moderate to severe burn injury and the meaning and visibility associated with the burn scars. Further research is needed to elucidate the role of guilt in the development and persistence of emotional distress in parents facing their child’s unintentional burn injury.
Abstract Participant attrition in longitudinal studies can lead to substantial bias in study results, especially when attrition is nonrandom. A previous study of the Burn Model System (BMS) database prior to 2002 identified participant and study-related factors related to attrition. The purpose of the current study was to examine changes in attrition rates in the BMS longitudinal database since 2002 and to revisit factors associated with attrition. Individuals 18 years and older enrolled in the BMS database between 2002 and 2018 were included in this study. Stepwise logistic regression models identified factors significantly associated with attrition at 6, 12, and 24 months postburn injury. The percentage of individuals lost to follow-up was 26% at 6 months, 33% at 12 months, and 42% at 24 months. Factors associated with increased risk of loss to follow-up across two or more time points include male sex, lower TBSA burn size, being unemployed at the time of burn, shorter duration of acute hospital stay, younger age, not having private health insurance or workers’ compensation, and a history of drug abuse. Retention levels in the BMS have improved by at least 10% at all time points since 2002. The BMS and other longitudinal burn research projects can use these results to identify individuals at high risk for attrition who may require additional retention efforts. Results also indicate potential sources of bias in research projects utilizing the BMS database.
Thermal injury results in damage to the skin and underlying subcutaneous tissues. Extensive cutaneous injuries result in loss of water and electrolytes, and a disturbance in the homeostatic balance. The purpose of this article is to describe the pathophysiological changes that occur following extensive thermal injury and the common fluid-management challenges they provide. Implications for perioperative nursing practice are discussed.
Pruritus is a frequent and severe symptom and a significant cause of distress for adult burn patients. Its effects in children are largely unstudied. The aim of this study is to characterize postburn itch in the pediatric population. This is a retrospective review from 2006 to 2013 for pediatric burn survivors who were enrolled in a longitudinal multicenter outcomes study. Demographic data, injury characteristics, associated symptoms (skin-related problems, pain, and sleep), and incidence and intensity (Numerical Rating Scale) of itch were examined. Measures were completed at hospital discharge and at 6, 12, and 24 months after injury. Spearman's correlations were used to examine the correlation between itch intensity and associated symptoms. Multivariate regression analyses examined the impact of associated symptoms on itch intensity. There were 430 pediatric burn survivors with a mean age of 7.8 years and a mean TBSA of 40.8%. Pruritus is present in most children (93%) and is of moderate intensity (5.7 ± 3.1) at discharge. The frequency and intensity of pruritus decreases over time; a majority of children continue to report symptoms at 2 years (63%). Itch was significantly correlated with associated symptoms. Regression analyses showed a correlation between itch intensity and pain at each time point. There was no association between itch intensity and burn etiology, age, gender, or burn size. Pruritus is a frequent complication that lasts for at least 2 years after injury in a majority of pediatric burn survivors. This information will enable better tracking of outcomes and will serve as a baseline for assessing interventions.
The effect of insulin-like growth factor-1 (IGF-1) on energy expenditure and protein and glucose metabolism in a group of patients with thermal injury was determined.Accelerated protein catabolism is a constant feature of the hypermetabolic response to thermal injury. Insulin-like growth factor-1 has been reported to minimize protein catabolism and normalize energy expenditure in animal models of thermal injury.To determine the efficacy of IGF-1 in human burn patients, resting energy expenditure (metabolic cart), whole body protein kinetics (N15 Lysine), and glucose disposal (glucose tolerance test) were assessed in eight burn patients before and after a 3-day infusion of IGF-1 (20 micrograms/kg/hr). All patients were fluid-resuscitated uneventfully and were without obvious infection at the time of study. Enteral nutrition was administered at a constant rate before and during the IGF-1 infusion.Resting energy expenditure was not altered by IGF-1 (40.3 +/- 2.2 vs. 39.1 +/- 2.3 kcal/kg/day). However, glucose uptake was promoted, and protein oxidation decreased significantly (0.118 +/- 0.029 vs. 0.087 +/- 0.021 g/kg/d, p < 0.05) by IGF-1. In addition, insulin secretion, in response to a glucose challenge, was blunted.Insulin-like growth factor-1 therapy has a beneficial effect in preserving lean body mass during severe stress conditions by minimizing the flux of amino acids toward oxidation.
Knowledge translation and consumer testing seeks to move clinical research from scientists, peer-reviewed journals, and conferences to the hands of end-users. The National Institute on Disability, Independent Living, and Rehabilitation Researched funded Burn Model System (BMS) and Model System Knowledge Translation Center (MSKTC) have worked together to develop and disseminate rehabilitation education materials.
Objective
The BMS in collaboration with the MSKTC uses a multi-step process for developing and consumer-testing evidence-based/consensus-derived educational information prioritized by consumers. The final written products are made available in multiple languages and are disseminated through websites, clinical encounters, social media, and national/international engagement with clinicians and burn-related organizations (end-users). We aimed to understand the impact of dissemination efforts overtime.
Methods
The number of online views, a measure of general dissemination, was used to calculate dissemination growth for each written product. Data reported for the annual performance reviews was used between the timepoints of mid-2019 to mid-2023 and was used to calculate the percent gained. The median value for percentage increase was calculated and used as the primary metric for dissemination growth.
Results
Since 2011, the collaboration between the BMS and the MSKTC has produced or updated 22 educational factsheets, three videos, three infocomics, and one infographic. Collectively, these products have been viewed over two million times by people in 216 countries. Online views of all products have generally increased year-to-year.
Conclusions
The process of developing and consumer-testing education information used by the BMS and MSKTC makes relevant health information accessible and understandable for consumers. As a result, Burn Model System informational products have been increasingly viewed by US and international consumers which directly benefits rehabilitation communities concerned with burn care and recovery.
