Abstract:OBJECTIVE: To explore information needs of unintentional injury patients and their carers over time, across services, and how such needs are met from the perspectives of patients, carers and service providers.METHODS: Qualitative nested study within a multi-centre longitudinal study quantifying psychosocial, physical, occupational outcomes and service use and costs following a range of unintentional injuries. Semi-structured interviews conducted with 45 patients during the first year post injury, 18 of their carers and 40 providers of services.RESULTS: Patients and carers needed information about the nature and severity of injury, prognosis, self-management and further services. Information needs changed over time with the biggest difficulties being during transfer from primary to secondary care. Barriers to information provision included service providers' time limitations and uncertainty around information provision, and patients' reluctance to ask for information or inability to process it. Suggested improvements included provision of reassurance as well as factual information, information about further services, earlier follow-up, increased appointment times and greater involvement of families where appropriate. This is an accepted manuscript of an article published by Elsevier in 'Injury' available online at http://www.sciencedirect.com/science/article/pii/S0020138314006305?via%3Dihub It is not the copy of record. Copyright © 2017, Elsevier 2 CONCLUSIONS: The information needs of patients and carers post injury change with time and there are a number of ways to remove gaps and barriers in current provision to meet such needs.PRACTICE IMPLICATIONS: Providing information on injury management, prognosis and available services and reassurance at each stage of the recovery process in secondary care and when transferring to primary care would be helpful for patients and carers. A follow-up contact soon after discharge and the opportunity to ask questions could be beneficial. Better information about the patient's needs and ways they can help could help carers fulfil their caring role.
ObjectiveTo explore views of service providers caring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision.DesignQualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers’ views were elicited through semistructured interviews. Data were analysed using thematic analysis.SettingParticipants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas.Participants40 service providers from a range of disciplines.ResultsService providers described two distinct models of trauma care: an ‘ideal’ model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a ‘real’ model based on the realities of National Health Service (NHS) practice. Participants’ ‘ideal’ model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, ‘real’ care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients’ needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice.ConclusionsService providers envisage an ‘ideal’ model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between ‘real’ and ‘ideal’ care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of care.
Hypertrophic scarring (HTS) is defined as a scar, which is raised above the skin level and remains within the confines of the original lesion. The authors hypothesize that small surface area burns can be left to heal beyond 21 days without an increase in the incidence of HTS formation, within the confines of a carefully selected patient population. The authors have documented the number of days to healing in all patients conservatively managed in their outpatient burns clinic. All patients who took longer than 21 days to heal receive a follow-up telephone call. A multivariate regression analysis is used to confirm significant factors that impede healing time. This study included 181 conservatively managed burns with a male:female ratio of 1.63:1 and average age of 24.7 ± 21.69 years (range, 1 month to 85 years). In total, 32 patients (18%) took more than 21 days to heal (range, 22-88 days), of which five patients presented with HTS (days to healing range, 23-47; one mixed depth and four deep dermal). One patient did not attend for follow-up, two patients settled with silicone gel alone whereas one settled with pressure garments. One patient is still being seen. The only significant factor in predicting time to healing in the ANOVA model in this study was depth of burn (P = .01; confidence interval, 1.18-6.07). Advances in wound care and better understanding of the physiological processes involved in healing may now enable the management of smaller burns with dressings, delaying the need for early surgical debridement and skin grafting in certain individuals.
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