Peer support group programs are often recommended for burn survivors as a way to facilitate their psychosocial recovery and reintegration into the community. Such programs provide opportunities for burn patients and their caretakers to access emotional and informational support from healthcare providers and other survivors in inpatient or outpatient settings. Despite their popularity, however, there is little information currently available on the efficacy of these groups. In response, we reviewed the existing literature on peer support group programs and their impacts on psychosocial outcomes for burn survivors and their caregivers. A systematic review of the literature utilizing PubMed, PsycINFO, and Medline databases was conducted for articles published between 1990 and 2018. Twenty-five articles including inpatient, outpatient, integrative peer support groups, and burn camps met our inclusion criteria. All inpatient peer support group program articles (n = 4) reported associations with psychosocial improvements. Integrative peer support group program articles (n = 2) reported associations with social integration and reduction in post-traumatic stress and anxiety. All outpatient peer support group program articles (n = 8) demonstrated associations with psychosocial outcomes involving life satisfaction, acceptance of self, and reduced levels of isolation. Findings were less consistent for burn camps: 8 articles suggested improvements in psychological outcomes while 3 articles reported no significant psychosocial effects. Although these results are encouraging, further study is indicated both to replicate these findings, and to determine the optimal implementation of inpatient and outpatient peer support programs.
During the Covid-19 pandemic, hospital systems delayed or halted elective surgeries and outpatient care, profoundly disrupting reconstructive burn treatment ranging from surgery to postoperative therapy. This study aims to characterize burn patients’ perspectives on reconstructive surgery during Covid-19. A 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA verified Burn Center was administered. Responses regarding willingness to undergo reconstruction, perceived medical and personal impacts of Covid-19, and perspectives on telehealth were gathered. Surveys were administered to patients/caregivers over the phone in English and Spanish. Inclusion criteria consisted of burn patients who had elective reconstructive surgeries delayed or canceled as a result of the pandemic. 51 patients met our inclusion criteria. Of those, 23 patients responded to our survey (45%). Average patient age was 23, 43% were male, and a majority (52%) were pediatric. 22 (96%) patients were willing to undergo reconstruction during the Covid-19 pandemic, despite a perceived increased risk. 43% disagreed or strongly disagreed that telehealth adequately enabled communication with their burn care provider. 78% agreed or strongly agreed that they felt more susceptible to Covid-19 as burn patients. 83% agreed or strongly agreed that the Covid-19 pandemic had created stressors specifically related to their burn care. The majority of patients expressed a strong desire to return to surgical and therapeutic care delayed by Covid-19. Patients reported feeling especially vulnerable to the Covid-19 pandemic as burn patients, and cited difficulty obtaining care and financial stressors as the main causes.
Purpose: Nanoparticles (NPs) carry important promises for the treatment of neurological diseases, such as glioblastoma multiform (GBM) and Parkinson's disease. Several methods have been developed to achieve higher NP concentrations in the brain, including local infusions using convection enhanced delivery (CED), focused ultrasound, and the use of surface targeting moieties specifically designed to increase the passage across the blood brain barrier (BBB). However, even when sufficient NP amounts are delivered to the targeted region, a better understanding of the interactions between the particles and the brain parenchyma will be necessary to reach clinical efficacy. This is particularly true for polymeric NPs, which behavior can be dramatically influenced by multiple factors such as their size and their surface properties. Here, we investigated the cellular fate of PLA-based nanoparticles of similar size, but bearing different surface modifications, following CED in the healthy brain and the tumor bearing brain. Methods: Four PLA-based NP formulations with different surface modifications (PLA, PLA-PEG, PLA-HPG and PLA-HPG-CHO) and similar size were obtained by emulsion or nanoprecipitation. CED of each formulation was performed in healthy or tumor bearing brain, and comparable volumes of distribution were obtained. 4 h and 24 h after infusion, brains were harvested and processed for flow cytometry analysis and immunohistochemical staining, to quantify particle internalization by neurons, astrocytes, microglia and tumor cells, when applicable. In vitro uptake studies were performed using relevant cell lines for neurons (N27 cells), astrocytes (TNC1), microglia (BV2) and tumors (RG2). Rate of association kinetics of different particles with these cells were derived from an uptake study and then correlated with in vivo internalization results. Finally, to evaluate how different NPs surface modifications and their different internalization patterns can influence survival benefits, the different particles were loaded with epothilone B (EB) and infused into rats bearing RG2 tumors via CED. Results: We observed that in the healthy brain, stealth NPs distributed evenly between neurons, astrocytes and microglia, while exhibiting the highest specificity towards tumor cells in the tumor bearing brain. Overall, the functionalization of PLA NPs with aldehyde groups allowed for an increased uptake by all cell types, in both healthy and tumor bearing brain. These NPs also presented an increased relative uptake by microglia cells in both environments, compared to stealth particles, suggesting the induction of an immune response. Rates of association of NPs in vitro varied significantly between particle types. We were then able to correlate the in vivo uptake of each particle and cell type with in vitro particle association rates with neurons, astrocytes and microglia in culture, demonstrating the possibility of predicting in vivo uptake using in vitro association rates. Finally, comparison of particles in a survival efficacy showed significant differences, highlighting the importance of uptake of NPs. Conclusions: This study demonstrates for the first time that NP surface modifications significantly influence the cellular tropism of NPs in the brain in vivo, and that in vitro association rates can be used to anticipate the different internalization patterns. These differences open the possibility of tuning surface properties to optimize cellular delivery and therapeutic outcome. Acknowledgements: This work is supported by a NIH/NCI R01 grant (#5R01CA149128-04). Citation Format: Eric Song, Alice Gaudin, Amanda R. King, Youngeun Seo, Paul Won, Heewon Suh, Yang Deng, Jiajia Cui, Gregory Tietjen, W Mark Saltzman. Surface chemistry governs cellular tropism of nanoparticles in the brain. [abstract]. In: Proceedings of the AACR Special Conference on Engineering and Physical Sciences in Oncology; 2016 Jun 25-28; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2017;77(2 Suppl):Abstract nr B46.
Background Burn patients have a relatively high rate of indwelling Foley catheter use because of their need for complex fluid management and wound care. However, Foley catheter use is associated with risks, including urinary tract infection. For female patients, an external urinary catheter is an alternative. Objectives To evaluate the use of female external urinary catheters in a burn intensive care unit and to develop a standard protocol. Methods This study involved female patients admitted to a burn intensive care unit from 2017 to 2020. An initiative to increase the use of female external urinary catheters was begun in 2019. A retrospective review of medical records was used to determine rates of indwelling and external catheter use and of catheter-associated urinary tract infection before and after implementation of the initiative. Results Of 77 female burn patients admitted to the unit between 2019 and 2020, 56 (73%) required indwelling Foley catheterization, a significant decrease from 94% before the initiative (P = .002). The mean duration of indwelling Foley catheter use decreased significantly from 19.4 days to 10.47 days (P = .049). Female external urinary catheters were used in 21 patients (27%). No patients with female external urinary catheters contracted urinary tract infections, compared with 9 patients with indwelling Foley catheters. Conclusion The use of female external urinary catheters may help reduce the risk of urinary tract infection in female burn patients. Further research is needed to refine the protocol for use of these devices and determine their safety profile.
Introduction Patients with psychiatric illness and substance use disorder have high rates of burn injuries. These patients require multidisciplinary care and experience prolonged admissions. Less is known about these patients after discharge due to challenges such as poor healthcare literacy and inequities to healthcare access. This study characterizes this marginalized population’s inpatient burn care and post-discharge outcomes compared to the general burn population. Methods Patients who were admitted to a single burn center from January 1st, 2018 to June 1st, 2022 were included. Patient demographics, history of psychiatric disorders, burn and psychiatric treatment data, and post-discharge outcomes were collected. Results A total of 1,660 patients were included in this study, of which 91 (6%) patients had psychiatric comorbidity and/or substance use disorder. These 91 patients had an average age of 36 years (standard deviation (SD): 12 years). In this cohort, the majority of patients were undomiciled (66%) and male (67%). On admission, 66 (72%) patients reported recent illicit substance use or had positive urine toxicology results. At the time of burn injury, 25 (28%) patients had a pre-existing psychiatric disorder. Patients were treated most for self-inflicted burns, with 36 (40%) patients presenting with burns secondary to self-immolation. In this population, 67 (74%) patients required inpatient psychiatric intervention, of which 31 (46%) were placed on a psychiatric hold. After discharge, 39 (43%) patients returned to the hospital for outpatient follow-up. The readmission rate for patients with psychiatric or substance use comorbidity was greater than 4 times higher than that of the general burn population (31% vs 7%). The most common cause of readmission were subsequent mental health crisis (40%) and inability to perform burn care (32%). Conclusions Burn patients with psychiatric disorders and substance abuse are most often young men who exhibit self-harm. These patients have limited outpatient follow up and access to support outside of the hospital. High readmission rates for subsequent mental health crises and inability to perform basic wound care exemplifies inadequate short-term care for this marginalized population. Applicability of Research to Practice In the short term, patients with psychiatric and substance use disorders may benefit from additional professional support and treatment to address burn care and comorbidities after burn injury.
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