Health related quality of life 5–7 years after minor and severe burn injuries: a multicentre cross-sectional study

IntroductionBurn injury can affect health-related quality of life (HRQL). Knowledge concerning long-term HRQL in burn patients is limited. Therefore our aim was to evaluate long-term HRQL and to study predictors of impaired long-term HRQL.MethodsAll adults with a length of stay (LOS) of ≥1 day (2011–2012) were invited. Also, adults with severe burns, i.e., >20% total body surface area (TBSA) burned or TBSA full thickness>5% (2010–2013) were invited. Participants completed the EuroQol(EQ)-5 D-5L + C and visual analogue scale (EQ-VAS) 5–7 years after burns.ResultsThis study included 256 patients (mean %TBSA 10%); 187 patients with minor burns and 69 patients with severe burns. Mean EQ-5D summary was 0.90 and EQ-VAS 83.2 in the minor burn patients, and 0.79 and 78.1 in the severe burn patients. Some problems in at least one dimension were experienced by 81% of patients with severe burns and 45% of those with minor burns. However, a minority reported severe or extreme problems; 15% of those with severe burns and 6% of those with minor burns. Patients with severe burns reported significantly more problems, except for anxiety/depression. In both patient groups most problems were reported on pain/discomfort. Length of hospital stay, gender and age were associated with lower long-term HRQL (EQ-VAS) in multivariate analyses, whereas only length of stay was associated with a lower summary score.ConclusionsThe majority of patients experienced some problems with HRQL 5–7 years post burn. This emphasizes that burns can have a negative impact on an individual’s HRQL, particularly in more severely burned patients, that persists for years. The HRQL dimensions most frequently affected include pain/discomfort and anxiety/depression. Patients with a prolonged hospital stay, females and older patients are at higher risk of poor HRQL in the long-term.     

Effects of oral mexiletine on left and right ventricular function

Malignant ventricular arrhythmias often occur in patients with left ventricular (LV) dysfunction. Antiarrhythmic drugs may further impair LV function in these patients. Mexiletine, a lidocaine congener, is an effective antiarrhythmic drug, but when administered orally, its effect on LV and right ventricular (RV) function is unknown. To determine the hemodynamic effects of mexiletine, LV and RV ejection fraction (EF) were measured by radionuclide ventriculography in 10 patients with LV dysfunction (LVEF less than 50%). Symptom-limited exercise tests were also performed. Patients were studied before and during therapy with oral mexiletine. There was no significant change in LVEF (28% vs 27%) or RVEF (46% vs 41%). Also, heart rate at rest, exercise duration and peak heart rate during exercise were unchanged. Thus, in patients with LV dysfunction, oral mexiletine does not significantly affect LV or RV function.     

Essential Trauma Care: strengthening trauma systems round the world

Injury has become a major cause of death and disability world-wide. Systematic approaches to its prevention and treatment are needed. In terms of treatment, there are many low-cost improvements that could be made particularly in low- and middle-income countries to strengthen their trauma systems. These can be formalised under "Essential Trauma Care" programme, similar to other global programmes for major public health problems. World Health Organisation (WHO), leading the initiative in this direction, convened a meeting at Geneva in June 2002, involving Injuries and Violence Prevention Department of the WHO, the Working Group for Essential Trauma Care of the International Association for Trauma and Surgical Intensive Care (IATSIC), representatives of other organisations and trauma care clinicians representing Africa, Asia, and Latin America. The meeting developed a preliminary list of Essential Trauma Care services and a model template for the skills and equipment needed to assure them. It is intended to be used to assist individual countries in planning their own trauma care services.     

The ‘Public Accountability Approach’: Suggestions for a Framework to Characterise,Compare, Inform and Evaluate Gambling Regulation

It is argued that the analytical comparison of gambling regulatory frameworks across jurisdictions requires the identification of salient dimensions to provide the basis for such. It is further suggested that governmental ‘conflict of interest’ might provide a useful dimension for such comparison, as operationalised by concomitant EGM harm and government dependence criteria. The same ‘conflict of interest’ criteria are then suggested as a guide for gambling regulation within single jurisdictions, this being named the ‘Public Accountability Approach.’ These points are discussed within broader reference to lines and webs of harm production within a public health analysis. Broader reference is also made to the proper role of government within contemporary democracy.

Opinions on research and evidence based medicine within the UK osteopathic profession: A thematic analysis of public documents 2003–2009

Background

Very little is known about the attitudes of osteopaths in the UK towards research and evidence based medicine (EBM). It is important to understand the attitudes of osteopaths in order to identify the issues surrounding research and EBM in osteopathy.

Objective

The objective of this study was to collect and thematically analyse public documents (for example editorials, letters, forum threads and essays) from carefully chosen sources, published 2003–2009. Such analysis enables themes and concepts to be drawn out of the data to reflect the hopes, goals, concerns or perceived barriers that osteopaths may have with regards to research and EBM.

Data sources

Two UK osteopathic magazines, two websites for osteopaths and five health databases were searched for data sections. Data sections were selected according to inclusion and exclusion criteria. Magazines were read by the researcher, the two websites’ forum archives were searched using keywords ‘research’ and ‘evidence based medicine,’ and the five databases were searched using MeSH terms ‘osteopathic medicine,’ ‘research’ and ‘evidence based medicine.’

Method

The method was a 6 stage thematic analysis of public documents 2003–2009. Data sections were identified from the public documents using inclusion and exclusion criteria. Sections were broken down into codes and themes were derived from codes using a flexible and reflective process. Higher concepts were then derived from the themes according to relationships and similarities identified between themes.

Results

129 data sections were identified from the 5 sources and coded. 20 themes were derived from the codes, then the themes were further analysed and six concepts were derived from the themes. A final conceptual framework was constructed to represent osteopaths’ opinions on research and EBM. The concepts identified were “uniqueness,” relating to respect for osteopathic principles and Andrew Taylor Still, and the profession maintaining autonomy from mainstream medicine; “position in healthcare,” relating to identifying the need to integrate into mainstream healthcare and gain status and respect from physicians outside of the osteopathic profession; “necessity,” relating to reasons why research should be carried out, and what it should focus on; “barriers,” relating to issues that hinder osteopaths in research such as experience, methods, funding; “solutions,” relating to some suggestions made for overcoming barriers; and “negative impact,” relating to the possible negative consequences that research might have on the profession.

Conclusions

A broad and complex range of issues were identified and osteopaths appear to have differing views about the importance of research and their position in a wider healthcare structure. Preserving osteopathic principles and the profession’s uniqueness is important when considering research and EBM. A fear exists with regards to the impact that research might have on clinical practice. Recommendations for further osteopathic research have been made.     

Does Hemophilia Increase Risk of Adverse Outcomes Following Total Hip and Knee Arthroplasty? A Propensity Score–Matched Analysis of a Nationwide,Population-Based Study

BackgroundEnd-stage hemophilic arthropathy is the result of recurrent joint hemarthrosis. Although total hip arthroplasty (THA) and total knee arthroplasty (TKA) can reduce severe joint pain and improve functional activity, controversy remains regarding outcomes after THA and TKA among patients with hemophilia. This study evaluated the risk of adverse outcomes of hemophilia patients who underwent THA and TKA.MethodsThis retrospective cohort study was conducted using data from the National Health Insurance Research Database. Patients who had hemophilia and underwent THA and TKA between 2000 and 2015 were identified. A total of 121 patients with hemophilia and 194,026 patients without hemophilia were included. Through propensity score matching, patients with hemophilia were matched at a 1:4 ratio to patients without hemophilia. Multivariable regression analysis was used to control for confounding variables and compare the risk of postoperative complications and mortality, differences in length of stay, and cost of care for the hospital.ResultsAfter propensity score matching and multivariate regression analysis, the adjusted hazard ratio of postoperative transfusion for hemophilia patients was 5.262 (95% confidence interval [CI] = 3.044-26.565, P < .001) in THA group and 6.279 (95% CI = 3.246-28.903, P < .001) in TKA group, when compared with the control group. Patients with hemophilia had longer length of hospital stay (THA group: 95% CI, 1.541-2.669, P < .001; TKA group: 95% CI, 1.568-2.786; P < .001) and higher total hospital charges (THA group: 95% CI, 3.518-8.293, P < .001; TKA group: 95% CI, 3.584-8.842; P < .001) compared to patients without hemophilia. Hemophiliacs had a higher yet nonsignificant 1-year infection rate (8.11% vs 3.38%, P = .206) in the THA group. There were no differences between the rates of 30-day and 90-day complications, 1-year infection, reoperation and mortality between the hemophilia and nonhemophilia groups.ConclusionHemophilia patients have higher rates of postoperative transfusion, hospital costs, and increased length of stay. There is an appreciable clinical difference in 1-year infection rates following THA but our analysis was limited by the small sample size. Other postoperative complications and mortality rates were comparable. Patients with hemophilia should be counseled that infection rate maybe as high as 8% following THA. Further investigation is needed to develop prophylactic and effective methods to decrease the rates of transfusions and associated adverse outcomes in hemophilia patients undergoing THA and TKA.