Impact of COVID-19 on global burn care.

Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pandemic, and whether country´s income, geographical location, COVID-19-transmission pattern, and levels of specialization of the burn units affected reallocation of resources and access to burn care. The Burn Care Survey is a questionnaire developed to collect information on the capacity to provide burn care by burn units around the world, before and during the pandemic. The survey was distributed between September and October 2020. McNemar`s test analyzed differences between services provided before and during the pandemic, χ2 or Fisher's exact test differences between groups. Multivariable logistic regression analyzed the independent effect of different factors on keeping the burn units open during the pandemic. The survey was completed by 234 burn units in 43 countries. During the pandemic, presence of burn surgeons did not change (p = 0.06), while that of anesthetists and dedicated nursing staff was reduced (<0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p < 0.01), collaboration between burn centers was not. Burn units in LMICs and LICs were more likely to be closed, after adjustment for other factors. During the pandemic, most burn units were open, although availability of standard resources diminished worldwide. The use of telemedicine increased, suggesting the implementation of new strategies to manage burns. Low income was independently associated with reduced access to burn care. [Abstract copyright: Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

Impact of COVID-19 on global burn care

Burn care; COVID-19; Surgical proceduresCura de cremades; COVID-19; Procediments quirúrgicsCuidado de quemaduras; COVID-19; Procedimientos quirúrgicosBackground Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pandemic, and whether country´s income, geographical location, COVID-19-transmission pattern, and levels of specialization of the burn units affected reallocation of resources and access to burn care. Methods The Burn Care Survey is a questionnaire developed to collect information on the capacity to provide burn care by burn units around the world, before and during the pandemic. The survey was distributed between September and October 2020. McNemar`s test analyzed differences between services provided before and during the pandemic, χ2 or Fisher’s exact test differences between groups. Multivariable logistic regression analyzed the independent effect of different factors on keeping the burn units open during the pandemic. Results The survey was completed by 234 burn units in 43 countries. During the pandemic, presence of burn surgeons did not change (p = 0.06), while that of anesthetists and dedicated nursing staff was reduced (<0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p < 0.01), collaboration between burn centers was not. Burn units in LMICs and LICs were more likely to be closed, after adjustment for other factors. Conclusions During the pandemic, most burn units were open, although availability of standard resources diminished worldwide. The use of telemedicine increased, suggesting the implementation of new strategies to manage burns. Low income was independently associated with reduced access to burn care

Influence of Habitat Heterogeneity on Small Mammals in the Central Platte River Valley, Nebraska

Although the loss of prairie is substantial across the extent of its historic range, large portions of native rangeland still remain throughout Nebraska. It is critical that resource managers and private landowners manage rangelands in a manner that will enhance ecosystem integrity by using techniques that provide disturbance regimes. Heterogeneity based management, such as patch-burn grazing and rest-rotation grazing, can be used as a conservation tool to increase biodiversity within management units and at a landscape level. Heterogeneity-based management has received much attention in the literature within the past decade, but there has been little focus on how these management systems influence small mammal communities. I trapped small mammals and surveyed vegetation structure among rangelands during 2009 and 2010 at the Platte River Whooping Crane Maintenance Trust in the Central Platte River Valley, Nebraska to determine the influence of structural heterogeneity on small mammals. Vertical height, litter depth, bare ground, and standing dead vegetation were different among burn units during both years. My data indicated no difference in grasses, forbs, or litter cover among burn units for either year. I used the significant variables in a direct gradient analysis to identify which variables were critical in determining small mammal species presence. The species identified with vegetation variables for 2009 but not 2010 suggested there were other variables not considered in my study. Species diversity measurements indicated the recently disturbed burn units had the lowest small mammal diversity and the undisturbed burn units had the greatest diversity. Community similarity was highest among similar burn units, which indicated that small mammal communities were similar among similar burn units during 2009 and 2010. Resource managers should recognize that alternative grazing systems that create a mosaic of vegetation structure can provide evolutionary processes necessary for prairie ecosystem function. Small mammals play a crucial role in grassland ecosystems and by using heterogeneity-based management, small mammal diversity increased which can lead to a healthier ecosystem

Speech-language pathology services in Australian and New Zealand pediatric burn units and chemical ingestion injury

To date, little is known regarding the extent and nature of involvement of speech-language pathology (SLP) services within pediatric burn settings. The aim of this clinical service study was to investigate the role of SLP services within burn teams across Australia and New Zealand. Eleven pediatric burn units were identified as members of the Australian and New Zealand Burn Association Bi National Burns Registry. Representatives from both burn units and SLP departments at each setting were sent a link to a purpose-built online questionnaire. Seven responses from eight centers were received, with paired responses (burn units and SLP departments) being obtained from six centers. Pediatric burn units and SLP departments were found to differ in perceptions of SLP involvement in burn care. No burn units reported utilization of a protocol for referral to SLP. Dysphagia, followed by orofacial contracture management was the most frequently reported areas of SLP involvement, and multidisciplinary contribution within these areas was recognized. A majority (71%) of SLP departments reported involvement with chemical ingestion injury; however, referral rates were low. This study confirms that SLP services are utilized within Australian and New Zealand pediatric burn units, and SLPs are involved with pediatric patients with chemical ingestion injuries. However, potential exists for increased SLP input. There is also evident needed for established guidelines surrounding referrals and greater education regarding the role of SLPs within pediatric burn care

Effects of Prescribed Burns on Grassland Breeding Birds at Mississippi Sandhill Crane National Wildlife Refuge

There has been a critical decline in grassland bird populations due to habitat fragmentation and deterioration, and suppression of natural fires. Alteration of the disturbance cycle may lead to changes in vegetation structure and thus habitat suitability for breeding grassland birds. Management practices at the Mississippi Sandhill Crane National Wildlife Refuge, including the use of prescribed fire, are in need of evaluation. My study asked what frequency of prescribed burns is necessary to support breeding grassland birds and whether vegetation structure varies among burn units. In this study, bird abundance and species richness did not differ significantly among burn units and vegetation cover-type was not a strong predictor of these factors either. There was evidence of site utilization by breeding grassland birds immediately following a burn, which suggests that the bird community is able to recovery quickly post-fire and these units may serve as viable habitat for breeding grassland birds

Extreme Fire as a Management Tool to Combat Regime Shifts in the Range of the Endangered American Burying Beetle

This study is focused on the population of federally-endangered American burying beetles in south-central Nebraska. It is focused on changes in land cover over time and at several levels of spatial scale, and how management efforts are impacting both the beetle and a changing landscape. Our findings are applicable to a large portion of the Great Plains, which is undergoing the same shift from grassland to woodland, and to areas where the beetle is still found

Investigating the level of moral distress and its related factors among nurses in mazandaran burn center

Background and purpose: Moral distress is a common phenomenon in nursing professional and burn nurses are constantly faced with making different moral decisions for patients who are in terrible conditions. Therefore, nurses in burn units experience moral distress as mental tension. This study was conducted to determine the severity of moral distress and the factors associated with that in burn nurses. Materials and methods: A descriptive- analytical study was conducted using census sampling on 172 nurses working in Mazandaran burn center, 2014. Data was collected through identifying demographic and occupational characteristics of the nurses (using relevant questionnaires) and Corley’s Moral Distress Scale. Data analysis was performed applying Mann-Whitney and Kruskal-Wallis test. Results: The mean score for moral distress was 105.65±52.39 which indicates a moderate level experienced by nurses. Kruskal-Wallis test showed a significant positive correlation between educational level and level of moral distress (P=0.011). There was no significant association between moral distress and other individual and professional characteristics (P>0.05). Conclusion: Moral distress is accompanied by many complications that have direct effects on nurses’ professional practice. Therefore, nurse managers should consider this issue and plan for programs on appropriate coping strategies. © 2015, Mazandaran University of Medical Sciences. All rights reserved

Cell therapies for skin regeneration: an overview of 40 years of experience in burn units.

The earliest attempts at cell therapy can be attributed to Charles-Edward Brown-Séquard (1817&amp;ndash;1894), who sought to treat senescence and aging by injecting animal gonad shreds into his contemporaries, a practice that was widespread in late 19th century. Since then, advances in science have enabled the development of biological substitutes to restore the function of various tissues. Skin was one of the first tissues to be regenerated. For severe burns, patient survival depends on the restoration of skin function as a barrier against pathogens and control of body temperature and fluid loss. We aim here to overview the different cell therapy techniques implemented at the University Hospital of Lausanne (CHUV), one of the two Swiss national centres of highly specialised medicine for burn care. In particular, we will describe the specific indications for each of the different therapies as well as future perspectives

Relationship between Clandestine Methamphetamine Laboratory Seizures and Burns in Kentucky

Methamphetamine is a highly addictive stimulant that is synthetically produced using equipment and chemicals available in the community. Its burden to society may be determined through a number of mechanisms, including the imposed strain on healthcare systems. The evolution of methamphetamine use and production methods has led to reports of increased methamphetamine related burn admissions among hospital burn units[1-3] . Current literature identifies an increase in injury severity, comorbid complications, and cost of care associated with methamphetamine related burn injuries[1-5]. The intent of this study is to identify burn injuries in Kentucky and assess whether a statistically significant association exists between burns and the number of methamphetamine laboratory seizures in Kentucky counties