Experiences of guilt, shame and blame in those affected by burns trauma : a qualitative systematic review.

Background: A significant burn can severely impact the lives of survivors and their carers. This systematic review sought to incorporate the experiences of guilt, blame and shame across the lifespan for burn survivors, their families as well as the experiences of the parents of burned children. Methods: A systematic review of qualitative studies on the experiences and perspectives of guilt, blame and shame by those affected by burn trauma across the lifespan. The databases, Pubmed, Scopus, EMBASE, CINAHL, PsychINFO were systematically searched. Authors independently rated the reporting of the qualitative studies included. Thematic synthesis was used to analyse the data. The search identified 230 papers. Eighteen research papers met the study inclusion criteria. Results: Guilt and ruminations of guilt, blame attribution and shame and body image were identified during thematic analysis as pivotal factors across the lifespan for burn survivors, their families as well as the experiences of the parents of burn injured children. Accounts presented, suggest that the impact of burns on the lives of the survivor and family covers a diverse spectrum of impact; personal, cultural and societal. Conclusion: From the findings of the literature searches and the post-burn experiences described in this review there is a gap in the psychological care for burn survivors and their caregivers. This is specifically relevant around issues of parental guilt and blame, ruminations of guilt and shame as well as body image. These findings may not be new to burns professionals but the key message is that management of these issues fall short of delivering comprehensive post trauma care. Identifying and highlighting the importance of residual psychosocial problems will ultimately influence positive outcomes for burn survivor

Surrogate consent for critical care research: exploratory study on public perception and influences on recruitment

INTRODUCTION: Critical Care research involves an increasing level of technical and clinical interventions for the unconscious patient. If the general public has a negative (unfavourable) view of surrogate consent, low recruitment rates are likely. Results bias will be introduced if study populations are small, hindering knowledge generation and transfer through research. In the rapidly expanding healthcare industry of South East Asia, opportunities for critical care research will grow given a positive willingness (favourability) by the general public to act as a surrogate in the consent process when the (unconscious) patient cannot consent for him/herself. METHODS: To determine public willingness for surrogate consent, a quantitative cross-sectional study was undertaken at a University Teaching Hospital in South East Asia during a three month interval. Four hypothetical critical care research scenarios were presented and responses from the public were analysed using a three-part questionnaire. RESULTS: Three hundred and five members of the public were recruited. In general, participants had a positive view of research. The level of education was significantly associated with a person's views about research especially in studies regarded as high risk. For low risk studies, a person's perception of research and willingness to be recruited to a study in the event that they were the (unconscious) patient, was the same whether they were the study subject or the person (legally acceptable representative) giving surrogate consent' on behalf of another (spouse, parent, child). Across all study scenarios, 60-80% of the public preferred to be approached by doctors to discuss the surrogate consent process. CONCLUSION: Given the hypothetical scenarios presented in this study, the odds of a person having a positive view and willingness to be consented to a critical care research study on the advice of another (surrogate consent) was greater than for those who had a negative or unfavourable view. Nurses may be disadvantaged in leading on the recruitment process due to a preference for information to be delivered by medically qualified clinicians. In the setting of South East Asia, cultural attitudes to nurse-led research in critical care must be taken in to consideration in the multidisciplinary approaches to building the research team

Feasibility and Variability of Automated Pupillometry Among Stroke Patients and Healthy Participants: Potential Implications for Clinical Practice.

BACKGROUND: Early neurological deterioration (END) is common after stroke and represents a poor prognostic marker. Manual pupillary assessment to detect END is subjective and has poor interrater reliability. Novel methods of automated pupillometry may be more reliable and accurate. This study aims to evaluate the acceptability and feasibility of automated pupillometry in patients with acute stroke and healthy volunteers and compare its interrater reliability with that of the traditional manual method. METHODS: Automated and manual pupillary assessments were recorded between 2 independent observers alongside routine neurological observations from 12 acute stroke patients at a high risk of END. The proportion of completed measurements, adverse events, and qualitative feedback from patients and staff nurses was used to assess acceptability and feasibility of automated pupillometry. Paired automated and manual assessments were supplemented with measures from healthy volunteers to analyze measures of variability and agreement. RESULTS: Automated pupillometry was acceptable and safe among 12 acute stroke patients, but feasibility criteria were not attained. Interrater agreement for automated pupillometry was superior to manual assessment for measurements of pupil size, anisocoria, and pupillary light reactivity, for both patients and healthy volunteers. Substantial disparity existed in agreement between automated and manual assessments of these parameters. CONCLUSIONS: Automated pupillometry represents an alternative to manual pupillary assessment that may have greater interrater agreement and reliability. As an optimized method of neurological assessment, it has the potential to improve detection and treatment of conditions leading to END after stroke

The environmental temperature of the residential care home: role in thermal comfort and mental health?

BACKGROUND: In the midst of changing environmental conditions and increasing populations aged over 65 years, how best to provide nursing care that promotes mental health and wellbeing within residential aged care facilities is an important concern. AIM/OBJECTIVE: To explore the perceptions of temperature control, thermal comfort and nursing care in a small group of older Australians. DESIGN: Descriptive, qualitative study using thematic analysis. METHODS: Individual semi-structured interviews (March to April 2017) were conducted with a group of older Australians who live within an aged care facility in NSW, Australia. Interviews were taped, transcribed and then analysed using thematic analysis. RESULTS: Five adults (three male and 2 female) participated. Themes emerging included: (1) Reliance on habitual behaviour to cope with temperature; (2) The importance of mobility to cope with temperature; (3) Balancing nursing care and resident autonomy. The importance of experiencing a sense of choice and ability to self-regulate personal environment arose as a substantial concern. CONCLUSIONS: The attention of older residents to personal issues related to thermal comfort linked to physical and mental health emphasise the importance of concerns regarding mobility, nursing care and autonomy. For older age residents the interplay between thermal comfort and behaviour adaptation is influenced by nurses and their control of the residential environment. Impact statement: Nursing staff need to consider aged care residents personal preference in choosing thermal control measures, thereby enhancing autonomy and resident satisfaction

Combat Sports as a Model for Measuring the Effects of Repeated Head Impacts on Autonomic Brain Function: A Brief Report of Pilot Data

Automated pupil light reflex (PLR) is a valid indicator of dysfunctional autonomic brain function following traumatic brain injury. PLR’s use in identifying disturbed autonomic brain function following repeated head impacts without outwardly visible symptoms has not yet been examined. As a combat sport featuring repeated ‘sub-concussive’ head impacts, mixed martial arts (MMA) sparring may provide a model to understand such changes. The aim of this pilot study was to explore which, if any, PLR variables are affected by MMA sparring. A cohort of n = 7 MMA athletes (age = 24 3 years; mass = 76.5 9 kg; stature = 176.4 8.5 cm) took part in their regular sparring sessions (eight rounds 3 min: 1 min recovery). PLR of both eyes was measured immediately preand post-sparring using a Neuroptic NPi-200. Bayesian paired samples t-tests (BF10 3) revealed decreased maximum pupil size (BF10 = 3), decreased minimum pupil size (BF10 = 4) and reduced PLR latency (BF10 = 3) post-sparring. Anisocoria was present prior to sparring and increased postsparring, with both eyes having different minimum and maximum pupil sizes (BF10 = 3–4) and constriction velocities post-sparring (BF10 = 3). These pilot data suggest repeated head impacts may cause disturbances to autonomic brain function in the absence of outwardly visible symptoms. These results provide direction for cohort-controlled studies to formally investigate the potential changes observed

Abdominal cutaneous thermography and perfusion mapping after caesarean section: A scoping review

Introduction: Caesarean section (CS) is the most prevalent surgical procedure in women. The incidence of surgical site infection (SSI) after CS remains high but recent observations of CS wounds using infrared thermography has shown promise for the technique in SSI prognosis. Although thermography is recognised as a ‘surrogate’ of skin perfusion, little is known of the relationship between skin temperature and skin perfusion in the context of wound healing. Aim: To assess the extent of literature regarding the application of infrared thermography and mapping of abdominal cutaneous perfusion after CS. Methods: Wide eligibility criteria were used to capture all relevant studies of any design, published in English, and addressing thermal imaging or skin perfusion mapping of the abdominal wall. The CINAHL and MEDLINE databases were searched, with two independent reviewers screening the title and abstracts of all identified citations, followed by full-text screening of relevant studies. Data extraction from included studies was undertaken using a pre-specified data extraction chart. Data were tabulated and synthesised in narrative format. Results: From 83 citations identified, 18 studies were considered relevant. With three additional studies identified from the reference lists, 21 studies were screened via full text. None of the studies reported thermal imaging and cutaneous perfusion patterns of the anterior abdominal wall. However, two observational studies partially met the inclusion criteria. The first explored analysis methodologies to ‘interrogate’ the abdominal thermal map. A specific thermal signature (‘cold spots’) was identified as an early ‘flag’ for SSI risk. A second study, by the same authors, focusing on obesity (a known risk factor for SSI after CS) showed that a 1 °C lower abdominal skin temperature led to a 3-fold odds of SSI. Conclusion: There is a significant gap in knowledge on how to forewarn of wound complications after CS. By utilising the known association between skin temperature and blood flow, thermographic assessment of the wound and adjacent thermal territories has potential as a non-invasive, independent, imaging option with which to identify tissue ‘at risk’. By identifying skin ‘hot’ or ‘cold’ spots, commensurate with high or low blood flow regions, there is potential to shed light on the underlying mechanisms leading to infective and non-infective wound complications

Old and Cold: Challenges in the Design of Personalised Thermal Comfort at Home

The link between winter cold and illness is a major health concern because 'cold kills'. Worse still, old and frail older people can feel cold at any time of year. Solutions need to be found to increase thermal comfort. Whilst clothing manufacturers have produced garment solutions for people to enjoy outdoor activities in the cold, there is a gap in our understanding about how to protect frail/older people from becoming chilled and cold at home. To date no evidence exists on the benefit of innovative clothing interventions for keeping older adults warm (and healthy) in the home. Our aim therefore was to first understand the behaviours of older adults at risk of indoor cold, living in different domestic environments. Focus groups/semi-structured interviews were used to identify body regions where old/frail older people feel cold and to learn about their attitudes to traditional and modern fabrics and garments for keeping warm at home. Findings from a funded pilot study (RDSYH, Public Involvement grant) are presented. The body regions most vulnerable to thermal discomfort are trunk and extremities (feet, hands). Given the anxiety, discomfort, pain, reduced activity (including taking to their bed to keep warm in early evening) design/engineering-led solutions for a ‘smart’ warm clothing 'wardrobe' for today’s and tomorrow’s older people are needed. Feedback suggests that older people are open to fresh ideas about garments and technology; important to them being fabric weight. Older people do not, as often thought, wear outdoor clothes (hats, gloves, scarves) indoors, and are not averse to ‘modern’ fabrics and garments. Style remains important to many. These findings provide the first step towards identifying 'candidate' fabric, material and garment designs preferred and acceptable to older people for the next stage of work; development of ‘smart’ personalised thermal comfort solutions for health and wellbeing at home