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Burn patients experience severe pain when undergoing rehabilitation after skin grafting, which negatively affects their recovery. Traditional analgesic methods (such as opioids) have the risk of addictiveness and side effects. Nitrous oxide, which has rapid analgesic and sedative effects, is commonly used for conscious analgesia. The purpose of this study was to determine whether diluted nitrous oxide reduces pain compared to Placebo(oxygen) during rehabilitation after burn surgery. This single-center, randomized, double-blind, and controlled trial will enroll 80 patients. Patients ≥ 18 years of age who underwent rehabilitation 1 month after burn surgery with acute pain (VAS ≥ 4) were included. The main exclusion criteria included: pulmonary disease (pulmonary embolism, pneumothorax), intestinal obstruction, etc. Patients were randomly assigned in a 1: 1 ratio to intervention (A) and control (B) groups. Doctors, therapists, patients, and data collectors were unaware of the assignment outcomes. Rehabilitation will be performed by a therapist. The nurse performing the intervention handed the envelope with the patient code and the A or B assignment to the physician. Group A will receive diluted nitrous oxide inhalation plus conventional therapy (without analgesics) 30 minutes once daily for 4 weeks, and Group B will receive oxygen plus conventional therapy (without analgesics) under the same conditions. Assessments will be performed before the intervention (T0), 2 minutes (T1) and 5 minutes (T2) after the start of the intervention, and 5 minutes (T3) after the start of the intervention. The primary outcome was pain score. Secondary outcomes included vital signs, side effects, quality of life score, scar score, need for adjuvant analgesia, therapist and patient satisfaction, and willingness to receive the same gas again. If the experimental results show that diluted nitrous oxide can bring good analgesic effects without serious side effects, it can improve patients' compliance with rehabilitation treatment and quality of life, and it is even widely implemented in hospitals and rehabilitation institutions.

This study aims to assess the effectiveness of early plastic surgery for deep hand burns by examining variables like VAS scores, wound healing time, and excellent hand function recovery rates. A total of 130 patients with deep hand burns admitted to our hospital between January 2020 and October 2021 were enrolled in this study. They were randomly assigned to either a control group (n = 65, deferred reconstructive surgery) or an observation group (n = 65, early reconstructive surgery) using a random number table. We compared the VAS scores, wound healing time, rates of excellent hand function recovery, complications, and overall treatment efficacy between the two groups. The preoperative VAS scores were comparable between the observation and control groups (P > .05). Postoperative VAS scores in the observation group were significantly lower than those in the control group at 1, 3, and 7 days following surgery (P < .05). Additionally, the observation group exhibited shorter wound healing times and higher rates of excellent hand function recovery (P < .05). The incidence of complications such as numbness, infection, and necrosis of implants was lower in the observation group compared to the control group (P < .05). The overall treatment efficacy was also significantly better in the observation group than in the control group (P < .05). These findings underscore the high clinical value of early surgical intervention, supporting its broader application in the treatment of deep hand burns and potentially improving patient outcomes.

Mothers of children with burn injuries often experience psychological distress, affecting their well-being and children’s pain. This study evaluates the impact of resilience training on maternal resilience and child pain. This randomized clinical trial was conducted at Amir Al-Momenin Burn Hospital, Shiraz, Iran, with 50 mothers in 2021–2022. Participants were assigned to an intervention group (six-day resilience training) or a control group (standard care). Outcomes were measured at multiple time points using the Connor-Davidson Resilience Scale and the Visual Analog Scale. Data were analyzed using SPSS v.22. The analysis revealed significant time effects on child pain intensity (B = − 0.84, p  < 0.001) and maternal resilience (B = 3.99, p  < 0.001). Significant group effects revealed greater improvements in the intervention group for child pain intensity (B = 2.85, p  < 0.001) and maternal resilience (B = − 3.05, p  < 0.001). The intervention group showed significant improvement in maternal resilience over time compared to the control group (B= − 2.06, p  = 0.001), with no significant difference in child pain intensity over time compared to the control group (B = − 0.05, p  = 0.69). Resilience training enhances maternal resilience and children’s pain over time. However, its impact on child pain intensity is limited compared to standard care. Therefore, integrating resilience training for mothers into pediatric burn care is recommended.

The tendency to use less-invasive laser-based methods with far more obvious effectiveness has been taken into consideration today for improvement of burning scars. The present study thus aimed to assess the efficacy of two laser-based techniques including pulsed dye laser (PDL) and ablative fractional CO2 laser (AFCL) and its combination on improving different aspects of burning scars regardless of the types of scar as hypertrophic or keloid scars. This randomized single-blinded clinical trial was performed on patients suffering hypertrophic or keloid burning scars. The patients were randomly assigned into three groups scheduling for treatment with PDL alone, AFCL alone, or its combination. All patients were visited before and 40 days after the last treatment session, and their scars were assessed. In all groups, significant improvement was revealed in the Vancouver scar scale (VSS) score, the color of scar, vascular bed in the scar, the and height of scar and its pliability; however, the improvement in each item was more highlighted in the group receiving a combination therapy with PDL and AFCL techniques. In this regard, the highest improvement was found in vascular bed and pliability in the combination therapy group as compared to other groups. Although the superiority of the combined group was not statistically significant, due to the high percentage of improvement in total VSS and most of its indicators, it can be clinically significant. The efficacy of the treatment protocols was different considering subgroups of mature and immature scars (less than 1 year), so that more improvement in pliability of scar, vascularity, and color of scar was found in the group scheduling for PDL + AFCL as compared to those who were treated with PDL alone in immature scar group but not in mature scar group. Combined treatment can be much more effective in improving the appearance and pathological characteristics of scars than each individual treatment. This effectiveness can be seen mainly in immature scars.

Frailty has demonstrated enhanced prognostic ability for elderly patient morbidity. The aim was to create a burn-specific frailty index for elderly patients and compare it to commonly used scoring systems in burn management. From 2013 to 2017, we prospectively surveyed a randomized cohort of patients ≥65-years-old previously admitted to our burn unit. Prognostic comparisons with 6 commonly used indices and multivariate risk analyses were performed. Of 100 included patients, n = 32 were classified as frail. The mean patient age was 73.0 ± 6.8-years with a median follow up of 20.9 months. There were 13 moralities in total, 12 occurred in the frail group including 5 in-house mortalities. Patients classified as frail had significantly more complications (p < 0.001), non-home discharges (p < 0.001), ICU admissions, and longer hospital and ICU lengths of stay (p < 0.001), decreased 1 and 3-year survival (p = 0.001). The BFI was identified as an independent predictor of mortality (p = 0.001) and course-altering diagnoses including sepsis/septic shock, ARDS/ALI, and AKI. The Burn Frailty Index accurately predicts morbidity and mortality in elderly frail patients suffering burn injuries. •Frail patients are at risk for complications including mortality, ARDS, sepsis/shock, and AKI.•Increasingly frail patients with low severity burns remain highly susceptible to complications.•The BFI can be calculated on patient arrival to the trauma bay during assessment.•The BFI predicts life-altering outcomes for elderly patients sustaining burn injuries.•The BFI can guide end-of-life discussion, disposition planning, and resource management.

Burn injuries trigger a greater and more persistent inflammatory response than other trauma cases. Exercise has been shown to positively influence inflammation in healthy and diseased populations, however little is known about the latent effect of exercise on chronic inflammation in burn injured patients. The aims of the pilot study were to assess the feasibility of implementing a long duration exercise training program, in burn injured individuals including learnings associated with conducting a clinical trial in COVID-19 pandemic. Fifteen participants with a burn injury between 5-20% total body surface area acquired greater than a year ago were randomised in a within-subject designed study, into one of two conditions, exercise-control or control-exercise. The exercise condition consisted of six weeks of resistance and cardiovascular exercises, completed remotely or supervised in a hospital gym. A comprehensive outcome measurement was completed at the initial, mid and end point of each exercise and control condition. To determine the success of implementation, the feasibility indicator for the data completeness across the comprehensive outcome battery was set at 80%. Half (49%) of eligible participants in the timeframe, were recruited and commenced the study. Six participants withdrew prior to completion and a total of 15 participants completed the study. Eight participants were randomised to the exercise-control and seven to the control exercise group. Five participants trained remotely and seven did supervised training. Three participants completed a mix of both supervised and remote training initiated due to COVID restrictions. Outcome measures were completed on 97% of protocolised occasions and 100% of participants completed the exercise training. Conducting a long duration exercise training study on burn injured individuals is feasible using the described methods. The knowledge gained helps improve the methodology in larger-scale projects. Insights into the impact of COVID-19 on this clinical trial and success enhancing adaptations for the researcher, research practice and the participant, are presented.

Scar formation, the most common complication of burns, significantly impacts patients’ quality of life. This study evaluates how the hospital-to-home care transition program reduces scar-related complications and improves health-related quality of life in patients with deep partial-thickness burns. This semi-experimental study involved 80 patients with deep partial-thickness burns, selected through convenience sampling and randomly assigned—by coin flipping—to the intervention group ( n  = 40) or the control group ( n  = 40). We used the Patient and Observer Scar Assessment Scale and the Burn Specific Health Scale-Brief to assess outcomes. The hospital-to-home care transition program was delivered to the intervention group through three face-to-face educational sessions during discharge from the emergency department and clinic visits, along with two telephone counseling and follow-up sessions in the second and third weeks post-discharge. Data collection occurred at three time points: baseline, the third week after emergency department discharge, and the 12th week post-discharge. We analyzed the data using SPSS v.22 with a significance level set at 0.05. The findings showed that time and group each contributed to reducing scars by 5.71 and 8.81 units, respectively, with an interactive effect of 5.22 units ( P  < 0.001). Similarly, time and group individually improved health-related quality of life by 21.68 and 26.74 units, respectively, with an interactive improvement of 24.71 units ( P  < 0.001). The results indicate that the hospital-to-home care transition program helped prevent excessive scar complications and promoted a more favorable scar maturation process, thereby enhancing health-related quality of life in patients with deep partial-thickness burns. Nurses and healthcare planners can apply these findings to improve outcomes for this patient group.

Burn scars present psychological and social challenges for patients, classified into atrophic and hypertrophic types. Treatments like corticosteroid injections, laser therapy, and platelet-rich plasma (PRP) injections are commonly recommended for hypertrophic scars, while regenerative medicine and fractional CO2 lasers are linked to some degree of improvement for atrophic scars. Hypopigmented and depigmented burn scars pose ongoing challenges for healthcare providers and patients, with therapies such as intense pulsed light and fractional CO2 laser showing variable effects in treating these conditions. This study evaluates the effectiveness of latanoprost, a prostaglandin analog, in combination with fractional CO2 laser for repigmentation of hypopigmented burn scar lesions. During the study, patients were treated with 0.005% latanoprost eye drop or normal saline twice a day for 6 months and underwent six monthly fractional CO2 laser sessions. Treatment instructions were provided by the physician, and patients were instructed to report any complications and avoid using other medications in the treatment area. Assessments included photography at the start of the study and in three follow-up sessions at three-month intervals. Improvement was assessed using the Subject Global Aesthetic Improvement Scale (SGAIS) by both the physician and patients. Patient satisfaction was evaluated using a Grade scale, and side effects were monitored in all follow-up sessions. In the third follow-up session, physicians assessing the Subject Global Aesthetic Improvement Scale (SGAIS) observed that a higher proportion (85.7%) of cases in the fractional CO2 laser with latanoprost group achieved a grade of 4 (50–74% improvement). In the placebo group, 0% of patients achieved grade 4, and 71.4% were classified as grade 2 (0–24% improvement), indicating a significant difference (P-value: 0.0001). Patient satisfaction, measured by the \"Grade scale to evaluate patient satisfaction\" index, revealed a notable contrast between the two groups, with average satisfaction scores of 8.50 ± 0.65 and 4.64 ± 1.00 for the fractional CO2 laser with latanoprost and placebo groups, respectively, indicating a statistically significant difference (P = 0.0001). Furthermore, throughout the study, no severe side effects were reported by any of the patients. Prostaglandin analogs, particularly latanoprost, have proven to be effective in promoting repigmentation of hypopigmented and depigmented burn scar lesions. When this topical medication is combined with fractional CO2 laser treatment, it enhances the laser's efficacy and overall effectiveness in treating the lesions. This combination is crucial for improving hypopigmented scar treatment by enhancing both the laser's effectiveness in scar improvement and the delivery of latanoprost through the laser. What is already known about this topic? Hypopigmented burn scars are one of the manifestations of burns that are resistant to treatment. These scars not only cause discomfort for patients but also present a treatment challenge for physicians. In previous studies, latanoprost and bimatoprost, analogs of prostaglandin PGF2a, showed effectiveness in repigmenting vitiligo lesions. However, no study has examined the role of these topical drugs in treating hypopigmented and depigmented burn scars. What does this study add? The fractional CO2 laser caused significant repigmentation in hypopigmented lesions of burn scars. 64.3% of the patients who received this intervention showed grade 2 improvement (0-24% improvement), 7.1% showed grade 3 improvement (25-49% improvement), and 28.6% showed no improvement (grade 1) in the third follow-up session based on the SGAIS criteria as evaluated by the patients. The combination of CO2 fractional laser and latanoprost caused significant repigmentation in hypopigmented burn scar lesions. 85.7% of patients showed grade 4 improvement (50-74% improvement), and 14.3% showed grade 3 improvement (25-49% improvement) and 0% showed no improvement (grade 1) in the third follow-up session based on the SGAIS criteria as evaluated by the patients. The combination of CO2 fractional laser and latanoprost was significantly more effective than CO2 fractional laser alone based on the SGAIS criteria, as evaluated by physicians and patients in all three follow-up sessions. Additionally, the satisfaction of the patients in the combined treatment group was significantly higher than that of the CO2 fractional laser treatment group.

Background Burn injuries in children often impair joint mobility and motor function, with concomitant pain often compromising rehabilitation compliance. Active video games (AVGs) may offer a motivating, fear-reducing alternative, yet their effects on burn-related outcomes remain understudied. This study aimed to evaluate AVGs’ impact on pain intensity, range of motion (ROM), and motor function in pediatric burn patients. Methods This two-phase study was conducted in 2024 at Imam Reza Hospital, Mashhad, Iran. First, an active video game was developed; then, a single-blind randomized controlled trial was conducted with 69 children aged 5–15 years with second-degree upper limb burns. Participants were block-randomized (1:1) using Stata 17. The intervention group received Kinect Xbox-based game therapy; the control group used traditional physiotherapy. Each session included a 15-minute warm-up followed by gameplay/ physiotherapy, held 10 times per week for two weeks. Pain, range of motion (ROM), and motor function were assessed using the Wong-Baker FACES ® scale, goniometry, and the Activities Scale for Kids (ASK), respectively. Data were analyzed using chi-square, t-test, Mann-Whitney U, repeated measures ANOVA, and Friedman tests in SPSS 28 ( p  < 0.05). Results The mean age was 7.94 ± 2.22 years in the intervention group and 8.29 ± 2.29 years in the control group ( p  = 0.890). The findings showed a significant reduction in pain intensity after the intervention in both groups compared to pre-intervention levels ( p  < 0.001, 95% CI: 0.87–1.30). Moreover, the increase in wrist joint range of motion after the intervention was significantly different between the two groups ( p  < 0.001, 95% CI: 2.61–10.62). However, no significant difference was observed between the groups regarding shoulder and elbow joint range of motion ( p  = 0.490, 95% CI: -39.91–26.86; p  = 0.060, 95% CI: -1.70–19.14, respectively). Additionally, no significant difference was found in motor function between the two groups after the intervention ( p  = 0.058, 95% CI: -0.16–9.68). Conclusion Our results demonstrated that active video game intervention significantly reduced pain intensity and improved wrist range of motion in children with burns. These findings suggest that active video games could serve as a complementary approach for wrist rehabilitation in pediatric burn patients. Future studies should validate these effects on other joints (shoulder/elbow) and functional outcomes. Trial registration This RCT was registered in the Iran Registry of Clinical Trials (IRCT20230723058891N1, https//irct.behdasht.gov.ir/trial/72575) on 11/04/2023.