Care of the Burn Patient - PHAR:8251 IP: Dermatology

Lectures: Community and Inpatient Focused

• Community Treatment of Burns

         Slides        Cases
  

• Inpatient Management of Burns

         Slides        Cases
  

Practice Guidelines - Interantional Society of Burn Injury (ISBI)

2016 Guideline

• ISBI Practice Guidelines Committee. ISBI Practice Guidelines for Burn Care. Burns. 2016 Aug;42(5):953-1021.
• This guideline addresses the management of hospitalized burn patients.

2018 Guideline

• ISBI Practice Guidelines Committee. ISBI Practice Guidelines for Burn Care, Part 2. Burns. 2018 Nov;44(7):1617-1706.
• This guideline provides additional information about special types of burns, more information on infections, sedation and pain management as well as providing information for first aid and topical treatments.

Learning Resources

Treatment of Minor Burns and Sunburns

• Chapter 41, Minor Burns, Sunburns and Wounds in the Handbook of Nonprescription Drugs, 19th edition.
• Good review of non-prescription treatments of minor burns and sunburns.

ABA Burn Center Referral Criteria

• Criteria identifying when patients can be treated locally or should be referred to an ABA certified treatment center.

Additional Resources

American Burn Association Resources

• ABA First-aid Fact Sheet
• Reviews the Do's and Don't's for initial treatment of minor burns.
• ABA Disaster-response & Treatment Posters
• PowerPoint examples of burn prevention and treatment posters.

Professional Discovery 1: Introduction Á Background (PHAR:8151)

Objective:

Professional Discovery I students will develop skills in the scientific method, hypothesis testing, presentation of scientific knowledge in written and verbal form, and analysis of clinical study design.

Course Glossary

Definitions of Study Types

• Meta-analysis: A statistical technique that summarizes the results of several studies in a single weighted estimate, in which more weight is given to results of studies with more events and sometimes to studies of higher quality.
• Systematic Review: a review in which specified and appropriate methods have been used to identify, appraise, and summarize studies addressing a defined question. (It can, but need not, involve meta-analysis). In Clinical Evidence, the term systematic review refers to a systematic review of RCTs unless specified otherwise.
• Randomized Controlled Trial: a trial in which participants are randomly assigned to two or more groups: at least one (the experimental group) receiving an intervention that is being tested and another (the comparison or control group) receiving an alternative treatment or placebo. This design allows assessment of the relative effects of interventions.
• Controlled Clinical Trial: a trial in which participants are assigned to two or more different treatment groups. In Clinical Evidence, we use the term to refer to controlled trials in which treatment is assigned by a method other than random allocation. When the method of allocation is by random selection, the study is referred to as a randomized controlled trial (RCT). Non-randomized controlled trials are more likely to suffer from bias than RCTs. Sometimes referred to as open-labeled controlled trials.
• Cohort Study: a non-experimental study design that follows a group of people (a cohort), and then looks at how events differ among people within the group. A study that examines a cohort, which differs in respect to exposure to some suspected risk factor (e.g. smoking), is useful for trying to ascertain whether exposure is likely to cause specified events (e.g. lung cancer). Prospective cohort studies (which track participants forward in time) are more reliable than retrospective cohort studies. Sometimes referred to as follow-up studies.
• Case control study: a study design that examines a group of people who have experienced an event (usually an adverse event) and a group of people who have not experienced the same event, and looks at how exposure to suspect (usually noxious) agents differed between the two groups. This type of study design is most useful for trying to ascertain the cause of rare events, such as rare cancers.
• Case Series: analysis of series of people with the disease (there is no comparison group in case series).

Every Research Study Answers a Clinical Question

• Clinical questions may be categorized as either background or foreground. Why is this important?
• Determining the type of question will help you to select the best study type to achive your answer
• Background questions ask for general knowledge about an illness, disease, condition, process or thing. These types of questions typically ask who, what, where, when, how & why about things like a disorder, test, or treatment, etc. For example:
•      - How overweight is a woman to be considered slightly obese?
•      - What are the clinical manifestations of menopause?
•      - What causes migraines?
• Foreground questions ask for specific knowledge to inform clinical decisions. These questions typically concern a specific patient or particular population. Foreground questions tend to be more specific and complex compared to background questions. Quite often, foreground questions investigate comparisons, such as two drugs, two treatments, two diagnostic tests, etc. Foreground questions may be further categorized into one of 4 major types: treatment/therapy, diagnosis, prognosis, or etiology/harm. For example:
•      - Is Crixivan effective when compared with placebo in slowing the rate of functional impairment in a 45 year old male patient with Lou Gehrig's Disease?
•      - In pediatric patients with Allergic Rhinitis, are Intranasal steroids more effective than antihistamines in the management of Allergic Rhinitis symptoms?
• Foreground questions can be further divided into questions that relate to therapy, diagnosis, prognosis, etiology/harm
•      Therapy: Questions of treatment in order to achieve some outcome. May include drugs, surgical intervention, change in diet, counseling, etc.
•      Diagnosis: Questions of identification of a disorder in a patient presenting with specific symptoms.
•      Prognosis: Questions of progression of a disease or likelihood of a disease occurring.
•      Etiology/Harm: Questions of negative impact from an intervention or other exposure.
• Knowing the type of foreground question can help you select the best study design to answer your question. You always want to look for the study design that will yield the highest level of evidence. Consult the pyramid and the definitions below.

Formulating a Well-Built Clinical Question

According to the Centre for Evidence Based Medicine (CEBM), "one of the fundamental skills required for practicing EBM is the asking of well-built clinical questions. To benefit patients and clinicians, such questions need to be both directly relevant to patients' problems and phrased in ways that direct your research to relevant and precise answers."

A well-built clinical foreground question should have all four components. The PICO model is a helpful tool that assists you in organizing and focusing your foreground question into a searchable terms for a drug information query or dveloping a researchable topic. Here is the PICO model:

• P = Patient, Problem, Population (How would you describe the group of patients? What are the most important characteristics of these patient?)
• I = Intervention, Prognostic Factor, Exposure (What main intervention are you considering? What do you want to do with this patient?)
• C = Comparison (How are you hoping to make the comparison with the intervention and another treatment, drug, placebo, a different diagnostic test, etc.? It's important to include the methodology (study design) for the comparison.)
• O = Outcome (What are you trying to accomplish, measure, improve or affect? Outcomes may be disease-oriented or patient-oriented.)

Evidence based medicine (EBM) has developed a levels of evidence pyramid to facilitate the understanding of the types of clinical questions and how they relate to study designs. The PICO model is a helpful tool that assists you in organizing and focusing your foreground question into a searchable terms for a drug information query or dveloping a researchable topic. Here is the PICO model:

The diagram below illustrates how some of the study types mentioned above can be prospective and some retrospective and how they relate to the pyramid of evidence.