The National Incidence and Resource Utilization of Burn Injuries Sustained While Smoking on Home Oxygen Therapy.

Considerable risk of burn injury exists for those patients on home oxygen therapy (HOT) who continue to smoke. In this study, the authors sought to establish the national incidence of burns incurred while smoking on HOT and to determine the resource utilization and sequelae of these injuries. A retrospective review of the American Burn Association's National Burn Repository was conducted to identify patients burned while on HOT during the years 2002 to 2011. Duplicate entries, as well as records of follow-up visits and readmissions, were removed. Univariate analysis was used to compare the differences between patients sustaining burn injuries related to HOT and patients with other mechanisms of injury. Multivariate analysis provided odds ratios for mortality controlling for all significant variables. The frequency of burns sustained on HOT significantly increased during the 10-year period reviewed and were associated with increased comorbidities and certain complications. Compared with non-HOT injuries, HOT injuries had higher incidence of inhalation injury and mortality. Inhalation injury was the strongest predictor of mortality in HOT burn injuries. The likelihood of poor prognosis was even more pronounced in patients who required intubation. Smoking was responsible for 83% of the HOT burn injuries described here. Therefore, smoking cessation counseling and treatment should be mandatory in all patients prescribed HOT.

Regional and national review of factors associated with burn wound cellulitis.

Burn wound cellulitis (BWC) is the second leading complication reported in burns. In this study we sought to identify demographic variables, burn factors, and other factors that may predispose patients to BWC. Regional data was obtained through retrospective medical record review of burn patients treated between May 2009 to April 2013 for BWC within 8 days of the injury. The patients were matched 1:2 with contemporaneously treated patients. Similarly, the National Burn Repository was queried to identify burn patients with BWC between the years 2002 to 2011, which were then compared to the remaining entries who did not have BWC reported. The data sets were analyzed separately. Univariate and multiple variable analyses were performed to evaluate risk factors for BWC. The risk factors that were consistent regionally and nationally were older age, male sex, African-American race (protective), lower extremity burns, scald burns, and full thickness burns. The treatment delay was only collected regionally, and was associated with an eight times increased risk. The factors that were inconsistent or significant in one sample only were smoking status, psychiatric conditions, upper extremity burns, and the place of injury. Cellulitis remains a significant problem for the burn community. Future prospective analyses need to clarify the impact of these factors as well as other factors on the development of BWC. Preventing BWC from occurring through earlier intervention or targeted prophylactic antibiotics may help reduce morbidity and decrease associated healthcare costs.

Deterioration of blood pressure control after discontinuation of a physician-pharmacist collaborative intervention.

STUDY OBJECTIVE: To assess blood pressure control after discontinuation of a physician-pharmacist collaborative intervention. DESIGN: Comparative analysis of data of the patients who received the intervention versus a control group from a prospective, cluster-randomized, 9-month efficacy trial and the same patients' data 18 and 27 months after completion of the trial, abstracted from their medical records. SETTING: Five primary care medical offices operated by a university health system. PATIENTS: One hundred four patients with hypertension; 65 were in the intervention group, and 39 were in the control group. MEASUREMENTS AND MAIN RESULTS: In the prospective study, patients were randomized to receive a physician-pharmacist collaborative intervention to improve blood pressure control or to the control group. Systolic and diastolic blood pressures were measured by a research nurse at baseline and at the end of the study (9 mo later). In the current study, data were abstracted for blood pressure and blood pressure control at 18 and 27 months (9 and 18 mo, respectively, after discontinuation of the study). At baseline, mean +/- SD systolic blood pressure was 152.5 +/- 9.5 and 150.1 +/- 9.6 mm Hg in the intervention and control groups, respectively (p=0.22). At 9 months, systolic blood pressure decreased to 124.5 +/- 10.7 and 132.0 +/- 15.1 mm Hg (p=0.0038 between groups), and blood pressure was controlled in 78.5% and 48.7% (p=0.0017) of patients in the intervention and control groups, respectively. By 18 months, systolic blood pressure had deteriorated to 131.0 +/- 12.2 and 143.3 +/- 17.5 mm Hg (p<0.001), and blood pressure control rates decreased to 53.9% and 30.8% (p=0.02). By 27 months, systolic blood pressure was 131.3 +/- 13.0 and 141.2 +/- 15.8 mm Hg (p=0.0008), and blood pressure control was 55.4% and 35.9% (p=0.05). CONCLUSION: A sustained positive effect on blood pressure control was noted up to 18 months after discontinuation of a physician-pharmacist collaborative intervention, when compared with a control group. Blood pressure control did deteriorate at a similar rate in both the intervention and control groups, but the percentage of patients with controlled blood pressure remained significantly higher in the intervention group. These results suggest that continued interventions by pharmacists may be necessary to maintain high rates of blood pressure control, especially in those patients whose blood pressure begins to increase.