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Innovation in clinical specialities 54 Burn management M Davey, B Ayeni, Y Ying and MJ Duncan 68 Cardiovascular risk factor trends and options for reducing future coronary heart disease mortality in the United States of America Simon Capewell, Earl S Ford, Janet B Croft, Julia A Critchley, Kurt J Greenlund and Darwin R Labarthe 76 The breast service psychosocial model of care project Lauren K Williams PhD and G Bruce Mann 81 Supporting cancer control for indigenous Australians: initiatives and challenges for Cancer Councils Shaouli Shahid, Kerri R Beckmann and Sandra C Thompson 88 Company profile: Technology of the 21st Century Pioneers in Diagnostic Imaging: Reliability and advanced technology add value and increase safe diagnosis Shimadzu Europa GmbH 90 Breast Cancer – a review for African surgeons Adisa Adeyinka Charles MD and Alexandra M Easson 109 Responding to challenges in physical therapy Catherine Sykes, Brenda Myers, Marilyn Moffat and Tracy Bury 112 Population based surgery in low and middle income countries David A Spiegel, Richard Gosselin, Adam Kushnerand Stephen Bickler 118 Company profile: Wipak Medical – Steriking ® Specialized Packaging for Hospital Sterilization WIPAK Medical Hospital and Healthcare Innovation Book 2009/2010 53
Innovation and clinical specialities: burns Burn management ARTICLE BY M DAVEY AND B AYENI (PICTURED) McMaster University, Hamilton, Ontario, Canada Y YING AND MJ DUNCAN Department of Plastic Surgery, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada Pepita, 6 years old, was thrown into a fire by another child two years earlier and sustained an 8% burn of her lower back. The burn was initially thought to be superficial, but, months later, the wound is still open and has never been grafted. Pepita cannot stand upright because she has flexion contractures of both hips and one knee. Instead, she has to crawl. Her groin was not burned, and the burn on her knee was only a minor one. Her contractures are the result of failing to ensure that she used her unburnt and minimally burnt limbs during the acute stage of her injury. She has now been abandoned by her family 1 . The devastating effects of burns are long lasting at both an individual and societal level. These impacts are compounded in resource-poor settings, where the human and material resources necessary to deal with this complex public health problem are lacking. Developing nations are disproportionately affected – 95% of the 322,000 global firerelated deaths in 2002 occurred in low to middle-resource countries. 2 A structured and comprehensive approach to burn care must be applied to resource-poor settings in order to improve outcomes. A combination of improved management and prevention strategies has resulted in important declines in morbidity and mortality in the developed world. A recent US study demonstrated a 50% decline in burn-related mortality and hospital admissions over a 20 year period. 3 Patients are frequently surviving even the most devastating burns due to advances in infection control, antimicrobial and biologic wound coverings, as well as a better understanding of resuscitation and the systemic effects of burn physiology and associated lung injury in burn patients. However, a stark contrast is seen when comparing the burn related mortality rates in high and low-income countries. For example, the WHO Global Burden of disease database has reported an over 10 fold difference between mortality rates in South East Asia and Europe (11.6 vs 0.7 per 100 000 population respectively). 2 Unfortunately, without adequate resources in first-aid, acute surgical management and rehabilitation facilities, patients that do survive their burn injuries in developing countries often have poor, disfiguring and disabling long term outcomes. A Ghanaian study found that 18 % of childhood burns patients had suffered a physical impairment or disability. 4 As surgeons working in or supporting those who work in resource-poor countries, it is imperative that we understand the region-specific risk factors associated with burns, support preventative measures and provide rapid and appropriate resuscitation, surgical treatment and rehabilitation. Etiology and epidemiology In order to understand and overcome the challenges in the management and prevention of burns in low-income countries, a close look at the epidemiology and causal factors involved is required. It is also necessary to understand the local economic constraints and the available healthcare infrastructure. There exist numerous hospital or clinic-based studies describing epidemiological characteristics of their burn population. Forjuoh has published a review of 117 articles from 34 low and middleincome countries. 5 The majority of these studies dealt with the pediatric population, with the highest incidence of burns occurring in infants and toddlers (ages 0-4 years) who are dependant on others for their care. In a study from Angola which looked at all age groups, the pediatric population accounted for as much as one third of all burn victims. 6 A comprehensive population-based study in Ghana identified and calculated the strength of specific risk factors found in childhood burns; the presence of a pre-existing impairment such as epilepsy was associated with 6.7 greater odds of a burn, a finding supported by many other studies. 7 Other risk factors identified in case-control studies include history of a burn or burn-death in a sibling, low income, illiteracy, poor living conditions (overcrowding, lack of water supply) and careless 7, 8, 9, 10 practices (cooking equipment within reach of children). All these reflect the importance of identifying and developing prevention strategies that reach marginalized populations. In many countries in Africa and Asia, young women are also at particular risk. A reversal of gender distribution is seen compared to most other injury mechanisms. Women in East Asia account for 26% of the burn deaths worldwide, the highest burn mortality rates of any population (16.9 per 100 000 population per year) 5, 11 . This risk is attributed to the domestic role of women cooking in the home, using unsafe ground-level stoves oil-lanterns or open-fires and frequently wearing highly flammable (yet inexpensive) synthetic, loose clothing 12 . Some authors have found that violence against women is a frequent underlying causal factor in fatal burns, 54 Hospital and Healthcare Innovation Book 2009/2010
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International Hospital Federation I
Page 4 and 5: Introduction Sterile Barrier System
Page 6 and 7: Contents Healthcare transformation
Page 8 and 9: International Hospital Federation H
Page 11 and 12: Introduction Introduction ERIC DE R
Page 13: Innovation and strategy 14 Creativi
Page 16 and 17: Innovation and strategy: creativity
Page 18 and 19: Innovation and strategy: risk manag
Page 26 and 27: Innovation and stategy: Acceleratin
Page 28 and 29: Innovation and stategy: Acceleratin
Page 30 and 31: Innovation and policy: disease surv
Page 36 and 37: Innovation and clinical specialitie
Page 42 and 43: Innovation and strategy: infectious
Page 48 and 49: Innovation and policy: infectious d
Page 70 and 71: Innovation in clinical specialities
Page 82 and 83: Innovations and clinical specialiti
Page 90 and 91: Company Profile: Shimadzu Europa Gm
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Innovation and clinical specialitie
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Company Profile: Wipak Medical Wipa
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Innovations in patient care: infect
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Innovation in patient care: patient
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Innovation in patient care: patient
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IHF reference The International Hos
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C M Y CM MY CY CMY K with support f
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IHF reference IHF Governing Council
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IHF reference IHF Consultants Audit
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IHF reference JAPAN JAPAN HOSPITAL
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IHF reference KENYA THE NAIROBI HOS
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IHF Corporate Member Profiles GE He
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How Can Health Organizations Get th
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