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Abdelrahman, Islam
Publications (10 of 11) Show all publications
Abdelrahman, I., Steinvall, I., Fredrikson, M., Sjöberg, F. & Elmasry, M. (2019). Use of the burn intervention score to calculate the charges of the care of burns. Burns, 45(2), 303-309
Open this publication in new window or tab >>Use of the burn intervention score to calculate the charges of the care of burns
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2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 2, p. 303-309Article in journal (Refereed) Published
Abstract [en]

Background To our knowledge this is the first published estimate of the charges of the care of burns in Sweden. The Linköping Burn Interventional Score has been used to calculate the charges for each burned patient since 1993. The treatment of burns is versatile, and depends on the depth and extension of the burn. This requires a flexible system to detect the actual differences in the care provided. We aimed to describe the model of burn care that we used to calculate the charges incurred during the acute phase until discharge, so it could be reproduced and applied in other burn centres, which would facilitate a future objective comparison of the expenses in burn care. Methods All patients admitted with burns during the period 2010–15 were included. We analysed clinical and economic data from the daily burn scores during the acute phase of the burn until discharge from the burn centre. Results Total median charge/patient was US$ 28 199 (10th–90th centiles 4668-197 781) for 696 patients admitted. Burns caused by hot objects and electricity resulted in the highest charges/TBSA%, while charges/day were similar for the different causes of injury. Flame burns resulted in the highest mean charges/admission, probably because they had the longest duration of stay. Mean charges/patient increased in a linear fashion among the different age groups. Conclusion Our intervention-based estimate of charges has proved to be a valid tool that is sensitive to the procedures that drive the costs of the care of burns such as large TBSA%, intensive care, and operations. The burn score system could be reproduced easily in other burn centres worldwide and facilitate the comparison regardless of the differences in the currency and the economic circumstances.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Burns;Charges;Intervention score;Costs;Payments
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-153636 (URN)10.1016/j.burns.2018.12.007 (DOI)000461044900004 ()
Note

Funding agencies: Department of Hand Surgery, Plastic Surgery, and Burns; Linkoping University, Linkoping, Sweden

Available from: 2019-01-06 Created: 2019-01-06 Last updated: 2019-04-01
Pompermaier, L., Elmasry, M., Abdelrahman, I., Fredrikson, M., Sjöberg, F. & Steinvall, I. (2018). Are there any differences in the provided burn care between men and women? A retrospective study. Burns & Trauma, 6, Article ID 22.
Open this publication in new window or tab >>Are there any differences in the provided burn care between men and women? A retrospective study
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2018 (English)In: Burns & Trauma, E-ISSN 2321-3876, Vol. 6, article id 22Article in journal (Refereed) Published
Abstract [en]

Background

Disparity between medical treatment for men and women has been recorded worldwide. However, it is difficult to find out if the disparities in both the use of resources and outcome depend entirely on sex-related discrimination. Our aim was to investigate if there are differences in burn treatments between the sexes.

Methods

All patients admitted with burns to Linköping University Hospital during the 16-year period 2000–2015 were included. Interventions were prospectively recorded using the validated Burn SCoring system (BSC). Data were analysed using a multivariable panel regression model adjusted for age, percentage total body surface area (%TBSA), and in-hospital mortality.

Results

A total of 1363 patients were included, who generated a total of 22,301 daily recordings while they were inpatients. Males were 70% (930/1363). Sex was not an independent factor for daily scores after adjustment for age, %TBSA, and mortality in hospital (model R2=0.60, p < 0.001).

Conclusion

We found no evidence of inequity between the sexes in treatments given in our burn centre when we had adjusted for size of burn, age, and mortality. BSC seems to be an appropriate model in which to evaluate sex-related differences in the delivery of treatments.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Burn care; Intervention score; Sex; Trauma model; Workload
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-150365 (URN)10.1186/s41038-018-0125-0 (DOI)000442159400001 ()30123802 (PubMedID)
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2019-04-18Bibliographically approved
Abdelrahman, I., Steinvall, I., Mossaad, B., Sjöberg, F. & Elmasry, M. (2018). Evaluation of Glandular Liposculpture as a Single Treatment for Grades I and II Gynaecomastia. Aesthetic Plastic Surgery, 42(2), 1222-1230
Open this publication in new window or tab >>Evaluation of Glandular Liposculpture as a Single Treatment for Grades I and II Gynaecomastia
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2018 (English)In: Aesthetic Plastic Surgery, ISSN 0364-216X, E-ISSN 1432-5241, Vol. 42, no 2, p. 1222-1230Article in journal (Refereed) Published
Abstract [en]

Background

Gynaecomastia is a benign enlargement of the male breast, of which the psychological burden on the patient can be considerable, with the increased risk of disorders such as depression, anxiety, and social phobia. Minimal scarring can be achieved by liposuction alone, though it is known to have a limited effect on the dense glandular and fibroconnective tissues. We know of few studies published on “liposuction alone”, so we designed this study to evaluate the outcome of combining liposuction with glandular liposculpturing through two axillary incisions as a single treatment for the management of grades I and II gynaecomastia.

Methods

We made a retrospective analysis of 18 patients with grade I or II gynaecomastia who were operated on by combined liposuction and glandular liposculpturing using a fat disruptor cannula, without glandular excision, during the period 2014–2016. Patient satisfaction was assessed using the Breast Evaluation Questionnaire (BEQ), which is a 5-point Likert scale (1 = very dissatisfied; 2 = dissatisfied; 3 = neither; 4 = satisfied; 5 = very satisfied). The post-operative aesthetic appearance of the chest was evaluated by five independent observers on a scale from 1 to 5 (5 = considerable improvement).

Results

The patient mean (SD) overall satisfaction score was 4.7 (0.7), in which 92% of the responders were “satisfied” to “very satisfied”. The mean (SD) BEQ for all questions answered increased from 2.1 (0.2) “dissatisfied” preoperatively to 4.1 (0.2) “satisfied” post-operatively. The observers’ mean (SD) rate for the improvement in the shape of the front chest wall was 4.1 (0.7). No haematomas were recorded, one patient developed a wound infection, and two patients complained of remnants of tissue. The median (IQR) body mass index was 27.4 (26.7–29.4), 11 patients had gynaecomastia grade I, and 7 patients grade II. The median (IQR) volume of aspirated fat was 700 ml (650–800), operating time was 67 (65–75) minutes, 14 patients had general anaesthesia, and hospital charges were US$ 538 (481–594).

Conclusions

Combined liposuction and liposculpturing using the fat disruptor cannula resulted in satisfied patients and acceptable outcomes according to the observers’ ratings. It could be a useful alternative with an outcome that corresponds to that of more expensive methods.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Gynaecomastia, Liposculpture, Liposuction, Patient satisfaction
National Category
Surgery Gastroenterology and Hepatology Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-146046 (URN)10.1007/s00266-018-1118-x (DOI)000445156900007 ()29549405 (PubMedID)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2019-04-18Bibliographically approved
Aboelnaga, A., Elmasry, M., Adly, O. A., Elbadawy, M. A., Abbas, A. H., Abdelrahman, I., . . . Steinvall, I. (2018). Microbial cellulose dressing compared with silver sulphadiazine for the treatment of partial thickness burns: A prospective, randomised, clinical trial. Burns, 44(8), 1982-1988
Open this publication in new window or tab >>Microbial cellulose dressing compared with silver sulphadiazine for the treatment of partial thickness burns: A prospective, randomised, clinical trial
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2018 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 44, no 8, p. 1982-1988Article in journal (Refereed) Published
Abstract [en]

Background

The current treatment for partial thickness burns at the trial site is silver sulphadiazine, as it minimises bacterial colonisation of wounds. Its deleterious effect on wound healing, together with the need for repeated, often painful, procedures, has brought about the search for a better treatment. Microbial cellulose has shown promising results that avoid these disadvantages. The aim of this study was therefore to compare microbial cellulose with silver sulphadiazine as a dressing for partial thickness burns.

Method

All patients who presented with partial thickness (superficial and deep dermal) burns from October 2014 to October 2016 were screened for this randomised clinical trial. Twenty patients were included in each group: the cellulose group was treated with microbial cellulose sheets and the control group with silver sulphadiazine cream 10 mg/g. The wound was evaluated every third day. Pain was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale during and after each procedure. Other variables recorded were age, sex, percentage total body surface area burned (TBSA%), clinical signs of infection, time for epithelialisation and hospital stay. Linear multivariable regression was used to analyse the significance of differences between the treatment groups by adjusting for the size and depth of the burn, and the patient’s age.

Results

Median TBSA% was 9% (IQR 5.5–12.5). The median number of dressing changes was 1 (IQR 1–2) in the cellulose group, which was lower than that in the control group (median 9.5, IQR 6–16) (p < 0.001). Multivariable regression analysis showed that the group treated with microbial cellulose spent 6.3 (95% CI 0.2–12.5) fewer days in hospital (p = 0.04), had a mean score that was 3.4 (95% CI 2.5–4.3) points lower during wound care (p < 0.001), and 2.2 (95% CI 1.6–2.7) afterwards (p < 0.001). Epithelialisation was quicker, but not significantly so.

Conclusion

These results suggest that the microbial cellulose dressing is a better first choice for treatment of partial thickness burns than silver sulphadiazine cream. Fewer dressings of the wound were done and, combined with the low pain scores, this is good for both the patients and the health care system. The differences in randomisation of the area of burns is, however, a concern that needs to be included in the interpretation of the results.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-150103 (URN)10.1016/j.burns.2018.06.007 (DOI)000451331200015 ()30005989 (PubMedID)
Note

Funding agencies: Suez Canal University, Ismailia, Egypt

Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-12-13
Abdelrahman, I., Elmasry, M., Fredrikson, M. & Steinvall, I. (2018). Validation of the burn intervention score in a National Burn Centre. Burns (5), 1159-1166
Open this publication in new window or tab >>Validation of the burn intervention score in a National Burn Centre
2018 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, no 5, p. 1159-1166Article in journal (Refereed) Published
Abstract [en]

The Linköping burn score has been used for two decades to calculate the cost to the hospital of each burned patient. Our aim was to validate the Burn Score in a dedicated Burn Centre by analysing the associations with burn-specific factors: percentage of total body surface area burned (TBSA%), cause of injury, patients referred from other (non-specialist) centres, and survival, to find out which of these factors resulted in higher scores. Our second aim was to analyse the variation in scores of each category of care (surveillance, respiration, circulation, wound care, mobilisation, laboratory tests, infusions, and operation).

We made a retrospective analysis of all burned patients admitted during the period 2000–15. Multivariable regression models were used to analyse predictive factors for an increased daily burn score, the cumulative burn score (the sum of the daily burn scores for each patient) and the total burn score (total sum of burn scores for the whole group throughout the study period) in addition to sub-analysis of the different categories of care that make up the burn score.

We retrieved 22 301 daily recordings for inpatients. Mobilisation and care of the wound accounted for more than half of the total burn score during the study. Increased TBSA% and age over 45 years were associated with increased cumulative (model R2 0.43, p < 0.001) and daily (model R2 0.61, p < 0.001) burn scores. Patients who died had higher daily burn scores, while the cumulative burn score decreased with shorter duration of hospital stay (p < 0.001).

To our knowledge this is the first long term analysis and validation of a system for scoring burn interventions in patients with burns that explores its association with the factors important for outcome. Calculations of costs are based on the score, and it provides an indicator of the nurses’ workload. It also gives important information about the different dimensions of the care provided from thorough investigation of the scores for each category.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Burn intervention score; Validation; Workload
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-145311 (URN)10.1016/j.burns.2018.02.001 (DOI)000436791900014 ()29475745 (PubMedID)2-s2.0-85042192631 (Scopus ID)
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-07-23Bibliographically approved
Abdelrahman, I., Elmasry, M., Steinvall, I., Olofsson, P., Nettelblad, H. & Zdolsek, J. (2018). Versatility of the Extensor Digitorum Brevis Muscle Flap in Lower Limb Reconstruction. Plastic and Reconstructive Surgery – Global Open, 6(12), Article ID e2071.
Open this publication in new window or tab >>Versatility of the Extensor Digitorum Brevis Muscle Flap in Lower Limb Reconstruction
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2018 (English)In: Plastic and Reconstructive Surgery – Global Open, E-ISSN 2169-7574, Vol. 6, no 12, article id e2071Article in journal (Refereed) Published
Abstract [en]

Background: Reconstruction of complex defects in the lower leg is a challenge. Although microvascular free tissue transfer is a popular technique, experience and available resources limit its use. Furthermore, free tissue transfer is not always required in the reconstruction of small lower leg defects, as many of them can be reconstructed with local alternatives such as an extensor digitorum brevis flap (EDB). Our aim was to describe our experience of the last 20 years with the EDB as a local muscle flap to cover small complex lower leg defects to establish its clinical feasibility and to document its associated complications. Methods: All adult patients who were operated with EDB flap reconstruction of the lower limb during 1997–2017 at the Department of Hand and Plastic Surgery, Linköping University Hospital, were included in this retrospective study. Results: Of 64 patients operated, only 7 had total flap failure, and the rate of complete success was 73% (47/64). Most of the skin defects were associated with fractures or complications thereof and were located in the ankle region, the dorsum of the foot, and the distal third of tibia or even the proximal tibia. Defects in the malleolar region and coexisting cardiovascular condition were factors associated with flap loss (either partial or total). Conclusion: The pedicled EDB-flap has, in our hands, proved to be a versatile and safe reconstructive option in the reconstruction of small defects in the lower leg and foot. Long-time follow-up is, however, recommended. 

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-153635 (URN)10.1097/GOX.0000000000002071 (DOI)
Available from: 2019-01-06 Created: 2019-01-06 Last updated: 2019-04-12
Abdelrahman, I., Elmasry, M., Olofsson, P., Steinvall, I., Fredrikson, M. & Sjöberg, F. (2017). Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care.. PLoS ONE, 12(3), Article ID e0174579.
Open this publication in new window or tab >>Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care.
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 3, article id e0174579Article in journal (Refereed) Published
Abstract [en]

Patients and Methods: Surgically managed burn patients admitted between 2010-14 were included. Operative stay was defined as the time from admission until the last operation, postoperative stay as the time from the last operation until discharge. The difference in variation was analysed with F-test. A retrospective review of medical records was done to explore reasons for extended postoperative stay. Multivariable regression was used to assess factors associated with operative stay and postoperative stay.less thanbr /greater thanResults: Operative stay/TBSA% showed less variation than total duration/TBSA% (F test = 2.38, pless than0.01). The size of the burn, and the number of operations, were the independent factors that influenced operative stay (R2 0.65). Except for the size of the burn other factors were associated with duration of postoperative stay: wound related, psychological and other medical causes, advanced medical support, and accommodation arrangements before discharge, of which the two last were the most important with an increase of (mean) 12 and 17 days (pless than0.001, R2 0.51).less thanbr /greater thanConclusion: Adjusted operative stay showed less variation than total hospital stay and thus can be considered a more accurate outcome measure for surgically managed burns. The size of burn and number of operations are the factors affecting this outcome measure.

Place, publisher, year, edition, pages
Public Library of Science, 2017
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-136275 (URN)10.1371/journal.pone.0174579 (DOI)000399175000022 ()
Note

Funding agencies: Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns; Linkoping University, Linkoping, Sweden

Available from: 2017-04-05 Created: 2017-04-05 Last updated: 2017-11-29
Abdelrahman, I., Elmasry, M., Steinvall, I., Fredrikson, M. & Sjöberg, F. (2017). Improvement in mortality at a National Burn Centre since 2000: Was it the result of increased resources?. Medicine (Baltimore, Md.), 96(25), Article ID e6727.
Open this publication in new window or tab >>Improvement in mortality at a National Burn Centre since 2000: Was it the result of increased resources?
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2017 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 25, article id e6727Article in journal (Refereed) Published
Abstract [en]

Abstract The aim of this study was to find out whether the charging costs (calculated using interventional burn score) increased as mortality decreased. During the last 2 decades, mortality has declined significantly in the Linköping Burn Centre. The burn score that we use has been validated as a measure of workload and is used to calculate the charging costs of each burned patient. We compared the charging costs and mortality in 2 time periods (2000–2007 and 2008–2015). A total of 1363 admissions were included. We investigated the change in the burn score, as a surrogate for total costs per patient. Multivariable regression was used to analyze risk-adjusted mortality and burn score. The median total body surface area % (TBSA%) was 6.5% (10–90 centile 1.0–31.0), age 33 years (1.3–72.2), duration of stay/ TBSA% was 1.4 days (0.3–5.3), and 960 (70%) were males. Crude mortality declined from 7.5% in 2000–2007 to 3.4% in 2008–2015, whereas the cumulative burn score was not increased (P=.08). Regression analysis showed that risk-adjusted mortality decreased (odds ratio 0.42, P=.02), whereas the adjusted burn score did not change (P=.14, model R2 0.86). Mortality decreased but there was no increase in the daily use of resources as measured by the interventional burn score. The data suggest that the improvements in quality obtained have been achieved within present routines for care of patients (multidisciplinary/ orientated to patients’ safety).

Abbreviation: TBSA% = total body surface area %.

Place, publisher, year, edition, pages
Wolters Kluwer, 2017
Keywords
burn, cost, hospital billing charge, interventional score, mortality, resources, survival
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-138833 (URN)10.1097/md.0000000000006727 (DOI)000404116900001 ()28640072 (PubMedID)
Note

Funding agencies: Department of Plastic and Hand Surgery Linkoping University Hospital; Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden

Available from: 2017-06-26 Created: 2017-06-26 Last updated: 2018-05-02
Abdelrahman, I. M., Elmasry, M., Steinvall, I. & Sjöberg, F. (2017). Response to comments on: A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy [Letter to the editor]. Journal of Plastic, Reconstructive & Aesthetic Surgery, 70(9), 1307-1308
Open this publication in new window or tab >>Response to comments on: A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy
2017 (English)In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 70, no 9, p. 1307-1308Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2017
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-139724 (URN)10.1016/j.bjps.2017.06.014 (DOI)000410902100027 ()28688867 (PubMedID)2-s2.0-85021804889 (Scopus ID)
Available from: 2017-08-14 Created: 2017-08-14 Last updated: 2017-10-24Bibliographically approved
Elmasry, M., Steinvall, I., Thorfinn, J., Abdelrahman, I., Olofsson, P. & Sjöberg, F. (2017). Staged excisions of moderate-sized burns compared with total excision with immediate autograft: an evaluation of two strategies.. International journal of burns and trauma, 7(1), 6-11
Open this publication in new window or tab >>Staged excisions of moderate-sized burns compared with total excision with immediate autograft: an evaluation of two strategies.
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2017 (English)In: International journal of burns and trauma, ISSN 2160-2026, Vol. 7, no 1, p. 6-11Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Different surgical techniques have evolved since excision and autografting became the treatment of choice for deep burns in the 1970s. The treatment plan at the Burn Center, Linköping University Hospital, Sweden, has shifted from single-stage excision and immediate autografting to staged excisions and temporary cover with xenografts before autografting. The aim of this study was to find out if the change in policy resulted in extended duration of hospital stay/total body surface area burned (LOS/TBSA%).

METHODS: Retrospective clinical cohort including surgically-managed patients with burns of 15%-60% TBSA% within each treatment group. The first had early full excisions of deep dermal and full thickness burns and immediate autografts (1997-98), excision and immediate autograft group) and the second had staged excisions before final autografts using xenografts for temporary cover (2010-11, staged excision group).

RESULTS: The study included 57 patients with deep dermal and full-thickness burns, 28 of whom had excision and immediate autografting, and 29 of whom had staged excisions with xenografting before final autografting. Adjusted (LOS/TBSA%) was close to 1, and did not differ between groups. Mean operating time for the staged excision group was shorter and the excised area/operation was smaller. The total operating time/TBSA% did not differ between groups.

CONCLUSION: Staged excisions with temporary cover did not affect adjusted LOS/TBSA% or total operating time. Staged excisions may be thought to be more expensive because of the cost of covering the wound between stages, but this needs to be further investigated as do the factors that predict long term outcome.

Place, publisher, year, edition, pages
E-Century Publishing Corporation, 2017
Keywords
Burn surgery, moderate sized burns, xenografts
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-135745 (URN)28123862 (PubMedID)
Available from: 2017-03-20 Created: 2017-03-20 Last updated: 2018-05-03Bibliographically approved
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