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Sample records for burns patients systematic

  1. Use of procalcitonin for the detection of sepsis in the critically ill burn patient: a systematic review of the literature.

    Science.gov (United States)

    Mann, Elizabeth A; Wood, Geri L; Wade, Charles E

    2011-06-01

    The purpose of this systematic review was to assess the evidence for use of routine procalcitonin testing to diagnose the presence of sepsis in the burn patient. The electronic databases MEDLINE, Cochrane, CINAHL, ProQuest, and SCOPUS were searched for relevant studies using the MeSH terms burn, infection, procalcitonin, and meta-analysis. The focus of the review was the adult burn population, but other relevant studies of critically ill patients were included as data specific to the patient with burns are limited. Studies were compiled in tabular form and critically appraised for quality and level of evidence. Four meta-analyses, one review of the literature, one randomized controlled trial, nine prospective observational, and three retrospective studies were retrieved. Six of these studies were specific to the burn population, with one specific to burned children. Only one meta-analysis, one adult burn and one pediatric burn study reported no benefit of procalcitonin testing to improve diagnosis of sepsis or differentiate sepsis from non-infectious systemic inflammatory response. The collective findings of the included studies demonstrated benefit of incorporating procalcitonin assay into clinical sepsis determination. Evaluation of the burn specific studies is limited by the use of guidelines to define sepsis and inconsistent results from the burn studies. Utility of the procalcitonin assay is limited due to the lack of availability of rapid, inexpensive tests. However, it appears procalcitonin assay is a safe and beneficial addition to the clinical diagnosis of sepsis in the burn intensive care unit.

  2. Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-.

    Directory of Open Access Journals (Sweden)

    Ernest A Azzopardi

    Full Text Available BACKGROUND: Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. METHODS: Studies investigating adult hospitalised patients (2000-2010 were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. PRIMARY FINDINGS: Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20 = 1.1, p = 0.3797; r2 = 9.84. INTERPRETATION: Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.

  3. A systematic review on intra-abdominal pressure in severely burned patients

    NARCIS (Netherlands)

    K.D. Strang; E.M.M. van Lieshout (Esther); R.S. Breederveld (Roelf S.); O.J.F. van Waes (Oscar)

    2014-01-01

    textabstractObjective Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are complications that may occur in severely burned patients. Evidenced based medicine for these patients is in its early development. The aim of this study was to provide an overview of literature rega

  4. Pain in burn patients.

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    Latarjet, J; Choinère, M

    1995-08-01

    While severe pain is a constant component of the burn injury, inadequate pain management has been shown to be detrimental to burn patients. Pain-generating mechanisms in burns include nociception, primary and secondary hyperalgesia and neuropathy. The clinical studies of burn pain characteristics reveal very clear-cut differences between continuous pain and pain due to therapeutic procedures which have to be treated separately. Some of the main features of burn pain are: (1) its long-lasting course, often exceeding healing time, (2) the repetition of highly nociceptive procedures which can lead to severe psychological disturbances if pain control is inappropriate. Pharmaco-therapy with opioids is the mainstay for analgesia in burned patients, but non-pharmacological techniques may be useful adjuncts. Routine pain evaluation is mandatory for efficient and safe analgesia. Special attention must be given to pain in burned children which remains too often underestimated and undertreated. More educational efforts from physicians and nursing staff are necessary to improve pain management in burned patients.

  5. Hyaluronic acid covers in burn treatment: a systematic review

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    Michel Marcos Dalmedico

    2016-06-01

    Full Text Available Abstract OBJECTIVE To evaluate the effectiveness of hyaluronic acid in the healing of partial thickness burns. METHOD Systematic review of randomized controlled trials on the use of hyaluronic acid for the topical treatment of skin burns, based on recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Two randomized controlled trials that analyzed 143 patients with partial thickness burns and/or deep partial thickness burns were selected. They compared the application of hyaluronic acid 0.2% associated to silver sulfadiazine 1% 5g/cm2 versus silver sulfadiazine 1% 5g/cm2 alone for the outcome of complete healing. CONCLUSION This review emphasizes the need for new well-designed randomized controlled trials to establish the therapeutic relevance of hyaluronic acid with respect to the healing of burns of partial thickness or deep partial thickness.

  6. Treatment of secondary burn wound progression in contact burns-a systematic review of experimental approaches.

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    Schmauss, Daniel; Rezaeian, Farid; Finck, Tom; Machens, Hans-Guenther; Wettstein, Reto; Harder, Yves

    2015-01-01

    After a burn injury, superficial partial-thickness burn wounds may progress to deep partial-thickness or full-thickness burn wounds, if kept untreated. This phenomenon is called secondary burn wound progression or conversion. Burn wound depth is an important determinant of patient morbidity and mortality. Therefore, reduction or even the prevention of secondary burn wound progression is one goal of the acute care of burned patients. The objective of this study was to review preclinical approaches evaluating therapies to reduce burn wound progression. A systematic review of experimental approaches in animals that aim at reducing or preventing secondary burn wound progression was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. The selected references consist of all the peer-reviewed studies performed in vivo in animals and review articles published in English, German, Italian, Spanish, or French language relevant to the topic of secondary burn wound progression. We searched MEDLINE, Cochrane Library, and Google Scholar including all the articles published from the beginning of notations to the present. The search was conducted between May 3, 2012 and December 26, 2013. We included 29 experimental studies in this review, investigating agents that maintain or increase local perfusion conditions, as well as agents that exhibit an anti-coagulatory, an anti-inflammatory, or an anti-apoptotic property. Warm water, simvastatin, EPO, or cerium nitrate may represent particularly promising approaches for the translation into clinical use in the near future. This review demonstrates promising experimental approaches that might reduce secondary burn wound progression. Nevertheless, a translation into clinical application needs to confirm the results compiled in experimental animal studies.

  7. Burn Patient Expectations from Nurses

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    Sibel Yilmaz sahin

    2014-02-01

    Full Text Available AIM: Burn is a kind of painful trauma that requires a long period of treatment and also changes patients body image. For this reason, nursing care of burn patients is very important. In this study in order to provide qualified care to the burned patients, patient and #8217;s expectations from nurses were aimed to be established. METHODS: Patients and #8217; expectations were evaluated on 101 patients with burn in Ministry of Health Ankara Numune Education and Research Hospital Burn Service and Gulhane Military Medical Academy Education and Research Hospital Burn Center. A questionnaire which was developed by the researchers was used for collecting data. The questions on the questionnaire were classified into four groups to evaluate the patients and #8217; expectations about communication, information, care and discharge. Data was evaluated by using SPSS 12 package software. RESULTS: In this study, 48.5% of patients were at 18-28 age group, 79.2% were male and 51.5% of patients were employed. Almost all of patients expect nurses to give them confidence (98% and to give them information about latest developments with the disease. Patients prior expectation from nurses about care was to do their treatments regularly (100% and to take the necessary precautions in order to prevent infection (100%. 97% of patient expect nurses to give them information about the drugs, materials and equipment that they are going to use while discharge. CONCLUSION: As a result we found that burn patient expectations from nurses about communication, information, care and discharge were high. [TAF Prev Med Bull 2014; 13(1.000: 37-46

  8. Rehabilitation of the burn patient

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    Procter Fiona

    2010-10-01

    Full Text Available Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing of skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approach, incorporating the patient and when appropriate, their family. The term ′Burns Rehabilitation′ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimise the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, maximising psychological wellbeing, maximising social integration

  9. Corneal Protection for Burn Patients

    Science.gov (United States)

    2014-11-01

    Amniotic Membrane for the Treatment of Severe Exposure Keratopathy in the New Zealand White Rabbit Introduction: Patients with severe facial burns...often suffer indirect damage to their eyes as a sequela of ocular surface exposure keratopathy. Burn wound contracture of the periocular skin causes...inflammatory properties, amniotic membrane has developed into a mainstay of treatment to help maintain the ocular surface when skin grafting is delayed

  10. Burn epidemiology and cost of medication in paediatric burn patients.

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    Koç, Zeliha; Sağlam, Zeynep

    2012-09-01

    Burns are common injuries that cause problems to societies throughout the world. In order to reduce the cost of burn treatment in children, it is extremely important to determine the burn epidemiology and the cost of medicines used in burn treatment. The present study used a retrospective design, with data collected from medical records of 140 paediatric patients admitted to a burn centre between 1 January 2009 and 31 December 2009. Medical records were examined to determine burn epidemiology, medication administered, dosage, and duration of use. Descriptive statistical analysis was completed for all variables; chi-square was used to examine the relationship between certain variables. It was found that 62.7% of paediatric burns occur in the kitchen, with 70.7% involving boiling water; 55.7% of cases resulted in third-degree burns, 19.3% required grafting, and mean duration of hospital stay was 27.5 ± 1.2 days. Medication costs varied between $1.38 US dollars (USD) and $14,159.09, total drug cost was $46,148.03 and average cost per patient was $329.63. In this study, the medication cost for burn patients was found to be relatively high, with antibiotics comprising the vast majority of medication expenditure. Most paediatric burns are preventable, so it is vital to educate families about potential household hazards that can be addressed to reduce the risk of a burn. Programmes are also recommended to reduce costs and the inappropriate prescribing of medication.

  11. Fluconazole Pharmacokinetics in Burn Patients

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    Boucher, Bradley A.; King, Stephen R.; Wandschneider, Heidi L.; Hickerson, William L.; Hanes, Scott D.; Herring, Vanessa L.; Canada, Todd W.; Hess, Mary M.

    1998-01-01

    The pharmacokinetics of fluconazole in nine adult patients with severe (30 to 95% total body surface area) burns were studied. There was no significant difference in half-life (t1/2), clearance (CL), or volume of distribution (V) over time in five patients on days 3 and 8 of the study (P > 0.05). Combined parameter estimates (means ± standard deviations) for all nine patients for the two study periods were as follows: t1/2, 24.4 ± 5.8 h; CL, 0.36 ± 0.09 ml/min/kg; and V, 0.72 ± 0.12 liters/kg. These estimates of t1/2 and CL in burn patients were approximately 13% shorter and 30% more rapid, respectively, than the most extreme estimates reported for other populations. PMID:9559811

  12. Physical fitness in people after burn injury : a systematic review

    NARCIS (Netherlands)

    Disseldorp, Laurien M.; Nieuwenhuis, Marianne; Van Baar, Margriet E.; Mouton, Leonora J.

    2011-01-01

    Disseldorp LM, Nieuwenhuis MK, Van Baar ME, Mouton U. Physical fitness in people after burn injury: a systematic review. Arch Phys Med Rehabil 2011;92:1501-10. Objective: To gain insight into the physical fitness of people after burn injury compared with healthy subjects, and to present an overview

  13. Zinc supplementation in burn patients.

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    Caldis-Coutris, Nancy; Gawaziuk, Justin P; Logsetty, Sarvesh

    2012-01-01

    Micronutrient supplementation is a common practice throughout many burn centers across North America; however, uncertainty pertaining to dose, duration, and side effects of such supplements persists. The authors prospectively collected data from 23 hospitalized patients with burn sizes ranging from 10 to 93% TBSA. Each patient received a daily multivitamin and mineral supplement, 50 mg zinc (Zn) daily, and 500 mg vitamin C twice daily. Supplements were administered orally or enterally. Albumin, prealbumin, C-reactive protein, serum Zn, and serum copper were measured weekly during hospital admission until levels were within normal reference range. Our study concluded that 50 mg daily dose of Zn resulted in normal serum levels in 19 of 23 patients at discharge; 50 mg Zn supplementation did not interfere with serum copper levels; and Zn supplements, regardless of administration route, did not result in gastrointestinal side effects.

  14. A Systematic Review on the Epidemiology of Pediatric Burn in Iran.

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    Hashemi, Sayed Saeed; Sharhani, Asaad; Lotfi, Bahare; Ahmadi-Juibari, Toraj; Shaahmadi, Zahra; Aghaei, Abbas

    2017-03-15

    Burn is the most common pediatric injuries all over the world. The aim of this study was to study the epidemiology of burn in under 15-year-old Iranian children by applying a systematic review. The related articles published before 2016 have been gathered from international databases by using the keywords in term of pediatric burns such as ScienceDirect, PubMed, Iranmedex, Google Scholar, Embase, Magiran, and SID. The checklists of STROBE have been applied to evaluate the quality of the reviewed data. A total of 35 relevant studies were extracted and evaluated. In most studies, the incidence of pediatric burns in male patients was more than female patients by 9.5 to 50 cases in 100,000 per children. Mortality rate of pediatric burn was between 1.7 and 18.5%. The most common cause of pediatric burn was hot water or other hot liquids. Pediatric burn in urban areas was higher and the highest number of pediatric burns occurred at home. Burn is considered as one of the major incidents related to children's health that required planning to reduce its incidence, especially in the lower age groups as well as male patients who are more active and susceptible to burn.

  15. Iatrogenic surgical microscope skin burns: A systematic review of the literature and case report.

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    Lopez, Joseph; Soni, Ashwin; Calva, Daniel; Susarla, Srinivas M; Jallo, George I; Redett, Richard

    2016-06-01

    Cutaneous burns associated with microscope-use are perceived to be uncommon adverse events in microsurgery. Currently, it is unknown what factors are associated with these iatrogenic events. In this report, we describe the case of a 1-year-old patient who suffered a full thickness skin burn from a surgical microscope after a L4-S1 laminectomy. Additionally, we present a systematic review of the literature that assessed the preoperative risk, outcome, and management of iatrogenic microscope skin burns. Lastly, a summary of the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database of voluntary adverse events was reviewed and analyzed for clinical cases of microscope thermal injuries. The systematic literature review identified only seven articles related to microsurgery-related cutaneous burns. From these seven studies, 15 clinical cases of iatrogenic skin burns were extracted for analysis. The systematic review of the FDA MAUDE database revealed only 60 cases of cutaneous burns associated with surgical microscopes since 2004. Few cases of microscope burns have been described in the literature; this report is, to our knowledge, one of the first comprehensive reports of this iatrogenic event in the literature.

  16. Predictive Factors of Mortality in Burn Patients

    OpenAIRE

    Fazeli; Karami-Matin; Kakaei; Pourghorban; Safari-Faramani

    2014-01-01

    Background: Burn injuries impose a considerable burden on healthcare systems in Iran. It is among the top ten causes of mortality and a main cause of disability. Objectives: This study aimed to examine factors influencing mortality in burn patients admitted to the main educational tertiary referral hospital in Kermanshah. Patients and Methods: All patients admitted to the Imam Khom...

  17. Acute pain management in burn patients

    DEFF Research Database (Denmark)

    Gamst-Jensen, Hejdi; Vedel, Pernille Nygaard; Lindberg-Larsen, Viktoria Oline

    2014-01-01

    management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units. METHOD: The study had...... patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn......OBJECTIVE: Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain...

  18. Aeromonas hydrophila in a burn patient.

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    Yasti, Ahmet Cinar; Otan, Emrah; Doganay, Mutlu; Kama, Nuri A

    2009-01-01

    Infectious consequences are still a major problem and leading cause of mortality in burn patients. Among others, aeromonads need special concern because they mimic pseudomonal infections; however, they have a more rapid progression with considerable mortality if undiagnosed promptly. Here, we present a major burn case extinguished with tap water pooled in a tank. With the possibility of aeromonal infection in mind, the patient underwent aggressive debridement with proper antibiotic medication, which resulted in a successful patient management. Aeromonads should always be kept in mind in burn cases that contacted with tanked water or soil after the burn.

  19. Vitamin E Supplementation in Burn Patients

    Science.gov (United States)

    2015-10-01

    AWARD NUMBER: W81XWH-12-1-0429 TITLE: Vitamin E Supplementation in Burn Patients PRINCIPAL INVESTIGATOR: Perenlei Enkhbaatar, MD., PhD...NOTES 14. ABSTRACT Our recent findings demonstrate that burn injury significantly depleted stores of vitamin E in adipose tissue of children by nearly...oxidative stress. The objectives of our proposal were to a) attenuate alpha-tocopherol depletion in burn patients by vitamin E supplementation, b) to

  20. Infection control in severely burned patients

    OpenAIRE

    Coban, Yusuf Kenan

    2012-01-01

    In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections (NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood strea...

  1. Renal failure in burn patients: a review.

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    Emara, S S; Alzaylai, A A

    2013-03-31

    Burn care providers are usually challenged by multiple complications during the management of acute burns. One of the most common complications worldwide is renal failure. This article reviews the various aspects of renal failure management in burn patients. Two different types of renal failures develop in these patients. The different aetiological factors, incidence, suspected prognosis, ways of diagnosing, as well as prevention methods, and the most accepted treatment modalities are all discussed. A good understanding and an effective assessment of the problem help to reduce both morbidity and mortality in burn management.

  2. Nutrition Support in Burn Patients

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    Cem Aydoğan

    2012-08-01

    Full Text Available Severe burn trauma causes serious metabolic derangements. Increased metabolic rate which is apart of a pathophysiologic characteristic of burn trauma results in protein-energy malnutrition. This situation causes impaired wound healing, muscle and fat tissue’s breakdown, growth retardation in children and infections. Nutrition support is vital in the treatment strategies of burn victims to prevent high mortal and disabling complications in this devastating trauma. Our aim in this study is to review management of nutrition in burn victims. (Journal of the Turkish Society Intensive Care 2012; 10: 74-83

  3. Crusted Scabies in the Burned Patient

    DEFF Research Database (Denmark)

    Berg, Jais Oliver; Alsbjørn, Bjarne

    2011-01-01

    The objectives of this study were 1) to describe a case of crusted scabies (CS) in a burned patient, which was primarily undiagnosed and led to a nosocomial outbreak in the burn unit; 2) to analyze and discuss the difficulties in diagnosing and treating this subset of patients with burn injury......; and 3) to design a treatment strategy for future patients. Case analysis and literature review were performed. The index patient had undiagnosed crusted scabies (sive Scabies norvegica) with the ensuing mite hyperinfestation when admitted to the department with minor acute dermal burns. Conservative...... healing and autograft healing were impaired because of the condition. Successful treatment of the burns was only accomplished secondarily to scabicide treatment. An outbreak of scabies among staff members indirectly led to diagnosis. CS is ubiquitous, and diagnosis may be difficult. This is the first...

  4. Transesophageal echocardiography in the management of burn patients.

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    Maybauer, Marc O; Asmussen, Sven; Platts, David G; Fraser, John F; Sanfilippo, Filippo; Maybauer, Dirk M

    2014-06-01

    A systematic review was conducted to assess the level of evidence for the use of transesophageal echocardiography (TEE) in the management of burn patients. We searched any article published before and including June 30, 2013. Our search yielded 118 total publications, 11 met the inclusion criteria of burn injury and TEE. Available studies published in any language were rated and included. At the present time, there are no available systematic reviews/meta-analyses published that met our search criteria. Only a small number of clinical trials, all with a limited number of patients were available. Therefore, a meta-analysis on outcome parameters was not performed. However, the major pathologic findings in burn patients were reduced left ventricular (LV) systolic and diastolic function, mitral valve vegetation, pulmonary hypertension, pericardial effusion, fluid overload, and right heart failure. The advantages of TEE include offering direct assessment of cardiac valve competency, myocardial contractility, and most importantly real time assessment of adequacy of hemodynamic resuscitation and preload in the acute phase of resuscitation, with minimal additional risk. TEE serves multiple diagnostic purposes and is being used to better understand the fluid status and cardiac physiology of the critically ill burn patient. Randomized controlled trials especially on fluid resuscitation and cardiac performance in acute burns are warranted to potentially further improve outcome.

  5. Osteomyelitis in burn patients requiring skeletal fixation

    NARCIS (Netherlands)

    Barret, JP; Desai, MH; Herndon, DN

    2000-01-01

    Deep and severe burns often present with the exposure of musculoskeletal structures and severe deformities. Skeletal fixation, suspension and/or traction are part of their comprehensive treatment. Several factors put burn patients at risk for osteomyelitis, osteosynthesis material being one of them.

  6. Infections in critically ill burn patients.

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    Hidalgo, F; Mas, D; Rubio, M; Garcia-Hierro, P

    2016-04-01

    Severe burn patients are one subset of critically patients in which the burn injury increases the risk of infection, systemic inflammatory response and sepsis. The infections are usually related to devices and to the burn wound. Most infections, as in other critically ill patients, are preceded by colonization of the digestive tract and the preventative measures include selective digestive decontamination and hygienic measures. Early excision of deep burn wound and appropriate use of topical antimicrobials and dressings are considered of paramount importance in the treatment of burns. Severe burn patients usually have some level of systemic inflammation. The difficulty to differentiate inflammation from sepsis is relevant since therapy differs between patients with and those without sepsis. The delay in prescribing antimicrobials increases morbidity and mortality. Moreover, the widespread use of antibiotics for all such patients is likely to increase antibiotic resistance, and costs. Unfortunately the clinical usefulness of biomarkers for differential diagnosis between inflammation and sepsis has not been yet properly evaluated. Severe burn injury induces physiological response that significantly alters drug pharmacokinetics and pharmacodynamics. These alterations impact antimicrobials distribution and excretion. Nevertheless the current available literature shows that there is a paucity of information to support routine dose recommendations.

  7. STUDY ON PRETHROMBOTIC STATE IN BURNED PATIENTS

    Institute of Scientific and Technical Information of China (English)

    王鸿利; 邵慧珍; 支立民; 肖玉瑞; 杨丽英; 史济湘

    1992-01-01

    Seventy-eight burned patients (53 males and 25 females) were classified into 4 groups (mild type: 14 cases, moderate type: 13 cases, severe type: 17 cases and super-severe type: 34 cases) in accordence with criteria established by the Chinese Society for burns. Twenty-two parameters related to platelet, coagulant and anticoagulant factors, fibrinolysis system and hemorrheology were determined at first 24 hours, on third and fifth post-burn days. The results were as follow: Fibrinogen antigen, von Willebrand factor antigen, plasminogen activitor inhibitor activity, thromboxane B2 and hematocrit and whole blood viscosity significantly increased, however antithrombin Ⅲ, protein C antigen, free protein S and 6-keto-prostaglandin F1α markedly decreased compared with normal control at first 24 hours post burn. In addition, fibrinogen antigen, von Willebrand factor antigen, plasminogen activitor inhibitor activity, thromboxane B2 and whole blood viscosity were persistently elevated, however, antithrombin Ⅲ, protein C, free protein S and 6-keto-prostaglandin F1α declined on third and fifth post burn days. These changes resulted in a prethrombotic state, being an important factor in genesis of microthrombosis on burn site and the cause of the deepening and aggravation of burn wound on the third and fifth days in burned patients.

  8. Psychiatric Assessment and Rehabilitation of Burn Patients

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    Süleyman Akarsu

    2017-03-01

    Full Text Available Objective: Psychiatric rehabilitation has gained significance owing to improved healthcare facilities for burn injuries and decreased mortality/ morbidity rates. Burn traumas may result in psychiatric signs such as denial, anger, guilt, confusion, disgrace, anxiety, distress, and nervousness. Psychiatric disorders such as delirium, depression, anxiety, post-traumatic stress disorder, and sexual problems can also be encountered. Therefore, it is necessary to look for these signs and disorders through regular sessions with burn patients and appropriate psychometric tests. This study aims at examining the process of psychological rehabilitation for burn patients in light of the current literature. Material and Methods: This study has been carried out in the light of the main and current literature review. The study intends to put forth the data observed in the course of the psychological diagnosis, treatment and rehabilitation of burn patients. The study has been conducted in accordance with the Helsinki Declaration Guidelines. Results: Treatment and rehabilitation process requires a multidisciplinary teamwork that consists of physicians, dieticians, psychologists, social service specialists, and other healthcare workers who can meet the needs of burn patients and their families. It is necessary for the team to contribute both to the hospitalization process and the social environment of the patients and their families. Conclusion: It is observed that the quality of life of these patients can be considerably improved with the effective assessment of psychiatric signs that occur during or after the injury and with appropriate treatment methods.

  9. The efficacy of aloe vera used for burn wound healing: a systematic review.

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    Maenthaisong, Ratree; Chaiyakunapruk, Nathorn; Niruntraporn, Surachet; Kongkaew, Chuenjid

    2007-09-01

    Aloe vera has been traditionally used for burn healing but clinical evidence remains unclear. We conducted a systematic review to determine the efficacy of topical aloe vera for the treatment of burn wounds. We electronically searched relevant studies in MEDLINE, CINAHL, Cochrane Library, HealthSTAR, DARE, South-East Asia Database, Chinese Databases, and several Thai local Databases (1918-June 2004). Only controlled clinical trials for burn healing were included. There were no restrictions on any language of publication. Two reviewers independently extracted data on study characteristics, patient characteristics, intervention, and outcome measure. Four studies with a total of 371 patients were included in this review. Based on a meta-analysis using duration of wound healing as an outcome measure, the summary weighted mean difference in healing time of the aloe vera group was 8.79 days shorter than those in the control group (P=0.006). Due to the differences of products and outcome measures, there is paucity to draw a specific conclusion regarding the effect of aloe vera for burn wound healing. However, cumulative evidence tends to support that aloe vera might be an effective interventions used in burn wound healing for first to second degree burns. Further, well-designed trials with sufficient details of the contents of aloe vera products should be carried out to determine the effectiveness of aloe vera.

  10. Increased mortality in hypernatremic burned patients

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    Lange, Thomas

    2010-01-01

    Full Text Available Introduction: In-hospital hypernatremia develops usually iatrogenically from inadequate or inappropriate fluid prescription. In severely burned patient an extensive initial fluid resuscitation is necessary for burn shock survival. After recovering of cellular integrity the circulating volume has to be normalized. Hereby extensive water and electrolyte shifts can provoke hypernatremia. Purpose: Is a hypernatremic state associated with increased mortality? Method: Retrospective study for the incidence of hypernatremia and survival in 40 patients with a totally burned surface area (TBSA >10%. Age, sex, TBSA, ABSI-Score and fluid resuscitation within the first 24 hours were analyzed. Patients were separated in two groups without (Group A or with (Group B hypernatremia. Results: Hypernatremia occurred on day 5±1.4. No significant difference for age, sex, TBSA, ABSI-Score and fluid resuscitation within the first 24 hours were calculated. In Group A all patients survived, while 3 of the hypernatremic patient in Group B died during ICU-stay (Odds-ratio = 1.25; 95% CI 0.971–1.61; p=0.046. Conclusion: Burned patients with an in-hospital acquired hypernatremia have an increased mortality risk. In case of a hypernatremic state early intervention is obligatory. There is a need of a fluid removal strategy in severely burned patient to avoid water imbalance.

  11. Optimal treatment of partial thickness burns in children: a systematic review.

    Science.gov (United States)

    Vloemans, A F P M; Hermans, M H E; van der Wal, M B A; Liebregts, J; Middelkoop, E

    2014-03-01

    A large part of the patient population of a burn centre consists of children, most of whom are younger than four years. The majority of these young children suffer from superficial and deep partial thickness scald burns that may easily deepen to full thickness burns. A proper wound therapy, that prevents infection and ensures a moist wound condition, might prevent the deterioration of the wound. Therefore, we performed a systematic review of wound management and dressing materials to select the best treatment option for children with burns. A search in Medline and Embase revealed 51 articles for a critical appraisal. The articles were divided into randomized controlled trials, cohort studies and a group of case-reports. Total appraisal did not differ much amongst the groups; the level of evidence was highest in the randomized controlled trials and lowest in the case-reports. In 16 out of 34 comparative studies, silver sulfadiazine or a silver sulfadiazine/chlorhexidine-gluconate combination was the standard of wound care treatment. The competitor dressing was Biobrane(®) in six studies and amnion membrane in three. Tulle gauze, or tulle gauze impregnated with an antibacterial addition were the standard of care treatment in seven studies. In general, membranous dressings like Biobrane(®) and amnion membrane performed better than the standard of care on epithelialization rate, length of hospital stay and pain for treatment of partial thickness burns in children. However, hardly any of the studies investigated long-term results like scar formation.

  12. Analysis of antibiotic consumption in burn patients

    Science.gov (United States)

    Soleymanzadeh-Moghadam, Somayeh; Azimi, Leila; Amani, Laleh; Rastegar Lari, Aida; Alinejad, Faranak; Rastegar Lari, Abdolaziz

    2015-01-01

    Infection control is very important in burn care units, because burn wound infection is one of the main causes of morbidity and mortality among burn patients. Thus, the appropriate prescription of antibiotics can be helpful, but unreasonable prescription can have detrimental consequences, including greater expenses to patients and community alike. The aim of this study was to determine the effect of antibiotic therapy on the emergence of antibiotic-resistant bacteria. 525 strains of Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus were isolated from 335 hospitalized burn patients. Antibiotic susceptibility tests were performed after identification the strains. The records of patients were audited to find the antibiotic used. The results indicated that P. aeruginosa is the most prevalent Gram-negative bacteria. Further, it showed a relation between abuse of antibiotics and emergence of antibiotic resistance. Control of resistance to antibiotics by appropriate prescription practices not only facilitates prevention of infection caused by multi-drug resistant (MDR) microorganisms, but it can also decrease the cost of treatment. PMID:26124986

  13. Analysis of antibiotic consumption in burn patients

    Directory of Open Access Journals (Sweden)

    Soleymanzadeh-Moghadam, Somayeh

    2015-06-01

    Full Text Available Infection control is very important in burn care units, because burn wound infection is one of the main causes of morbidity and mortality among burn patients. Thus, the appropriate prescription of antibiotics can be helpful, but unreasonable prescription can have detrimental consequences, including greater expenses to patients and community alike. The aim of this study was to determine the effect of antibiotic therapy on the emergence of antibiotic-resistant bacteria. 525 strains of and were isolated from 335 hospitalized burn patients. Antibiotic susceptibility tests were performed after identification the strains. The records of patients were audited to find the antibiotic used.The results indicated that is the most prevalent Gram-negative bacteria. Further, it showed a relation between abuse of antibiotics and emergence of antibiotic resistance. Control of resistance to antibiotics by appropriate prescription practices not only facilitates prevention of infection caused by multi-drug resistant (MDR microorganisms, but it can also decrease the cost of treatment.

  14. Managing burn patients in a fire disaster: Experience from a burn unit in Bangladesh

    Directory of Open Access Journals (Sweden)

    Mashreky S

    2010-10-01

    Full Text Available Although burn disaster is not a frequent event, with urbanisation and industrialisation, burn disaster is becoming an emerging problem in Bangladesh. On 3 June 2010, a fire disaster killed 124 people in Neemtali, Dhaka, Bangladesh. This paper narrates the management of burn patients of this disaster in the burn unit of Dhaka Medical College Hospital. The burn unit managed 192 burn victims of the disaster. Forty-two victims were admitted and 150 of them received primary care at the emergency room and were sent back home. Ten patients among 42 in-patients died. The in-patient mortality was 23.8%. Burn unit in Dhaka Medical College Hospital is the only burn management centre in Bangladesh. Proper planning and coordinated effort by all sectors and persons concerned were the key elements in this successful management.

  15. [Physical rehabilitation in extensively burned patients].

    Science.gov (United States)

    Martín Martínez, V; Díez Sanz, Ma J; Corona Fernández, O; García Aragón, A; González Fraile, L

    2014-02-01

    The rehabilitation of the extensively burned patient aims to prevent and minimize consequences of the own lesion this is supported by three pillars: 1) postural treatment to prevent contractures; 2) kinesiotherapy to maintain/restore joint range of movement and muscle strength; 3) functional recovery. Physical therapy is essential in the multidisciplinary team. A coordinated team assures better results and positively influences the quality of life of the patients.

  16. Thermoregulation in burn patients during exercise.

    Science.gov (United States)

    Austin, K G; Hansbrough, J F; Dore, C; Noordenbos, J; Buono, M J

    2003-01-01

    The purpose of this study was to assess the ability of patients with burns on 30 to 40% and 60% or greater of their BSA to thermoregulate their core temperature during exercise in the heat. Two groups (n = 3 in each) of subjects with healed third-degree burns (34.0 +/- 1.4% and 77.7 +/- 12.4%, respectively) and a group of unburned subjects (n = 2) exercised for 1 hour on a cycle ergometer at 75 Watts in an environmental chamber set at 35 degrees C and 60% relative humidity. Subjects were monitored for rectal and skin temperatures, heart rate, whole body sweat rate, skin blood flow, and active sweat gland density (number per cm ) in unburned, burned, and harvested skin. The results demonstrated that patients with burns on 60% or greater BSA did not show an intolerance to moderate exercise in the heat, as evidenced by only a moderate rise in rectal temperature and heart rate. Furthermore, the responses were similar to those of the unburned subjects.

  17. Patient safety measures in burn care: do National reporting systems accurately reflect quality of burn care?

    Science.gov (United States)

    Mandell, Samuel P; Robinson, Ellen F; Cooper, Claudette L; Klein, Matthew B; Gibran, Nicole S

    2010-01-01

    Recently, much attention has been placed on quality of care metrics and patient safety. Groups such as the University Health-System Consortium (UHC) collect and review patient safety data, monitor healthcare facilities, and often report data using mortality and complication rates as outcomes. The purpose of this study was to analyze the UHC database to determine if it differentiates quality of care across burn centers. We reviewed UHC clinical database (CDB) fields and available data from 2006 to 2008 for the burn product line. Based on the September 2008 American Burn Association (ABA) list of verified burn centers, we categorized centers as American Burn Association-verified burn centers, self-identified burn centers, and other centers that are not burn units but admit some burn patients. We compared total burn admissions, risk pool, complication rates, and mortality rates. Overall mortality was compared between the UHC and National Burn Repository. The UHC CDB provides fields for number of admissions, % intensive care unit admission, risk pool, length of stay, complication profiles, and mortality index. The overall numbers of burn patients in the database for the study period included 17,740 patients admitted to verified burn centers (mean 631 admissions/burn center/yr or per 2 years), 10,834 for self-identified burn centers (mean 437 admissions/burn center/yr or per 2 years), and 1,487 for other centers (mean 11.5 admissions/burn center/yr or per 2 years). Reported complication rates for verified burn centers (21.6%), self-identified burn centers (21.3%), and others (20%) were similar. Mortality rates were highest for self-identified burn centers (3.06%), less for verified centers (2.88%), and lowest for other centers (0.74%). However, these outcomes data may be misleading, because the risk pool criteria do not include burn-specific risk factors, and the inability to adjust for injury severity prevents rigorous comparison across centers. Databases such as the

  18. Oral Rehydration Therapy in Burn Patients

    Science.gov (United States)

    2014-04-24

    Burn Any Degree Involving 20-29 Percent of Body Surface; Burn Any Degree Involving 30-39 Percent of Body Surface; Burn Any Degree Involving 40-49 Percent of Body Surface; Burn Any Degree Involving 50-59 Percent of Body Surface; Burn Any Degree Involving 60-65 Percent of Body Surface

  19. The elderly patient with burns: treatment considerations.

    Science.gov (United States)

    Staley, M; Richard, R

    1993-01-01

    When therapists treat elderly patients with burns, they should ask themselves several questions: Am I treating elderly patients with burns "just like other patients with burns?" Am I assessing the patient's joint mobility and strength as critically as I should? Am I ensuring that further tissue trauma is avoided by instructing the nursing staff in turning/transfer techniques? Am I routinely monitoring heart rate and blood pressure? Am I requiring repetition and practice of exercises before the patient's discharge? Is my patient safe to function in the environment to which he or she is being discharged? Most physical changes in the elderly population are attributed to the aging process but often are due to diminished movement disorders arising from poor physical fitness and disuse. The "slowdown" in the older adult may result from a lack of appropriate movement practice and failure to receive reinforcement for activity. Regardless of age, physiological challenges result in enhanced functional status. Training for a specific skill increases performance in that skill just as strength training increases strength. Practice or repetition of a task improves movement and response time for that task. Appropriate physical training programs for the elderly can (1) counterbalance age-associated declines in work capacity and physical performance; (2) maintain and improve range of motion, strength, flexibility, balance, and endurance; and (3) reduce the disability of the cardiovascular, respiratory, and musculoskeletal systems that may result in decreased risk of falls and accidents. Practice of a task and maintenance of physical fitness helps ensure a high level of motor performance and speed as a person grows older. One is never too old to exercise!

  20. Physical fitness in people after burn injury : a systematic review

    NARCIS (Netherlands)

    Disseldorp, Laurien M; Nieuwenhuis, Marianne K; Van Baar, Margriet E; Mouton, Leonora J

    2011-01-01

    OBJECTIVE: To gain insight into the physical fitness of people after burn injury compared with healthy subjects, and to present an overview of the effectiveness of exercise training programs in improving physical fitness in people after burn injury. DATA SOURCES: Electronic databases EMBASE, PubMed,

  1. [Risk factors for development of hypomagnesemia in the burned patient].

    Science.gov (United States)

    Durán-Vega, Héctor César; Romero-Aviña, Francisco Javier; Gutiérrez-Salgado, Jorge Eduardo; Silva-Díaz, Teresita; Ramos-Durón, Luis Ernesto; Carrera-Gómez, Francisco Javier

    2004-01-01

    Electrolyte abnormalities are common in the severely burned patient. There is little information with regard to the frequency and magnitude of hypomagnesemia, as well as on risk factors for this condition. We performed an observational, retrospective analysis of 35 burned patients treated at the Plastic and Reconstructive Surgery Service at the Hospital Central Sur PEMEX, Mexico City. We determined serum magnesium behavior and divided patients into two groups: the first included 11 patients with burns and hypomagnesemia, and the second, 24 patients with burns but without hypomagnesemia. Risk factor identification was performed. We found patient at risk was the one with more than 40% of 2nd or 3rd degree total burned body area, in day 4 or 10 after the burn, and with hypokalemia, hypocalcemia, or both, and without intravenous (i.v.) supplementation of magnesium. The best way to prevent or avoid major complications is to identify the high-risk patient, or to diagnose earlier.

  2. Ceruloplasmin and Hypoferremia: Studies in Burn and Non-Burn Trauma Patients

    Directory of Open Access Journals (Sweden)

    Michael A. Dubick

    2015-03-01

    Full Text Available Objective: Normal iron handling appears to be disrupted in critically ill patients leading to hypoferremia that may contribute to systemic inflammation. Ceruloplasmin (Cp, an acute phase reactant protein that can convert ferrous iron to its less reactive ferric form facilitating binding to ferritin, has ferroxidase activity that is important to iron handling. Genetic absence of Cp decreases iron export resulting in iron accumulation in many organs. The objective of this study was to characterize iron metabolism and Cp activity in burn and non-burn trauma patients to determine if changes in Cp activity are a potential contributor to the observed hypoferremia. Material and Methods: Under Brooke Army Medical Center Institutional Review Board approved protocols, serum or plasma was collected from burn and non-burn trauma patients on admission to the ICU and at times up to 14 days and measured for indices of iron status, Cp protein and oxidase activity and cytokines. Results: Burn patients showed evidence of anemia and normal or elevated ferritin levels. Plasma Cp oxidase activity in burn and trauma patients were markedly lower than controls on admission and increased to control levels by day 3, particularly in burn patients. Plasma cytokines were elevated throughout the 14 days study along with evidence of an oxidative stress. No significant differences in soluble transferrin receptor were noted among groups on admission, but levels in burn patients were lower than controls for the first 5 days after injury. Conclusion: This study further established the hypoferremia and inflammation associated with burns and trauma. To our knowledge, this is the first study to show an early decrease in Cp oxidase activity in burn and non-burn trauma patients. The results support the hypothesis that transient loss of Cp activity contributes to hypoferremia and inflammation. Further studies are warranted to determine if decreased Cp activity increases the risk of

  3. Burn patients' experience of pain management: a qualitative study.

    Science.gov (United States)

    Yuxiang, Li; Lingjun, Zhou; Lu, Tang; Mengjie, Liu; Xing, Ming; Fengping, Shen; Jing, Cui; Xianli, Meng; Jijun, Zhao

    2012-03-01

    Pain is a major problem after burns and researchers continue to report that pain from burns remains undertreated. The inadequate pain control results in adverse sequalae physically and psychologically in the burn victims. A better understanding of a burn patient's experience is important in identifying the factors responsible for undertreated pain and establishing effective pain management guidelines or recommendation in the practice of pain relief for burn injuries. This study sought to explore and describe the experience that patients have about pain related to burn-injury during hospitalization. Semi-structured interviews were conducted on eight patients with moderate to severe pain from burn injuries recruited from a Burn Centre in Northwest China. Data was collected by in-depth interviews and qualitative description after full transcription of each interview. Analysis involved the identification of themes and the development of a taxonomy of patients' experience of burn pain and its management. Three themes were indentified: (1) patients' experience of pain control, (2) patients' perception on burn pain management, and (3) patients' expectation of burn pain management. Findings from this study suggested that patients experience uncontrolled pain both physically and psychologically which may serve as an alert for awareness of health professionals to recognize and establish a multidisciplinary pain management team for burn victims, including surgeons, critical care specialists, anesthesiologists, nurses, psychologists, and social workers to accomplish safe and effective strategies for pain control to reach an optimal level of pain management in burn patients. It also provides insights and suggestions for future research directions to address this significant clinical problem.

  4. Prehospital Care of Burn Patients and Trajectories on Survival.

    Science.gov (United States)

    Kallinen, Outi; Koljonen, Virve; Tukiainen, Erkki; Randell, Tarja; Kirves, Hetti

    2016-01-01

    We sought to identify factors associated with the prognosis and survival of burn patients by analyzing data related to the prehospital treatment of burn patients transferred directly to the burn unit from the accident site. We also aimed to assess the role of prehospital physicians and paramedics providing care to major burn patients. This study included adult burn patients with severe burns treated between 2006 and 2010. Prehospital patient records and clinical data collected during treatment were analyzed, and the Injury Severity Scale (ISS) was calculated. Patients were grouped into two cohorts based on the presence or absence of a physician during the prehospital phase. Data were analyzed with reference to survival by multivariable regression model. Specific inclusion criteria resulted in a sample of 67 patients. The groups were comparable with regard to age, gender, and injury etiology. Patients treated by prehospital physicians (group 1, n = 49) were more severely injured than patients treated by paramedics (group 2, n = 18) in terms of total burn surface area (%TBSA) (32% vs. 17%, p = 0.033), ISS (25 vs. 8, p prehospital prognostic factors affecting patient outcomes. Based on the results from this study, our current EMS system is capable of identifying seriously injured burn patients who may benefit from physician attendance at the injury scene.

  5. Septicemia: The Principal Killer of Burns Patients

    Directory of Open Access Journals (Sweden)

    B. R. Sharma

    2005-01-01

    Full Text Available Burn injury is a major problem in many areas of the world and it has been estimated that 75% of all deaths following burns are related to infection. Burns impair the skin’s normal barrier function thus allowing microbial colonization of the burn wounds and even with the use of topical antimicrobial agents, contamination is almost unavoidable. It is therefore essential for every burn institution to determine its specific pattern of burn wound microbial colonization, time related changes in predominant flora and antimicrobial resistance profiles. This would allow early management of septic episodes with proper empirical systemic antibiotics before the results of microbiologic culture becomes available, thus improving the overall infection-related morbidity and mortality. We attempted to examine the factors affecting risk of infection; strategies for infection control and prevention in burn victims.

  6. Burns

    Science.gov (United States)

    ... home, work, and school. Remove electrical cords from floors and keep them out of reach. Know about and practice fire escape routes at ... Burn, thermal - close-up Airway burn Skin First degree burn ...

  7. Co-occurrence of Pain Symptoms and Somatosensory Sensitivity in Burning Mouth Syndrome: A Systematic Review

    Science.gov (United States)

    Moisset, Xavier; Calbacho, Valentina; Torres, Pilar; Gremeau-Richard, Christelle; Dallel, Radhouane

    2016-01-01

    Background Burning mouth syndrome (BMS) is a chronic and spontaneous oral pain with burning quality in the tongue or other oral mucosa without any identifiable oral lesion or laboratory finding. Pathogenesis and etiology of BMS are still unknown. However, BMS has been associated with other chronic pain syndromes including other idiopathic orofacial pain, the dynias group and the family of central sensitivity syndromes. This would imply that BMS shares common mechanisms with other cephalic and/or extracephalic chronic pains. The primary aim of this systematic review was to determine whether BMS is actually associated with other pain syndromes, and to analyze cephalic and extracephalic somatosensory sensitivity in these patients. Methods This report followed the PRISMA Statement. An electronic search was performed until January 2015 in PubMed, Cochrane library, Wiley and ScienceDirect. Searched terms included “burning mouth syndrome OR stomatodynia OR glossodynia OR burning tongue OR oral burning”. Studies were selected according to predefined inclusion criteria (report of an association between BMS and other pain(s) symptoms or of cutaneous cephalic and/or extracephalic quantitative sensory testing in BMS patients), and a descriptive analysis conducted. Results The search retrieved 1512 reports. Out of these, twelve articles met criteria for co-occurring pain symptoms and nine studies for quantitative sensory testing (QST) in BMS patients. The analysis reveals that in BMS patients co-occurring pain symptoms are rare, assessed by only 0.8% (12 of 1512) of the retrieved studies. BMS was associated with headaches, TMD, atypical facial pain, trigeminal neuralgia, post-herpetic facial pain, back pain, fibromyalgia, joint pain, abdominal pain, rectal pain or vulvodynia. However, the prevalence of pain symptoms in BMS patients is not different from that in the age-matched general population. QST studies reveal no or inconsistent evidence of abnormal cutaneous cephalic

  8. Burns in patients over 90: a fifteen-year series from a regional burns centre.

    Science.gov (United States)

    Shariff, Zakir; Rodrigues, Jeremy N; Anwar, Umair; Austin, Orla; Phipps, Alan

    2015-03-01

    The elderly constitute an expanding subgroup within society, and may have differences in health needs compared to younger patients. The specific needs and outcomes of elderly patients with burns have been widely studied. However, the definition of elderly often used in previous studies is a cut off of 65 years old. Within this broadly defined group, the very elderly may have distinct health care needs and issues. This study investigated aetiology, management and outcome of burns in those over 90 years treated at a single UK burns service over a period of 15 years between 1998 and 2013, and compares these data to published data describing 'younger' elderly burns patients. Twenty two patients were included, with a 2:1 female:male ration, and a mean 9%TBSA burn. Six of the 22 died during their admission, and those who survived averaged 8 days inpatient stay per %TBSA. The very elderly with burns may fare worse than younger elderly patients. Although burns in the very elderly are relatively infrequent events, they require significant resource. Further work to optimise their outcome is required.

  9. Pyoderma gangrenosum in burned patient: Case report

    Directory of Open Access Journals (Sweden)

    Obradović-Tomašev Milana

    2015-01-01

    Full Text Available Introduction. Pyoderma gangrenosum is a rare, chronic, destructive, ulcerating skin disease of uncertain etiology. It develops most frequently in patients between 25-45 years of age and affects both sexes equally. Case report. We present a case of pyoderma gangrenosum in a young female patient who sustained a burn injury of 40% total body surface area. She underwent four operations. She developed a wound infection and urinary infection during her hospital stay. By the end of hospitalization, the papules followed with coalesce of ulcerations formed on the previously epithelized areas of her legs. The patient complained of the intensive pain localized on these surfaces. Since pyoderma gangrenosum was suspected, a dermatologist was included in treatment. Therapy was initiated (methylprednisolone 60 mg per day intravenously with gradual reduction of the dosage. The patient was discharged from hospital two weeks later with almost fully complete cicatrization and epithelization. Conclusion. Pyoderma gangrenosum is still difficult to be diagnosed in the absence of specific and sensitive diagnostic methods; however, it is crucial to be suspected as early as possible and to start treatment immediately. Multidisciplinary approach is essential for optimal results.

  10. Prognostic indicators in acute burned patients-a review

    Institute of Scientific and Technical Information of China (English)

    Sherif Emara

    2015-01-01

    Burn trauma is in need for prognostic indicators or admission scores. This aims for realistic documentation of the burn injury, expectation of the prognosis, and to facilitate a patient stratification to evaluate therapeutic strategies. A computer search through different medical websites was performed looking for articles correlating prognosis with different burn indices. These were carefully summarized and analyzed for this review. Variable studies were found related to that issue; the reliable indicators found had been classified as general or specific. All of them had certain clinical importance, but limitations are a common feature. All the listed indices are useful to serve in the only special clinical situations. We couldn't claim that they are actual prognostic indicator in burn victims. We believe that we still lack the proper prognostic indicator in burn patients. Researchers are invited for more effort to organize a more reliable prognostic indicator and scoring system for burn patients.

  11. Ultrasound assessed thickness of burn scars in association with laser Doppler imaging determined depth of burns in paediatric patients.

    Science.gov (United States)

    Wang, Xue-Qing; Mill, Julie; Kravchuk, Olena; Kimble, Roy M

    2010-12-01

    This study describes the ultrasound assessment of burn scars in paediatric patients and the association of these scar thickness with laser Doppler imaging (LDI) determined burn depth. A total of 60 ultrasound scar assessments were conducted on 33 scars from 21 paediatric burn patients at 3, 6 and 9 months after-burn. The mean of peak scar thickness was 0.39±0.032 cm, with the thickest at 6 months (0.40±0.036 cm). There were 17 scald burn scars (0.34±0.045 cm), 4 contact burn scars (0.61±0.092 cm), and 10 flame burn scars (0.42±0.058 cm). Each group of scars followed normal distributions. Twenty-three scars had original burns successfully scanned by LDI and various depths of burns were presented by different colours according to blood perfusion units (PU), with dark blue burns, with the thinnest scars for green coloured burns and the thickest for dark blue coloured burns. Within light blue burns, grafted burns healed with significantly thinner scars than non-grafted burns. This study indicates that LDI can be used for predicting the risk of hypertrophic scarring and for guiding burn care. To our knowledge, this is the first study to correlate the thickness of burns scars by ultrasound scan with burn depth determined by LDI.

  12. Prevalence of scar contractures after burn : A systematic review

    NARCIS (Netherlands)

    Oosterwijk, Anouk M.; Mouton, Leonora J.; Schouten, Hennie; Disseldorp, Laurien M.; van der Schans, Cees P.; Nieuwenhuis, Marianne K.

    2017-01-01

    Objective: Burn scar contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such contractures, insight into the pr

  13. Prevalence of scar contractures after burn : A systematic review

    NARCIS (Netherlands)

    Oosterwijk, Anouk M; Mouton, Leonora J; Schouten, Hennie; Disseldorp, Laurien M; van der Schans, Cees P; Nieuwenhuis, Marianne K

    2016-01-01

    OBJECTIVE: Burn scar contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such contractures, insight into the pr

  14. Factors influencing resilience in patients with burns during rehabilitation period

    Directory of Open Access Journals (Sweden)

    Zhen Yang

    2014-03-01

    Conclusion: During psychological crisis intervention, medical staff should guide burn patients according to their individual coping styles. Such guidance would achieve a better effect, improve patient resilience, and promote positive psychological adaptation.

  15. Epidemiology, etiology and outcomes of burn patients in a Referral Burn Hospital, Tehran

    Directory of Open Access Journals (Sweden)

    Mohammad Mehdi Soltan Dallal

    2016-08-01

    Full Text Available Background: Burns and its complications are regarded as a major problem in the society. Skin injuries resulted from ultraviolet radiation, radioactivity, electricity or chemicals as well as respiratory damage from smoke inhalation are considered burns. This study aimed to determine the epidemiology and outcome of burn patients admitted to Motahari Hospital, Tehran, Iran. Methods: Two hundred patients with second-degree burns admitted to Motahari Referral Center of Burn in Tehran, Iran. They were studied during a period of 12 months from May 2012 to May 2013. During the first week of treatment swabs were collected from the burn wounds after cleaning the site with sterile normal saline. Samples were inoculated in blood agar and McConkey agar, then incubation at 37 C for 48 hours. Identification was carried out according to standard conventional biochemical tests. Treatment continued up to epithelial formation and wound healing. Results of microbial culture for each patient was recorded. Healing time of the burn wounds in patients was recorded in log books. Chi-square test and SPSS Software v.19 (IBM, NY, USA were used for data analysis. Results: Our findings indicate that the most causes of burns are hot liquids in 57% of cases and flammable liquid in 21% of cases. The most cases of burns were found to be in the range of 21 to 30 percent with 17.5% and 7% in male and female respectively. Gram-negative bacteria were dominated in 85.7% and among them pseudomonas spp. with 37.5% were the most common cause of infected burns, followed by Enterobacter, Escherichia coli, Staphylococcus aureus, Acinetobacter and Klebsiella spp. Conclusion: The results of this study showed that the most cause of burns in both sex is hot liquid. Men were more expose to burn than women and this might be due to the fact that men are involved in more dangerous jobs than female. Pseudomonas aeruginosa was the most common organism encountered in burn infection.

  16. Management of cyanide toxicity in patients with burns.

    Science.gov (United States)

    MacLennan, Louise; Moiemen, Naiem

    2015-02-01

    The importance of cyanide toxicity as a component of inhalational injury in patients with burns is increasingly being recognised, and its prompt recognition and management is vital for optimising burns survival. The evidence base for the use of cyanide antidotes is limited by a lack of randomised controlled trials in humans, and in addition consideration must be given to the concomitant pathophysiological processes in patients with burns when interpreting the literature. We present a literature review of the evidence base for cyanide antidotes with interpretation in the context of patients with burns. We conclude that hydroxycobalamin should be utilised as the first-line antidote of choice in patients with burns with inhalational injury where features consistent with cyanide toxicity are present.

  17. Epidemiology of burn injuries in the East Mediterranean Region: a systematic review

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    Kendrick Denise

    2010-02-01

    Full Text Available Abstract Background Burn injuries remain one of the leading causes of injury morbidity and mortality in the World Health Organization's East Mediterranean Region. To provide an overview on the epidemiology of burn injuries in this region, a systematic review was undertaken. Methods Medline, Embase and CINAHL were searched for publications on burns in this region published between 01/01/1997 and 16/4/2007. Data were extracted to a standard spreadsheet and synthesised using a narrative synthesis. No attempt has been made to quantitatively synthesise the data due to the large degree of clinical heterogeneity between study populations. Results Seventy one studies were included in the review, from 12 countries. Burn injuries were found to be one of the leading causes of injury morbidity and mortality. The reported incidence of burns ranged from 112 to 518 per 100,000 per year. Burn victims were more frequently young and approximately one third of the victims were children aged 0-5 years. Hospital mortality ranged from 5 to 37%, but was commonly above 20%. Intentional self-harm burns particularly involving women were common in some countries of the region and were associated with a very high mortality of up to 79%. Conclusion Burn injuries remain an important public health issue in the East Mediterranean Region therefore further research is required to investigate the problem and assess the effectiveness of intervention programmes.

  18. A systematic review of the psychometric properties of self-reported scales assessing burn contractures reveals the need for a new tool to measure contracture outcomes.

    Science.gov (United States)

    Ehanire, Tosan; Vissoci, Joao Ricardo Nickenig; Slaughter, Keimun; Coêlho, Rafael; Bond, Jennifer; Rodrigues, Clarissa; Pietrobon, Ricardo; Levinson, Howard

    2013-01-01

    Approximately 40% of burn patients develop scar contractures. It is unknown which scar contracture therapy best optimizes activities of daily living (ADL).The appropriateness of self-reported outcome tools in measuring anti-scar contracture therapies has not been assessed. We conducted a systematic review to determine the quality of existing self-reported scales in measuring ADL among burn patients by analyzing and comparing psychometric properties-factor analysis, validity, reliability, and responsiveness. EMBASE, LILACS, American Psychological Association PsycNET databases were searched for relevant articles. Forty-one articles discussing 10 burn and non-burn-specific scales met eligibility criteria of ADL assessment, and available psychometric analyses. A common strength in most scales was good overall reliability. Common weaknesses were insufficient data on factor analyses, content validity specific to ADL assessment, and responsiveness. The psychometric analyses studies on these scales had poor sample variability. There is insufficient data on the dimensionality and responsiveness of existing scales to support their use for measuring ADL in burn patients. Existing scales do not comprehensively measure ADLs as an isolated parameter. A psychometrically valid, comprehensive self-reported burn contracture scale that measures ADLs among a diverse group of burn patients needs to be developed to optimize burn contracture treatments and develop new therapies.

  19. A Goniometry Paradigm Shift to Measure Burn Scar Contracture in Burn Patients

    Science.gov (United States)

    2016-10-01

    cost extension has been granted to extend the study period to September 14, 2017. Standard Goniometry (SG) Position to Measure Wrist Extension 42...1 AD______________ AWARD NUMBER: W81XWH-14-2-0148 TITLE: A Goniometry Paradigm Shift to Measure Burn Scar Contracture in Burn Patients...subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO

  20. Burns

    Science.gov (United States)

    A burn is damage to your body's tissues caused by heat, chemicals, electricity, sunlight, or radiation. Scalds from hot ... and gases are the most common causes of burns. Another kind is an inhalation injury, caused by ...

  1. Neuroendocrine system response modulates oxidative cellular damage in burn patients.

    Science.gov (United States)

    Xie, Xiao-Qi; Shinozawa, Yotaro; Sasaki, Junichi; Takuma, Kiyotsugu; Akaishi, Satoshi; Yamanouchi, Satoshi; Endo, Tomoyuki; Nomura, Ryosuke; Kobayashi, Michio; Kudo, Daisuke; Hojo, Nobuko

    2007-02-01

    Oxygen-derived free radicals play important roles in pathophysiological processes in critically ill patients, but the data characterizing relationships between radicals and neuroendocrine system response are sparse. To search the cue to reduce the oxidative cellular damage from the point of view of neuroendocrine system response, we studied the indicators of neuroendocrine and inflammatory responses excreted in urine in 14 burn patients (42.3 +/- 31.4 years old, and 32.3 +/- 27.6% burn of total body surface area [%TBSA]) during the first seven days post burn. The daily mean amounts of urinary excretion of 8-hydroxy-2'-deoxy-guanosine (8-OHdG), a marker of oxidative cellular damage, were above the upper limit of the standard value during the studied period. The total amount of urinary excretion of 8-OHdG in the first day post burn correlated with burn severity indices: %TBSA (r = 0.63, p = 0.021) and burn index (r = 0.70, p = 0.008). The daily urinary excretion of 8-OHdG correlated with the daily urinary excretion of norepinephrine and nitrite plus nitrate (NOx) during the studied period except day 2 post burn, and correlated with the daily urinary excretion of 17-hydroxycorticosteriod (17-OHCS) in days 2, 3, and 7 post burn. These data suggest that oxidative cellular damage correlates with burn severity and neuroendocrine system response modulates inflammation and oxidative cellular damage. Modulation of neuroendocrine system response and inflammation in the treatment in the early phase of burn may be useful to reduce the oxidative cellular damage and to prevent multiple organ failures in patients with extensive burn.

  2. Poor methodological quality and reporting standards of systematic reviews in burn care management.

    Science.gov (United States)

    Wasiak, Jason; Tyack, Zephanie; Ware, Robert; Goodwin, Nicholas; Faggion, Clovis M

    2016-12-18

    The methodological and reporting quality of burn-specific systematic reviews has not been established. The aim of this study was to evaluate the methodological quality of systematic reviews in burn care management. Computerised searches were performed in Ovid MEDLINE, Ovid EMBASE and The Cochrane Library through to February 2016 for systematic reviews relevant to burn care using medical subject and free-text terms such as 'burn', 'systematic review' or 'meta-analysis'. Additional studies were identified by hand-searching five discipline-specific journals. Two authors independently screened papers, extracted and evaluated methodological quality using the 11-item A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool and reporting quality using the 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Characteristics of systematic reviews associated with methodological and reporting quality were identified. Descriptive statistics and linear regression identified features associated with improved methodological quality. A total of 60 systematic reviews met the inclusion criteria. Six of the 11 AMSTAR items reporting on 'a priori' design, duplicate study selection, grey literature, included/excluded studies, publication bias and conflict of interest were reported in less than 50% of the systematic reviews. Of the 27 items listed for PRISMA, 13 items reporting on introduction, methods, results and the discussion were addressed in less than 50% of systematic reviews. Multivariable analyses showed that systematic reviews associated with higher methodological or reporting quality incorporated a meta-analysis (AMSTAR regression coefficient 2.1; 95% CI: 1.1, 3.1; PRISMA regression coefficient 6·3; 95% CI: 3·8, 8·7) were published in the Cochrane library (AMSTAR regression coefficient 2·9; 95% CI: 1·6, 4·2; PRISMA regression coefficient 6·1; 95% CI: 3·1, 9·2) and included a randomised control trial (AMSTAR regression

  3. Physical functional outcome assessment of patients with major burns admitted to a UK Burn Intensive Care Unit.

    Science.gov (United States)

    Smailes, Sarah T; Engelsman, Kayleen; Dziewulski, Peter

    2013-02-01

    Determining the discharge outcome of burn patients can be challenging and therefore a validated objective measure of functional independence would assist with this process. We developed the Functional Assessment for Burns (FAB) score to measure burn patients' functional independence. FAB scores were taken on discharge from ICU (FAB 1) and on discharge from inpatient burn care (FAB 2) in 56 patients meeting the American Burn Association criteria for major burn. We retrospectively analysed prospectively collected data to measure the progress of patients' physical functional outcomes and to evaluate the predictive validity of the FAB score for discharge outcome. Mean age was 38.6 years and median burn size 35%. Significant improvements were made in the physical functional outcomes between FAB 1 and FAB 2 scores (ppatients were discharged home, 8 of these with social care. 8 patients were transferred to another hospital for further inpatient rehabilitation. FAB 1 score (≤ 9) is strongly associated with discharge outcome (pburn patients.

  4. Checklist and Decision Support in Nutritional Care for Burned Patients

    Science.gov (United States)

    2014-10-01

    attenuates the hypermetabolic state , improves wound healing, decreases catabolism, and increases the chance of survival. 7,8,25,26 Since nutrition plays...severely injured patient. Contemporary Surgery. 1978;13:15-20. 2. Lee JO, Herndon DN. Modulation of the post-burn hypermetabolic state . Nestle Nutrition ...in Nutritional Care for Burned Patients PRINCIPAL INVESTIGATOR: Steven E. Wolf, MD CONTRACTING ORGANIZATION: REPORT DATE

  5. Incidence of flap procedures in the management of burn patients.

    Science.gov (United States)

    Lineaweaver, William C; Craft-Coffman, Beretta; Oswald, Tanya M

    2015-03-01

    Increased survival of burn patients presents opportunities for reconstructive strategies to improve outcomes in management of acute and secondary burn injuries. To assess one such strategy, namely flap reconstruction, we reviewed cases performed during the first 4.5 years of the JMS Burn and Reconstruction Center. We found that flap procedures accounted for 0.8% of acute cases (23 of 2723 procedures) and 33% of secondary cases (260 of 790 procedures). This initial finding shows that in this practice flap procedures are applied to a small number of acute problems while flap procedures comprise 33% of secondary procedures. Reconstructive flap surgery plays a measurable role in burn treatment at this center. Further study of outcomes and timing could lead to better understanding of optimal strategies for flap reconstruction in burns.

  6. A Systematic Review of the Evolution of Laser Doppler Techniques in Burn Depth Assessment

    Directory of Open Access Journals (Sweden)

    Manaf Khatib

    2014-01-01

    Full Text Available Aims. The introduction of laser Doppler (LD techniques to assess burn depth has revolutionized the treatment of burns of indeterminate depth. This paper will systematically review studies related to these two techniques and trace their evolution. At the same time we hope to highlight current controversies and areas where further research is necessary with regard to LD imaging (LDI techniques. Methods. A systematic search for relevant literature was carried out on PubMed, Medline, EMBASE, and Google Scholar. Key search terms included the following: “Laser Doppler imaging,” “laser Doppler flow,” and “burn depth.” Results. A total of 53 studies were identified. Twenty-six studies which met the inclusion/exclusion criteria were included in the review. Conclusions. The numerous advantages of LDI over those of LD flowmetry have resulted in the former technique superseding the latter one. Despite the presence of alternative burn depth assessment techniques, LDI remains the most favoured. Various newer LDI machines with increasingly sophisticated methods of assessing burn depth have been introduced throughout the years. However, factors such as cost effectiveness, scanning of topographically inconsistent areas of the body, and skewing of results due to tattoos, peripheral vascular disease, and anaemia continue to be sighted as obstacles to LDI which require further research.

  7. Enteral nutrition intolerance in critically ill septic burn patients.

    Science.gov (United States)

    Lavrentieva, Athina; Kontakiotis, Theodore; Bitzani, Militsa

    2014-01-01

    The purpose of this study was to investigate the frequency of enteral feeding intolerance in critically ill septic burn patients, the effect of enteral feeding intolerance on the efficacy of feeding, the correlation between the infection marker (procalcitonin [PCT]) and the nutrition status marker (prealbumin) and the impact of feeding intolerance on the outcome of septic burn patients. From January 2009 to December 2012 the data of all burn patients with the diagnosis of sepsis who were placed on enteral nutrition were analyzed. Septic patients were divided into two groups: group A, septic patients who developed feeding intolerance; group B, septic patients who did not develop feeding intolerance. Demographic and clinical characteristics of patients were analyzed and compared. The diagnosis of sepsis was applied to 29% of all patients. Of these patients 35% developed intolerance to enteral feeding throughout the septic period. A statistically significant increase in mean PCT level and a decrease in prealbumin level was observed during the sepsis period. Group A patients had statistically significant lower mean caloric intake, higher PCT:prealbumin ratio, higher pneumonia incidence, higher Sequential Organ Failure Assessment Maximum Score, a longer duration of mechanical ventilation, and a higher mortality rate in comparison with the septic patients without gastric feeding intolerance. The authors concluded that a high percentage of septic burn patients developed enteral feeding intolerance. Enteral feeding intolerance seems to have a negative impact on the patients' nutritional status, morbidity, and mortality.

  8. Novel Predictors of Sepsis Outperform the American Burn Association Sepsis Criteria in the Burn Intensive Care Unit Patient

    Science.gov (United States)

    2013-01-01

    Albrecht MC, Albrecht MA, Griffith ME, et al. Impact of Acinetobacter infection on the mortality of burn patients. J Am Coll Surg 2006;203:546–50. 18...31 Sepsis is a significant problem for burn patients. It is a systemic infection that overwhelms the body’s immune system, triggering an... Infection has been demonstrated to precede multiple organ failure syndrome in 83% of burn patients, and reported mortality in this population

  9. Mortality rate associated with hospital acquired infections among burn patients

    Directory of Open Access Journals (Sweden)

    Saima Aslam Bharwana

    2016-09-01

    Full Text Available Hospital acquired infections (HAIs are the major contributors of mortality associated with burn injuries. The aim of this research was to document the antecedents affiliated with major burn injuries, hospitalization and mortality in burn patients. We performed a single center prospective study of patients admitted during 3 months period (April-June 2014 in burn wards of government hospital. There were 100 patients in this investigation which were observed weekly. The inclusion criterion was based on the shifting of patients from emergency to the wards after initial treatment of more than 24 h. Variables included were age and gender of the patient, the percent total body surface area (%TBSA burn, the cause of the burn. Mean age of patients was 30.29 years. More females (55.67% were admitted than males (44.32%. The total body surface area (%TBSA burnt were from 15%- 95% respectively moreover children were more sensitive to hospital acquired infections (HAIs and mortality rate was 34% in children with mean age of 5 years and disability of body parts were 42% among 75% were females. Whereas the most common (HAIs were primary blood stream (PBS with mean value of 30.50, wound infections (WIS were at second prevalence with mean value of 27.50, followed by sepsis (S and pneumonia (P 10.33, eye infections (EIs 4.833 and urinary tract infections (UTIs 2.667. Factors significantly (p-value= 0.000 associated with increased duration of hospitalization caught HAIs mortality include the age and gender of the patient, the cause of burn, inhalation injury, the region affected and %TBSA burnt. It concluded that the mortality was very much dependent on age and gender of the patient, burn causes, affected area as well as %TBSA burnt are considerable factors in determining the relationship of HAIs and whether the patients will survive or knuckle to injuries. Better compliance techniques, stricter control over disinfection and sterilization practices and usage of

  10. [Amylase-creatinine clearance ratios in burned patients (author's transl)].

    Science.gov (United States)

    Minaire, Y; Marichy, J; Forichon, J; Motin, J

    1978-09-01

    The amylase/creatinine clearance ratio (ACCR) has been examined every 3 days, in 34 burned patients during the 20 days following the accident. This ratio was often abnormal since it was found increased at least on one occasion, in 75% of these patients, to be compared with 23 and 13% for amylase in serum and urine respectively. In another group of 9 burned patients, the ACCR was monitored for time-period between 10 to 52 days. It was observed that a high frequency in increased ACCR was associated with a fatal outcome. Finally simultaneous measurements of ACCR and of the beta2 microglobulin/creatinine clearance ratio (MCCR) showed that increased ACCR were statistically associated with increased MCCR suggesting a decreased renal tubular reabsorption of low molecular weight proteins in these burned patients.

  11. A systematic review on burn scar contracture treatment: searching for evidence.

    Science.gov (United States)

    Stekelenburg, Carlijn M; Marck, Roos E; Tuinebreijer, Wim E; de Vet, Henrica C W; Ogawa, Rei; van Zuijlen, Paul P M

    2015-01-01

    Treating burn scar contracture remains a challenging problem for reconstructive surgeons. At present, no consensus exists on when to use what kind of technique. Therefore, a systematic review was performed on the effectiveness of the different surgical techniques after burn scar contracture release. Electronic databases were searched using a predefined search strategy. Studies evaluating the outcome of surgical techniques for the treatment of burn scar contractures were included. The methodological quality was tested and the data were summarized. One thousand six hundred fourty-nine papers were identified of which 17 met the inclusion criteria. Three papers reported on a controlled trial, 14 were cohort studies, including 10 of a pre-post operative design and 4 of a comparative design. The papers described outcomes of grafts, flaps with random or defined vascularization, and dermal substitutes. All studies had methodological shortcomings and most used inappropriate statistical methods. The current evidence on the effectiveness of reconstruction techniques for burn scar contractures was summarized. Due to the scarcity and low quality of the included studies, no definitive conclusions could be reached about the effectiveness of different techniques. Therefore, no direct implications for daily practice could be made. However, recommendations could be given for improvement of the quality of further primary research on the effectiveness of surgical treatment strategies for burn scar contracture release.

  12. Successful treatment of invasive burn wound infection with sepsis in patients with major burns

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To investigate the clinical characteristics of invasive bum wound infection with sepsis in patients with major burns and to summarize the successful expenences in the treatment of such patients. Methods Eight patients with major bums, complicated by invesive bum wound infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock. The plasma concentrations of IL-6,IL-8,TNFα and lypopolysaccharibe (LPS) were assayed before and after surgical intervention, as well as when the patient' s vital signs became stable. Results The patients' conditions usually deterieorated abruptly when extensive invasive bum wound infection emerged. While multi-microbial infection was usually found, Pseudomonas aeruginosa was the predominant bactena isolated from the subeschar tissue. The plasma concentrations of IL-6, IL-8, TNFα and LPS before surgical intervention wore significantly higher than those after surgical intervention (P<0.05).The lowest levels of the inflammatory mediators were abserved when the patients'conditions became stable,and the values were significantly lower than those before surgical intervention ( P<0.001). Conclusion Since the main cause of burn wound sepsis is the presence of a large area of infected bum wound, they should be excised and covered as early as possible. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn sepsis. Athough favorable results should be attributed to compmhessive treatment, we believe that early, aggressive and thorough surgical excision of infected burn wounds, followed by sound and complete coverage of the area, play a crucial role.

  13. National trends in burn and inhalation injury in burn patients: results of analysis of the nationwide inpatient sample database.

    Science.gov (United States)

    Veeravagu, Anand; Yoon, Byung C; Jiang, Bowen; Carvalho, Carla M; Rincon, Fred; Maltenfort, Mitchell; Jallo, Jack; Ratliff, John K

    2015-01-01

    The aim of this study was describe national trends in prevalence, demographics, hospital length of stay (LOS), hospital charges, and mortality for burn patients with and without inhalational injury and to compare to the National Burn Repository. Burns and inhalation injury cause considerable mortality and morbidity in the United States. There remains insufficient reporting of the demographics and outcomes surrounding such injuries. The National Inpatient Sample database, the nation's largest all-payer inpatient care data repository, was utilized to select 506,628 admissions for burns from 1988 to 2008 based on ICD-9-CM recording. The data were stratified based on the extent of injury (%TBSA) and presence or absence of inhalational injury. Inhalation injury was observed in only 2.2% of burns with burns with 80 to 99% TBSA. Burn patients with inhalation injury were more likely to expire in-hospital compared to those without (odds ratio, 3.6; 95% confidence interval, 2.7-5.0; P Patients treated at rural facilities and patients with hyperglycemia had lower mortality rates. Each increase in percent of TBSA of burns increased LOS by 2.5%. Patients with burns covering 50 to 59% of TBSA had the longest hospital stay at a median of 24 days (range, 17-55). The median in-hospital charge for a burn patient with inhalation injury was US$32,070, compared to US$17,600 for those without. Overall, patients who expired from burn injury accrued higher in-hospital charges (median, US$50,690 vs US$17,510). Geographically, California and New Jersey were the states with the highest charges, whereas Vermont and Maryland were states with the lowest charges. The study analysis provides a broad sampling of nationwide demographics, LOS, and in-hospital charges for patients with burns and inhalation injury.

  14. Visual analogue thermometer: a valid and useful instrument for measuring pain in burned patients.

    Science.gov (United States)

    Choinière, M; Auger, F A; Latarjet, J

    1994-06-01

    This study assessed the psychometric qualities of a new pain rating instrument--the visual analogue thermometer (VAT)--which was developed to measure pain in burned patients. The validity and utility of the VAT was assessed and compared with a conventional numeric (NUM) and adjective pain scale (ADJ) with a group of 103 burned patients and 51 nurses. Analyses of the results support the concurrent and construct validity of the VAT as a pain measure. Furthermore, the VAT gave more sensitive and precise pain measures than the ADJ and/or NUM scales. No major difference between the three scales emerged in the patients' preference. The same was true for the nurses' evaluation except for those who had more clinical experience with the VAT and who tended to prefer this scale for its accuracy and ease of utilization. The VAT appears to be a valid, sensitive and clinically useful tool to measure pain in burned patients. A systematic pain assessment procedure which can be easily implemented in burn care facilities is presented.

  15. The role of resilience in the recovery of the burn-injured patient: an integrative review

    Directory of Open Access Journals (Sweden)

    Kornhaber R

    2016-05-01

    Full Text Available R Kornhaber,1 H Bridgman,2 L McLean,3–6 J Vandervord7 1School of Health Sciences, Faculty of Health, University of Tasmania, Hobart, TAS, 2Centre for Rural Health, School of Health Sciences, Faculty of Health, University of Tasmania, Hobart, TAS, 3Brain and Mind Centre, 4Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, 5Sydney West and Greater Southern Psychiatry Training Network, Cumberland Hospital, Western Sydney Local Health District, Sydney, NSW, 6Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, 7Severe Burns Injury Unit, Royal North Shore Hospital, St Leonards, NSW, Australia Abstract: Severe burn injuries are catastrophic life events resulting in significant physical and psychological effects. With long periods of hospitalization and rehabilitation, burn survivors encounter many issues, including an altered body image and loss of function and independence that subsequently influence quality of life and the family unit. Consequently, resilience has been identified as a fundamental concept that facilitates the adaptability required to navigate the lengthy and complex recovery process. However, over time, the notion of resilience has shifted from a static, innate trait to a fluid and multidimensional concept. Here, we review the evidence surrounding the role of resilience in the recovery of burn injury. This integrative review was based on a systematic search of five electronic databases. Of the 89 articles identified, ten primary research papers met the inclusion criteria. Three key themes were identified encompassing relational strengths, positive coping, and the resistance to trauma symptoms that are fundamental constructs associated with developing and sustaining resilience that resonate with the broader literature on burn recovery. However, limited evidence is currently available within the burns context. While resilience appears to be a vital

  16. [On the rehabilitation of pediatric burn patients in China].

    Science.gov (United States)

    Jia, Chi-yu

    2013-02-01

    Rehabilitation medicine is an emerging discipline. At present, there are many problems in rehabilitation of pediatric burn patients in China, including idea lag, weak technical force, lack of standardized technology, disunity in evaluation indexes, etc. The new era of reformation of health system and development and flourish of medical insurance business bring good opportunity for the development of rehabilitation medicine.

  17. The Changing Epidemiology of Infection in Burn Patients,

    Science.gov (United States)

    1992-01-01

    Ann. Surg. 176: 108, 1972 por organismos oportunisticos no bacterianos en Una etapa en 12. Pruitt, B.A., Jr,: The burn patient: 11. Later care and...S.H., Hubbard, G.B., McManus, W.F., Mason, A.D._ Pruitt, paciente han variado en concierto con los cambios en Ia flora de B.A. Jr.: Frozen section

  18. Nutritional, immunological and microbiological profiles of burn patients

    Directory of Open Access Journals (Sweden)

    ASAA Barbosa

    2009-01-01

    Full Text Available A burn is a lesion on an organic tissue resultant from direct or indirect action of heat on the organism. The present study aimed to evaluate the nutritional, immunological and microbiological status of burn patients at the Bauru State Hospital, São Paulo state, Brazil, in 2007. Eight patients, aged more than 18 years and injured up to 24 hours, were evaluated at the moment of hospitalization and seven days later. All victims were males with a mean age of 38 years. On average, 17.5% of their body surfaces were burned and 50% of the patients were eutrophic. There were significant alterations in levels of erythrocytes, hemoglobin, hematocrit, total protein and albumin due to increased endothelial permeability, direct destruction of proteins in the heat-affected area and blood loss from lesions or debridement. At a second moment, cytokines IL-6 and TNF-α had augmented significantly, with IL-6 presenting elevated levels in relation to controls at the first moment. Microbiological analysis showed that 100% of the samples collected at hospital admission were negative and after one week Staphylococcus aureus was found in all cultures. Therefore, a burn patient may be considered immunosuppressed and these results indicate significant nutritional, immunological and microbiological alterations that can interfere in his recovery.

  19. Clinical characteristics and treatment of burn wound sepsis in extensive burn patients: successful experience with eight cases

    Institute of Scientific and Technical Information of China (English)

    柴家科; 盛志勇; 杨红明

    2000-01-01

    Eight burn wound sepsis patients, in which 6 cases were diagnosed as MODS and two as septic shock, were treated consecutively in our hospital from September 1997 to October 1998. The plasma concentration of IL-6, IL-8, TNFα and LPS were assayed before and after surgical intervention, as well as when the patients' vital signs became stable. The results showed: ①The patients' conditions abruptly deteriorated when the burn wound sepsis emerged;②The major cause related to burn wound sepsis was extensive burn injuries, with large areas of deep burn remaining open; ③Although wound swabs taken on admission revealed the presence of colonization by many pathogenic bacteria, Pseudomonas aeruginosa was one of the most frequent bacteria isolated from the subeschar tissue; ④The plasma concentrations of IL-6, IL-8, TNF and LPS before surgical intervention were significantly higher than that after surgical intervention (P<0.05) ;⑤The lowest level of the inflammatory mediators was observed when the patients' conditions became stable, as compared with before surgical intervention (P<0. 001).These findings suggest that the clinical characteristics of burn wound sepsis are abrupt deterioration of the general condition and prominent septic symptoms, often complicated by MODS. The main cause of burn wound sepsis is the presence of a large area of open deep burn wounds, which should be excised and covered early. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn wound sepsis. Although success in treating these patients is the result of appropriate application of multiple treatments, early, aggressive and thorough surgical excision of invasive burn infectious tissue and closure of wound play a crucial role in the successful treatment of patients complicated by burn wound sepsis. Other treatments are adjuvant but also important.

  20. A Medical Mystery: Unexplained Renal Failure in Burn Patients.

    Science.gov (United States)

    Lands, Harrison M; Drake, David B

    2017-01-31

    The objective of this study was to review the investigation that uncovered the medical mystery of burn patients developing unexpected renal failure. The authors examined published and unpublished manuscripts and case reports, as well as conducted personal interviews with primary sources. In the late 1970s, emergence of resistant bacterial strains to the topical antimicrobial silver sulfadiazine occurred at the University of Virginia Medical Center. In the search for an alternative topical antimicrobial with known coverage of Pseudomonas aeruginosa, Furacin Soluble Dressing was substituted. However, Furacin Soluble Dressing produced an unexpected toxicity syndrome of hyperosmolality, metabolic gap acidosis, hypercalcemia, and ultimately renal failure. In a search for an antimicrobial with an improved spectrum against Pseudomonas, a Federal Drug Administration-approved product was used to treat large surface area burns. An unexpected toxicity syndrome developed which was traced to the polyethylene glycol base of Furacin Soluble Dressing. This substance was absorbed through the burn wounds, metabolized, and resulted in a toxicity syndrome leading to renal failure. The burn community should be cautious when using products that may be approved as nontoxic for small surface area application, as they may have unexpected medical side effects when used with large surface area burns.

  1. Management of a Patient With Faciocervical Burns and Inhalational Injury Due to Hydrofluoric Acid Exposure.

    Science.gov (United States)

    Yuanhai, Zhang; Xingang, Wang; Liangfang, Ni; Chunmao, Han

    2014-05-01

    Hydrofluoric acid, a highly dangerous substance, can cause tissue damage and systemic toxicity by its unique mechanisms. Many cases of severe faciocervical burns due to hydrofluoric acid exposure are lethal. Herein, we present a case of 37-year-old man who suffered from hydrofluoric acid burns to his face, anterior neck, lips, and nasal cavity. On admission, this patient coughed with much sputum, and the chest auscultation detected rough breath sounds, wheezes, and very weak heart sounds, indicating possible inhalation injury. This case highlights the extreme complexity of managing this kind of injury. Timely and accurate wound treatment and respiratory tract care, as well as active systematic support treatment, played vital roles in the management of this patient.

  2. [Pseudothrombocytopenia induced by ethylenediaminetetraacetic acid in burned patients].

    Science.gov (United States)

    Carrillo-Esper, Raúl; Contreras-Domínguez, Vladimir

    2004-01-01

    The EDTA-dependent pseudothrombocytopenia is a false decrease in the number of platelets below the normal value when analyzed with automated devices. There is an incidence of 0.09 to 0.21% in hospitalized patients. Pseudothrombocytopenia is secondary to platelet clumping induced by antibodies in the presence of EDTA and has been associated with sepsis, cancer, cardiac surgery and drugs. We report the first case of pseudothrombocytopenia induced by EDTA in a burn patient.

  3. Few Young U.S. Burn Patients Transferred to Specialized Centers

    Science.gov (United States)

    ... gov/news/fullstory_160791.html Few Young U.S. Burn Patients Transferred to Specialized Centers Researchers call for clearer ... guidelines are needed on the care of pediatric burn patients, said the researchers after analyzing 2012 data from ...

  4. Vitamin E Supplementation in Burn Patients

    Science.gov (United States)

    2014-10-01

    patients, oxidative stress, pulmonary function, ICU days 3. Accomplishments: a. What were the major goals and objectives of the project? Our...subjects. Dr. Linda Sousse (Co-Investigator and Study Coordinator) has visited the site to ensure that all sample collection is consistent at all sites

  5. Use of sugammadex on burn patients: descriptive study

    Directory of Open Access Journals (Sweden)

    Eduardo Rodríguez Sánchez M.

    2015-08-01

    Full Text Available OBJECTIVES: A burn patient is a challenge for any anesthesiologist, undergoing several surgeries during admission, and requiring general anesthesia and muscle relaxation most of the times. The victim may have respiratory system impairment and a response to muscle relaxants that differs from the healthy patient, thus proper monitoring and reversal is crucial. We analyzed sugammadex effectiveness and safety in this population.MATERIALS AND METHODS: It was a prospectively descriptive study, including 4 patients, and all of them were considered major burn patients, who underwent escharotomy with general anesthesia and neuromuscular relaxation. The main variable was the time for recovery of a TOF higher than 0.9 after the administration of sugammadex before extubation.RESULTS: Mean time of recovery from a TOF ratio higher than 0.9 following the administration of Sugammadex was of 4.95 min 95% CI (3.25-6.64, p= .53.CONCLUSIONS: The reversion of neuromuscular relaxation with sugammadex appears to be effective and safe in the burn patient. More analytical, comparative studies of larger populations would be necessary to confirm these data.

  6. Early and Late Acute Kidney Injury in Severely Burned Patients

    Science.gov (United States)

    Witkowski, Wojciech; Kawecki, Marek; Surowiecka-Pastewka, Agnieszka; Klimm, Wojciech; Szamotulska, Katarzyna; Niemczyk, Stanisław

    2016-01-01

    Background This study evaluated factors influencing early and late occurrence of AKI in severely burned patients and assessed the relationship between time of occurrence of AKI and mortality of AKI patients. Material/Methods Renal function was evaluated at 3 time points: at admission, at the critical point or middle point of hospitalization, and at the endpoint for which death or a discharge from the center was considered. AKI criteria were: decrease in GFR of less than 60 ml/min at admission, decrease in GFR of more than 75% compared to baseline, and decrease in the daily diuresis of less than 500 ml/24 h. Results At admission, 15.1% of the patients had eGFR burns, respiratory failure, low protein concentration (for all ppatients. Mortality was 100% with the initial GFR ≥60, 100% with the initial GFR patients and mortality in this group was 79.2%. Mortality in the entire group with AKI was 88.0% versus 24.5%. Conclusions The frequent occurrence of AKI, especially early, worsens the prognosis for survival. Assessment of renal function should be included in the prognostic scales for burned patients. PMID:27746455

  7. Self-Inflicted Burns in Patients with Chronic Combat-Related Post-Traumatic Stress Disorder

    OpenAIRE

    Braš, Marijana; Lončar, Zoran; Boban, Maja; Gregurek, Rudolf; Brajković, Lovorka; Tomičić, Hrvoje; Muljačić, Ante; Mičković, Vlatko; Kalenić, Barbara

    2007-01-01

    This study examined self-inflicted burns in case series of four patients with chronic combat-related post-traumatic stress disorder (PTSD). Those patients were hospitalized in the Burn Unit of the University Hospital of Traumatology in Zagreb because of severe burns and had a premorbid psychiatric history of PTSD. Demographic data and information regarding the circumstances surrounding the incident, burn severity, treatment and outcomes of these patients were collected. The author...

  8. Dysnatremias and Survival in Adult Burn Patients: A Retrospective Analysis

    Science.gov (United States)

    2013-01-11

    DOI: 10.1159/000346206 Dysnatremias and Survival in Adult Burn Patients: A Retrospective Analysis Ian J. Stewart a Benjamin D. Morrow a... mortality rate of 4.3%. On Cox proportional hazard regres- sion age, %TBSA, ISS, and AKIN stage were found to be sig- nificant predictors of mortality ...hypernatremia [1–4] and hyponatremia [1, 4, 5] have been examined in the hospital setting and have been found to be significantly associated with mortality

  9. [The basic principles of the antibiotic therapy of burn patients].

    Science.gov (United States)

    Leseva, M; Khadzhiĭski, O; Grigorov, G; Dimitrova, A

    1995-01-01

    Proceeding from many years experience with antibiotic treatment of bacterial infections in burnt patients, accumulated in the Section of Burns and Plastic Surgery, and pertinent literature reports, the basic principles of antibacterial therapy in this contingency of patients are set forth. A detailed protocol is presented, based on: 1) presence of clinical and laboratory evidence of infection and its location, and the most likely causing agents involved, 2) bacteriological data on the commonest causing agents of local and systemic infection in burns, and their sensitivity to antibiotics, 3) duration and surface, deepness and location of the burn injury, and 4) spectrum of action, pharmacokinetics, pharmacodynamics and side effects of the various groups of antibiotics, consistent with the age and concomitant diseases of the patients. A number of antibiotic constellations in cases presenting sepsis where resorting to "blind" therapy is necessitated, are recommended. It is underscored that the protocol suggested is open for modifications, and also that antibiotic therapy efficiency may be anticipated only when combined with adequate infusional and operative management.

  10. Povidone-iodine in the treatment of burn patients.

    Science.gov (United States)

    Zellner, P R; Bugyi, S

    1985-03-01

    The improvement in infusion therapy of burn patients in the last decades has led to a marked reduction of the early mortality rate and to an increase in the importance of severe wound infection and septicaemia. For the control of infection, detailed bacteriological monitoring is recommended. The main therapeutic fields for prevention of infection are: immunotherapy, antisepsis, aseptic techniques, and rapid restoration of the destroyed body surface. The most important part of antisepsis in burns is topical treatment. The good bacteriological and clinical results with povidone-iodine (PVP-I), in combination with open treatment are described. A possible disadvantage of this therapy was the extensive iodine resorption. However, no disorders of thyroid function were revealed, and the TRH test indicated no abnormal reactions of the hypothalamus-pituitary axis. The high serum and urine iodine levels returned rapidly to normal after discontinuing the PVP-I application.

  11. How Disabling Are Pediatric Burns? Functional Independence in Dutch Pediatric Patients with Burns

    Science.gov (United States)

    Disseldorp, Laurien M.; Niemeijer, Anuschka S.; Van Baar, Margriet E.; Reinders-Messelink, Heleen A.; Mouton, Leonora J.; Nieuwenhuis, Marianne K.

    2013-01-01

    Although the attention for functional outcomes after burn injury has grown over the past decades, little is known about functional independence in performing activities of daily living in children after burn injury. Therefore, in this prospective cohort study functional independence was measured by burn care professionals with the WeeFIM[R]…

  12. The effect of extensive excision of burn wound with invasive infection on hypermetabolism in burn patients with sepsis

    Institute of Scientific and Technical Information of China (English)

    柴家科; 盛志勇; 刁力

    2000-01-01

    Objective: To evaluate the effect of extensive excision of invasive burn wound infection on hypermetabolic response in burn patients with sepsis. Methods:Eight patients with major burn, complicated by invasive burn wound infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. REEs were monitored by means of Cardiorespiratory Diagnostic System (Medical Graphics Corporation, USA) at patients bedside. Plasma concentration of IL-6、IL-8、TNF-α and LPS were assayed before and after surgical intervention and at the time when the patients' vital signs became stable. Correlation analysis between REEs and IL-6、IL-8、TNF-α、LPS was respectively made. Results: A total of 8 patients were treated and all of them survived. Values of REE before surgical intervention were significantly higher than those after surgical intervention(P<0.01), and when patients vital signs became stable the values were significantly lower compared with that after surgical intervention(P<0.01). The plasma concentrations of IL-6、 IL-8、TNF-α and LPS after excision of invasive burn wound infection were significantly lower than those before surgical intervention (P<0.05). The lowest levels of these inflammatory mediators were observed when the conditions of patients became stable, and the values were significantly lower compared with those before surgical intervention (P<0. 001). There was a significant positive correlation between REE level and respective values of plasma IL-6、 IL-8、 TNF-α、 LPS(P <0.01). Conclusions: It is deemed that the extensive excision of invasively infected burn wound in patients with major burn should be performed as early as possible to reduce an increased release of inflammatory mediators, and to control the hypermetabolic response during sepsis.

  13. A Goniometry Paradigm Shift to Measure Burn Scar Contracture in Burn Patients

    Science.gov (United States)

    2015-10-01

    movement.  Due to this  biomechanical  difference, the validity of current standard GM methods related to patient  function with burn scars is questioned...as a source of tissue recruitment or  restriction when evaluating ROM.  Standard GM methods do not account for the cutaneous  biomechanical ...STANDARD POSITION  Testing Position: Sitting upright with thoracic and lumbar  spine supported,  cervical  spine should have 0 degrees of  rotation or

  14. Is location of burns related to outcome? A comparison between burns on extremities and burns on head and/or trunk in patients with low to intermediate TBSA in a burn center in The Netherlands.

    Science.gov (United States)

    Menger, Tirsa; Krijnen, Pieta; Tuinebreijer, Willem E; Breederveld, Roelf S

    2014-01-01

    In the literature no study was found about the effect of location of burns on outcome. The objective of this retrospective study was to investigate the effect of location on outcome parameters of 371 patients, admitted to our burn center from January 2009 to December 2011. The patients were included in the study if more than 80% of the burn(s) was localized either on the extremities or on the head and/or trunk. Two groups of TBSA were elaborated, low: 0 to 5% and intermediate: 5 to 15%. Two-hundred ninety-two patients (78.7%) had a low TBSA (patients died. The patients with an intermediate TBSA were on average 8.0 days longer admitted compared with the patients with a low TBSA adjusted for age and depth (95% confidence interval: 6.5-9.4). The patients with burns on the head and/or trunk were more often admitted to the intensive care unit, mostly as a result of suspected inhalation injury (6.2 vs 0.9%; P = .008). More complications were seen in the intermediate TBSA group. In this study no difference in outcome was found between burns on the head and/or trunk or on extremities. The patients with burns on the head and/or trunk group are more frequently admitted to intensive care.

  15. ED handles 30 burn patients after plant fire and explosion in Georgia.

    Science.gov (United States)

    2008-04-01

    Dealing with a mass casualty event involving a high number of burn victims requires strategic use of ED resources. The ED at Memorial University Medical Center in Savannah, GA, was praised by the receiving burn center for the care it gave victims of a recent plant disaster. Here are some of their key strategies: After making your primary concern the patient's airway, turn to fluid resuscitation and pain management. Be certain burn victims are placed in warm rooms and are covered with blankets. Have a pre-plan with a regional burn center, then establish contact with that center in multiple-burn patient incidents.

  16. Burns ITU admissions: length of stay in specific levels of care for adult and paediatric patients.

    Science.gov (United States)

    Maan, Zeshaan N; Frew, Quentin; Din, Asmat H; Unluer, Zeynep; Smailes, Sarah; Philp, Bruce; El-Muttardi, Naguib; Dziewulski, Peter

    2014-12-01

    Prediction of total length of stay (LOS) for burns patients based on the total burn surface area (TBSA) is well accepted. Total LOS is a poor measure of resource consumption. Our aim was to determine the LOS in specific levels of care to better inform resource allocation. We performed a retrospective review of LOS in intensive treatment unit (ITU), burns high dependency unit (HDU) and burns low dependency unit (LDU) for all patients requiring ITU admission in a regional burns service from 2003 to 2011. During this period, our unit has admitted 1312 paediatric and 1445 adult patients to our Burns ITU. In both groups, ITU comprised 20% of the total LOS (mean 0.23±0.02 [adult] and 0.22±0.02 [paediatric] days per %burn). In adults, 33% of LOS was in HDU (0.52±0.06 days per %burn) and 48% (0.68±0.06 days per %burn) in LDU, while in children, 15% of LOS was in HDU (0.19±0.03 days per %burn) and 65% in LDU (0.70±0.06 days per %burn). When considering Burns ITU admissions, resource allocation ought to be planned according to expected LOS in specific levels of care rather than total LOS. The largest proportion of stay is in low dependency, likely due to social issues.

  17. Airway management in patients with burn contractures of the neck.

    Science.gov (United States)

    Prakash, Smita; Mullick, Parul

    2015-12-01

    Airway management of patients with burn contracture of the neck (PBC neck) is a challenge to the anesthesiologist. Patient evaluation includes history, physical and airway examination. A safe approach in the airway management of a patient with moderate to severe PBC neck is to secure the airway with the patient awake. The anesthesiologist should have a pre-planned strategy for intubation of the difficult airway. The choices advocated for airway management of such patients include awake fiberoptic-guided intubation, use of intubating laryngeal mask airway, intubation without neuromuscular blocking agents, intubation with neuromuscular blocking agents after testing the ability to ventilate by mask, pre-induction neck scar release under local anesthesia and ketamine or sedation followed by direct laryngoscopy and intubation and video-laryngoscope guided intubation, amongst others. Preparation of the patient includes an explanation of the proposed procedure, sedation, administration of antisialogogues and regional anesthesia of the airway. The various options for intubation of patients with PBC neck, intraoperative concerns and safe extubation are described. Back-up plans, airway rescue strategies and a review of literature on this subject are presented.

  18. Comparison of Efflux Pump Involvement in Antibiotic Resistance Among Pseudomonas aeruginosa Isolates of Burn and Non-Burn Patients

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    Azimi

    2016-05-01

    Full Text Available Background Pseudomonas aeruginosa is an important cause of hospital-acquired infections that can create serious problem for patients and physicians. Many factors are associated with the antibiotic resistance of P. aeruginosa, such as efflux pumps. Objectives The aim of this study was the phenotypic and molecular detection of efflux pumps in our clinical P. aeruginosa isolates in a comparison between burn and non-burn specimens. Materials and Methods In this study, clinical strains of P. aeruginosa were collected from burn and non-burn specimens from April - July 2013. Antibiotic susceptibility testing of the isolates was performed after biochemical and molecular identification. The minimum inhibitory concentration (MIC of imipenem, cefepime, gentamycin, and ciprofloxacin, with and without carbonyl cyanide 3-chlorophenylhydrazone (CCCP, was determined for phenotypic detection of efflux pumps. Results Our results confirmed 203 and 60 P. aeruginosa isolates from burn and non-burn specimens, respectively. The most antibiotic resistance was observed against tobramycin in both group of specimens, and no resistance was seen to colistin. Phenotypic detection of efflux pumps was determined to correlate to a > 4-fold decrease in the MICs of the tested antibiotics with CCCP compared to without CCCP in 57 strains. Conclusions High-level antibiotic resistance can occur as a result of multidrug efflux pumps combined with other mechanisms of resistance. However, the association between over-expression of these genes and highly resistant clinical isolates cannot be ignored.

  19. Sepsis in burned patients Sepse em pacientes queimados

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    Jefferson Lessa S. de Macedo

    2003-12-01

    Full Text Available A prospective study was conducted from June 2001 to May 2002 at the Burns Unit of Hospital Regional da Asa Norte, Brasília, Brazil. During the period of the study, 252 patients were treated at the Burns Unit, 49 (19.4% developed clinically and microbiologically proven sepsis. Twenty-six (53.1% were males and 23 (46.9% females with a mean age of 22 years (range one to 89 years and mean burned body surface area of 37.7 ± 18.4% (range 7 to 84%. Forty-three patients had flame burns, five a scald and one an electric burn. These 49 patients had a total of 62 septic episodes. Forty (81.6% patients had only one and nine (18.4% had up to three episodes of sepsis. Thirty (61.2% patients had their first septicemic episode either earlier or by one week postburn. Out of 62 septic episodes, 58 were due to bacteria and four due to Candida sp. The most common bacteria isolated from blood culture were Staphylococcus aureus, coagulase-negative Staphylococcus, Acinetobacter baumannii, Enterobacter cloacae and Klebsiella pneumoniae. Eleven (18.9% episodes were due to oxacillin resistant Staphylococcus aureus. Acinetobacter baumannii was sensitive to ampicillin/sulbactam in 71.4% and to imipenem in 85.7% of the cases. The primary foci of sepsis were the burn wound in 15 ( 24.2% episodes. The most common clinical findings of sepsis in these patients were fever, dyspnea, hypotension and oliguria. The most common laboratory findings of these patients were anemia, leukocytosis, hypoalbuminemia and thrombocytopenia. Twelve (24.5% patients died. The appropriate knowledge of clinical, epidemiological, laboratorial and microbiological aspects of sepsis in burned patients permits an adequate diagnosis and treatment of this complication.Um estudo prospectivo foi realizado de junho de 2001 a maio de 2002, na Unidade de Queimados do Hospital Regional da Asa Norte, Brasília, Brasil. Durante o período do estudo, 252 pacientes foram tratados na Unidade de Queimados, 49 (19

  20. Multi-variate analysis of burns patients in the Singapore General Hospital Burns Centre (2003-2005).

    Science.gov (United States)

    Chong, S J; Song, C; Tan, T W; Kusumawijaja, G; Chew, K Y

    2009-03-01

    The Burns Centre at the Singapore General Hospital (SGH) serves as a tertiary referral centre for burns management for Singapore's 4 million residents as well as the Southeast Asia region. Our study is a multivariate analysis of all burns patients admitted between 2003 and 2005. A total of 482 patients were admitted during this period with an average annual admission of 161. This represents a low incidence of 0.04 per 1000 admissions for the Singapore population. 13.3% of the study population were children, which is lower than previous studies. The mean age at admission was 35 years old and the male:female ratio was 1.9:1. We found a significant difference in age between the local and foreign patients, with the latter being younger. Our study demonstrated a 7.3% increase in cases of occupational burns. The bulk of our patients (57.3%) were directly admitted from SGH's Accident and Emergency Department. The patient characteristics of the various referral sources were found to be very different. GP referrals had significantly lower TBSA while overseas patients had significantly higher TBSA and longer length of stay. The mean and median time to admission was 3.05 days (+/-6.26) and 0 (0-60) day, respectively and the mean and median time to surgery was 7.33 days (+/-8.18) and 5 (0-22) days, respectively. The most common cause of burns was due to scalding. The mean extent of burn (TBSA) was 13.5% (+/-18.0), with significant correlation with the social background. Length of stay was dependent on the need for surgery. The overall mortality rate in this study population was 4.5%, with inhalation injury the main aetiological factor. In addition, the mean duration of the first surgery that patients undergo was significantly longer than that of the second one. This information will be useful for estimating operation times in the future. Finally, Acinetobacter baumannii was the most common bacteria in wound cultures. There is a need for periodic reviews of wound cultures in

  1. [The pain from burns].

    Science.gov (United States)

    Latarjet, J

    2002-03-01

    The painful events associated with the treatment of a severe burn can, because of their long-lasting and repetitive characteristics, be one of the most excruciating experiences in clinical practice. Moreover, burn pain has been shown to be detrimental to burn patients. Although nociception and peripheral hyperalgesia are considered the major causes of burn pain, the study of more hypothetical mechanisms like central hyperalgesia and neuropathic pain may lead to a better understanding of burn pain symptoms and to new therapeutic approaches. Continuous pain and intermittent pain due to therapeutic procedures are two distinct components of burn pain. They have to be evaluated and managed separately. Although continuous pain is by far less severe than intermittent pain, the treatment is, in both cases, essentially pharmacological relying basically on opioids. Because of wide intra- and inter-individual variations, protocols will have to leave large possibilities of adaptation for each case, systematic pain evaluation being mandatory to achieve the best risk/benefit ratio. Surprisingly, the dose of medication decreases only slowly with time, a burn often remaining painful for long periods after healing. Non pharmacological treatments are often useful and sometimes indispensable adjuncts; but their rationale and their feasibility depends entirely on previous optimal pharmacological control of burn pain. Several recent studies show that burn pain management is inadequate in most burn centres.

  2. Novel predictors of sepsis outperform the American Burn Association sepsis criteria in the burn intensive care unit patient.

    Science.gov (United States)

    Mann-Salinas, Elizabeth A; Baun, Mara M; Meininger, Janet C; Murray, Clinton K; Aden, James K; Wolf, Steven E; Wade, Charles E

    2013-01-01

    The purpose of this study was to determine whether systemic inflammatory response syndrome (SIRS) and American Burn Association (ABA) criteria predict sepsis in the burn patient and develop a model representing the best combination of novel clinical sepsis predictors. A retrospective, case-controlled, within-patient comparison of burn patients admitted to a single intensive care unit from January 2005 to September 2010 was made. Blood culture results were paired with documented sepsis: positive-sick, negative-sick (collectively defined as sick), and negative-not sick. Data for all predictors were collected for the 72 hours before blood culture. Variables were evaluated using regression and area under the curve (AUC) analyses. Fifty-nine subjects represented 177 culture periods. SIRS criteria were not discriminative: 98% of the subjects met criteria. ABA sepsis criteria were different on the day before (P = .004). The six best-fit variables identified for the model included heart rate > 130 beats per min, mean arterial pressure 150 mg/dl. The model was significant in predicting positive-sick and sick, with an AUC of 0.775 (P burn patient.

  3. Neuronal Plasticity Associated with Burn Injury and Its Relevance for Perception and Management of Pain in Burn Patients

    Directory of Open Access Journals (Sweden)

    Terence J Coderre

    2000-01-01

    Full Text Available Through the introduction of the gate control theory and various subsequent works, Ronald Melzack has inspired many investigators worldwide to realize two important facts about pain. First, incoming pain messages are subject to both negative and positive modulation, which significantly affect its perception. Second, the progression of knowledge about the basic mechanisms underlying persistent and chronic pain is critically dependent on the increased understanding of the complexity of the symptoms experienced by pain patients. The present paper examines these two very important issues in an effort to understand better the mechanisms that underlie the pain suffered by burn patients. The physiological responses to burn injury involve many different mediators and mechanisms, all of which contribute to pain perception and development of neuronal plasticity underlying short and long term changes in pain sensitivity. While experimental burn injuries in humans and animals are typically well controlled and mild, in burn victims, the severity is much more variable, and clinical care involves repeated traumas and manipulations of the injured sites. Recurrent inputs from damaged and redamaged tissue impinge on a nervous system that becomes an active participant in the initiation of changes in sensory perception and maintenance of long term sensory disturbances. Recently acquired experimental evidence on postburn hyperalgesia, central hyperexcitability and changes in opioid sensitivity provides strong support that burn patients need an analgesic approach aimed at preventing or reducing the 'neural' memory of pain, including the use of more than one treatment modality. Burn injuries offer a unique opportunity to combine experimental and clinical research to understand pain mechanisms better. Over the years, Ronald Melzack has insisted that one of the most laudable enterprises in research is to span the gap between these two often separate worlds.

  4. An epidemiological study of 500 paediatric burn patients in Mumbai, India

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    Verma S

    2007-01-01

    Full Text Available Aim: To study the epidemiological data of paediatric burn patients to determine the role of demographic distribution and epidemiological parameters for assessment of mortality rate and development of burn prevention strategy. Materials and Methods : Epidemiological data of 500 patients admitted to the Burns and Plastic Surgery Unit of B.J. Wadia Hospital, Mumbai over a period of six years (2000-2005 was reviewed from medical records. Age, sex, demographic distribution, seasonal variation, total body surface area (TBSA involved, type and place of burn injury, parental occupation, family size, first aid and mortality rate were studied. Result: Median age group for patient was 3.44 years (range one month to 14 years. The majority (24% of burns occurred in children between the one to two years age group. Male to female sex ratio was 1.38:1. Most of the patients were from the defined demographic region served by the hospital. A significant number of patients however were from outside this region. Burn injury occurred predominantly during winter. Most common type of burn was scalds which occurred mainly in domestic circumstances. In the majority of patients, less than 10% TBSA was involved. All patients were managed as per the unit protocol. Mortality rate was 10.4%. Mortality rate was high in patients having more than 40% TBSA involvement. Seventy-three per cent of the total deaths occurred in the patients coming from regions outside the demographic region served by the hospital. Parental occupation, family size and the first aid did not affect the mortality rate. Conclusion: Availability of a burn care unit in the vicinity can decrease the mortality rates in the paediatric burn patients. An intense and focused burn prevention campaign to educate the general population about dangerous aetiological factors will decrease the incidence of paediatric burns.

  5. Successful skin homografting from an identical twin in a severely burned patient.

    Science.gov (United States)

    Turk, Emin; Karagulle, Erdal; Turan, Hale; Oguz, Hakan; Abali, Ebru Sakallioglu; Ozcay, Necdet; Moray, Gokhan; Haberal, Mehmet

    2014-01-01

    Flame burns are a serious condition and usually have high morbidity and mortality because they affect large areas of the body surface as well as the lungs. In these patients, it is especially difficult to find healthy skin for grafting if they have more than 70% third-degree burns. Repeated autografting or synthetic wound care materials are the only treatment options to cover burned areas. Partial-thickness skin grafting from the patient's identical twin sibling may be an alternative treatment option, if possible. Here, we report a patient with severe flame injury treated with skin from his identical twin. The patient had third-degree burns covering 70% of his body surface. Initial treatment consisted of fluid and electrolyte replacement, daily wound care, and surgical debridements, as well as nutritional support. After initial treatment, we performed a successful skin grafting from his identical twin. Skin grafting between identical twins might be an alternate method for severely burned patients.

  6. Wound Healing Trajectories in Burn Patients and Their Impact on Mortality

    Science.gov (United States)

    2014-12-01

    Trauma 1970;10: 1103–8. 5. McManus WF, Mason AD Jr, Pruitt BA Jr. Excision of the burn wound in patients with large burns. Arch Surg 1989;124:718...combat casualties and civilian patients admitted to a burn unit. J Am Coll Surg 2009;208:348–54. 11. Danon D, Kowatch MA, Roth GS. Promotion of wound...a swine model. J Burn Care Rehabil 1999;20(1 Pt 1):15–21. 15. Graves TA, Cioffi WG, McManus WF, Mason AD Jr, Pruitt BA Jr. Fluid resuscitation of

  7. [An epidemiological investigation of pediatric patients under 14 with large area burns: a multicenter study].

    Science.gov (United States)

    Cheng, W F; Zhao, D X; Shen, Z A; Zhang, H Y; Tu, J J; Yuan, Z Q; Duan, P; Song, G D

    2017-02-14

    Objective: To investigate and evaluate the epidemiological characteristics of patients under 14 with large area burns in China. Methods: Data of pediatric patients aged 0-14yr with ≥30% total body surface area (TBSA) burned admitted into 106 burn centers in the mainland of China in 2014 were retrieved. The children were divided into three age groups: 0-3, 4-6 and 7-14 years according to the age. Information of age, gender, time of burn injury, causes of burns, admission time, prehospital emergency care of burn wound, burn area, inhalation injuries, the case fatality rate and length of hospital stay were collected for analysis. Results: Of the 486 cases included, 285 (58.6%) were boys and 201 (41.4%) were girls. The mean age of the children was (3.4±2.8) years. Children under 3 years old accounted for 67.5% of all the cases. 271 of the burn injuries (55.8%) occurred from April through August. Scalds and flames were the main causes of burns, which were the causes of 394 cases (81.1%) and 71 cases (14.6%), respectively. The burn injuries resulted from scalds and flames accounted for 89.6% and 7.3%, 70.8% and 21.9%, 51.6% and 41.9% in the age group of 0-3, 4-6 and 7-14 years respectively. The distribution of burn etiology in different age groups differed significantly (χ(2)=21.239, 59.442, 7.333, all Parea of 236 patients (48.6%) were treated improperly with toothpaste, soy sauce, eggs or other non-standard disposal. The mean TBSA area of the patients was (42.1±14.5)%, while 288 (59.3%) of the patients suffered full thickness burns with mean TBSA of (24.5±17.9)%. The case fatality rate (CFR) was 4.1%, and the CFR of patients complicated with inhalation injury was significantly higher than those without (P<0.01). The average length of stay for pediatric burn patients was (52.3±40.2) days. Conclusions: Children under 3 years old are important target population of severe burns. Scald is the most common type of burns, while the proportion of flames increases as age

  8. Characterization of Pseudomonas aeruginosa strains isolated from burned patients hospitalized in a major burn center in Tehran, Iran.

    Science.gov (United States)

    Ranjbar, Reza; Owlia, Parviz; Saderi, Horie; Mansouri, Sadegh; Jonaidi-Jafari, Nematollah; Izadi, Morteza; Farshad, Shohreh; Arjomandzadegan, Mohammad

    2011-01-01

    Pseudomonas aeruginosa is an important life-threatening nosocomial pathogen and plays a prominent role in serious infections in burned patients. The current study was undertaken to characterize P. aeruginosa strains isolated from burned patients in Tehran, Iran. The study was conducted in a major burn center in Tehran, Iran in 2007. A total of seventy specimens obtained from different clinical origin with positive culture results for P. aeruginosa were included in the study. Antimicrobial susceptibility test was performed according to the standard CLSI guideline. The relationship between the strains was also determined using antimicrobial drug resistance pattern analysis and plasmid profiling. All strains were multi drug resistant. The percentage of resistance to tested antibiotics was: imipenem 97.5%, amikacin 90%, piperacillin 87.5%, ceftizoxime 72.7%, gentamicin 67.5%, ciprofloxacin 65%, ceftriaxone 60%, and ceftazidime 57.5%. Thirteen resistant phenotypes were recognized, R3 (TET, IPM, AMK, CIP, PIP, GM, CAZ, CRO, CT) was the predominant resistance pattern seen in 27.5% of isolates. Results obtained from E-test showed that 100% of P. aeruginosa strains were resistant to cefoxitin, 97% to cefotetan, 93% to ticarcillin, 89% to ticarcillin/clav, 76% to gentamicin and imipenem, 63% to piperacillin, 49% to tetracycline, and 20% to meropenem. Nine different plasmid profiles were observed among the strains. The current study showed an increase rate of resistance for some antibiotics tested among P. aeruginosa strains isolated from burned patients in Tehran. A combination of antibiotic susceptibility testing and profile plasmid analysis, which are relatively cheap and available methods, showed to be useful to characterize the clinical strains of P. aeruginosa isolated from burned patients in Iran.

  9. Characterization of Pseudomonas Aeruginosa Strains Isolated from Burned Patients Hospitalized in A Major Burn Center in Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Mohammad Arjomandzadegan

    2011-10-01

    Full Text Available Pseudomonas aeruginosa is an important life-threatening nosocomial pathogen and plays a prominent role in serious infections in burned patients. The current study was undertaken to characterize P. aeruginosa strains isolated from burned patients in Tehran, Iran. The study was conducted in a major burn center in Tehran, Iran in 2007. A total of seventy specimens obtained from different clinical origin with positive culture results for P. aeruginosa were included in the study. Antimicrobial susceptibility test was performed according to the standard CLSI guideline. The relationship between the strains was also determined using antimicrobial drug resistance pattern analysis and plasmid profiling. All strains were multi drug resistant. The percentage of resistance to tested antibiotics was: imipenem 97.5%, amikacin 90%, piperacillin 87.5%, ceftizoxime 72.7%, gentamicin 67.5%, ciprofloxacin 65%, ceftriaxone 60%, and ceftazidime 57.5%. Thirteen resistant phenotypes were recognized, R3 (TET, IPM, AMK, CIP, PIP, GM, CAZ, CRO, CT was the predominant resistance pattern seen in 27.5% of isolates. Results obtained from E-test showed that 100% of P. aeruginosa strains were resistant to cefoxitin, 97% to cefotetan, 93% to ticarcillin, 89% to ticarcillin/clav, 76% to gentamicin and imipenem, 63% to piperacillin, 49% to tetracycline, and 20% to meropenem. Nine different plasmid profiles were observed among the strains. The current study showed an increase rate of resistance for some antibiotics tested among P. aeruginosa strains isolated from burned patients in Tehran. A combination of antibiotic susceptibility testing and profile plasmid analysis, which are relatively cheap and available methods, showed to be useful to characterize the clinical strains of P. aeruginosa isolated from burned patients in Iran.

  10. Assessment of Substances Abuse in Burn Patients by Using Drug Abuse Screening Test

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    Kobra Gaseminegad

    2012-04-01

    Full Text Available There has been an increase in the frequency of substance abuse among hospitalized burn injury patients. However, few studies have investigated substance abuse among burn patients. This study was aimed to identify the incidence of substance abuse in burn injury patients using the "Drug Abuse Screening Test" (DAST-20. We determined the validity of DAST-20 in spring 2010. Subsequently, this descriptive study was performed on 203 burn injury patients who fit the study's inclusion criteria. We chose a score of 6 as the cutoff and thus achieved a sensitivity of 89% and a specificity of 85% for the DAST-20. During the study, we gathered demographic data, burn features and DAST-20 results for all patients. Patients with scores of 6 or more were considered to be substances abusers. A statistical analysis was conducted using SPSS v16 software. According to the DAST-20 results, 33% of the patients were in the user group. The mean score of DAST-20 was significantly higher among users than it was among nonusers (P<0.05. The level of substance abuse was severe in 77% of users. No significant differences were found among the substances, with the exception of alcohol. Substance abuse is an important risk factor for burn patients. In addition, this study showed that DAST-20 is a valid screening measure for studies on burn patients.

  11. The Evolution and Utility of the Burn Specific Health Scale: A Systematic Review

    Science.gov (United States)

    2010-01-01

    Loneliness Scale - Social Isolation Schedule - Burn Psycho-Somatic Morbidity Scale (BPSM) - Hospitalization characteristics Does not use BSHS in this...Esselman PC, Thombs BD, Magyar- Russell G, Fauerbach JA. Burn rehabilitation: state of the science. Am J Phys Med Rehabil 2006;85:383–413. [6] Harden NG

  12. Characteristics of 985 pediatric burn patients in the south of Liaoning province of China

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    Hongjun Zhai

    2014-07-01

    Full Text Available Accidental injury due to burns is a serious and common, but preventable, occurrence in children. To analyze the characteristics of pediatric burns in the south of Liaoning province of China, a retrospective review was conducted of information, including general characteristics, demographics, etiology of burns, anatomical areas burned, and severity of injuries, obtained from medical records of pediatric burn patients admitted to the Burn Center of Anshan Hospital of the First Hospital of China Medical University from 2002 to 2011. Differences between age-groups and cause and severity of injuries were examined using Cochran-Mantel-Haenzsel ­(C-M-H statistic or chi-square (χ2 analyses where appropriate. A total of 985 pediatric burn cases were included, with only one death. The maximal burn area recorded was 80% and the maximal third-degree burn area was 45%. The majority of burns (637/985, 64.67% were moderate second-degree wounds, encompassing 5-14% of the total body surface area. The infant age-group (<3 years old had the largest representation (622/985, 63.15%, with more males than females affected. Most of the injuries occurred at home in children living in the local region. Scalding accounted for 89.85% (885/985 of all injuries, with a decreasing incidence with age, whereas injuries due to flames and from electrical sources markedly increased with age. Only a minority of guardians (244/985, 24.77% had burn prevention knowledge, and none of them knew how to provide first-aid treatment for burn injuries. These results indicate that the majority of pediatric burns occur in children less than 3 years of age from scalds received while at home. As a large proportion of these cases occurred in rural areas, programs emphasizing burn prevention and treatment knowledge should therefore be made more available to these families.

  13. Airway Management and Smoke Inhalation Injury in the Burn Patient

    Science.gov (United States)

    2009-10-01

    deficit and alveolar -arterial gradient during resuscitation contribute independently but modestly to the prediction of mortality after burn injury. J Burn...parenchymal injuries (eg, tracheal, bronchial, and alveolar injuries) caused by chemical and particulate constituents of smoke. Unless otherwise...perivascular fuzziness or cuffing, alveolar or intersitital pulmonary edema, consolidation, and atelectasis, have been reported.20–23 In sheep, Park and

  14. Fire Service Training. Immediate Care of the Burn Patient.

    Science.gov (United States)

    North Carolina State Dept. of Community Colleges, Raleigh.

    Part of a series of instructional outlines intended for use in a training program for firemen with no previous formal training, this curriculum guide discusses the emergency treatment of thermal, chemical, and electrical burns. The topics covered are as follow: (1) evaluation of the degree and extent of the burn; (2) shock, its signs and…

  15. Nutritional and metabolic consequences in the pediatric burn patient.

    Science.gov (United States)

    Schulman, Carl I; Ivascu, Felicia A

    2008-07-01

    Nutritional support is one of the many important considerations when treating severe burn injury in children. The type, route, timing, amount, and monitoring of nutritional support have been widely investigated, yet many questions remain. This review will highlight the current state of knowledge and the important aspects of nutritional support in severe burn injury in children.

  16. [Advances in the research of effects of music therapy on pain and anxiety in burn patients].

    Science.gov (United States)

    Jinyi, Li; Yungui, Wang

    2015-06-01

    Pain and anxiety engender major psychic problems during all phases of treatment for burn patients. Analgesic alone does not allay these problems satisfactorily in these patients. Music therapy, as an important complementary and alternative therapy, has been widely used in multiple medical fields. However, its positive effect on alleviation of pain and anxiety in burn patients is undefined. The objective of this review is to summarize the feasibility, application fields, methods, and the effectiveness of music therapy in allaying pain and anxiety of burn patients during the whole course of treatment.

  17. Fast resuscitation and care of the burn patients by telemedicine: A review

    Directory of Open Access Journals (Sweden)

    Sima Ajami

    2014-01-01

    Full Text Available Background: In Iran, burns are the second most common cause of death, after traffic accidents in individuals under the age of 15 years. Many burned patients die or suffer injury due to lack of immediate care, so we need to use an alternative resuscitations to cure them immediately. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients′ health status and care. The aim of this study was to express the advantages of Telemedicine to resuscitate and care burn patients. Materials and Methods: This study was a narrative review. The literature was searched on fast resuscitation and care of the patients′ burn by telemedicine with the help of libraries, databases, and also searches engines available at Google, Google scholar, books and conference proceedings. In our searches, we employed the following keywords and their combinations: Telemedicine, Telecare, Burn, Burn patient, Air transport, Triage and Health Information Management in the searching areas of titles, keywords, abstracts and full texts. Results: In this study, more than 78 articles and reports were collected and 30 of them were selected based on their relevancy. Conclusion: Acute evaluation of burn patients can be performed by the telemedicine and it plays an important role in improving access to the required expertise, and raises physician confidence in treating burn patients. This can reduce under-triage or over-triage for air transport and finally lead to saving time and cost.

  18. Unplanned decannulation of tracheotomy tube in massive burn patients: a retrospective case series study

    Institute of Scientific and Technical Information of China (English)

    BEN Dao-feng; MA bing; XIA Zhao-fan; L(U) Kai-yang; CHEN Xu-lin; YU Xi-ya; XI Hui-Jun; CHANG Fei; ZHU Shi-hui; TANG Hong-tai; LU Wei

    2011-01-01

    Background Unplanned extubation is associated with adverse outcomes in intensive care unit.The massive burn patient differs from other critically ill patients in many ways.However,little is known about the unplanned decannulation (UD) in Burn Intensive Care Unit.This paper describes the special features of the circumstances and outcome of UD of tracheotomy tube in massive burn patients.Methods A case series study was performed between January 1999 and December 2008 and UD of tracheotomy tube was analyzed retrospectively.A total of 21 patients with 29 UD events were identified.Demographic data,diagnosis,intervention,UD events and outcome of UD patients were collected.Differences in proportions were compared using the chi-square (X2) or Fisher's exact test.Results Patients with UD were often burned with head and neck (67%) and combined with inhalation injury (62%).The majority of them (76%) were transferred patients,occurred early (55%) and were accidental UD (79%).UD events tended to happen in day shift (90%) and to be associated with the medical procedure that was performing by caregivers at besides (79%).Loose of the stabilizing rope,medical procedure and tracheotomy malposition were the main causes of UD.Early UD and reintubation failure were associated with patients' death.Conclusions UD happened to massive burn patients can lead to patient death.Careful management of respiratory tract was essential for massive burn patients.

  19. Aerobic exercise training in modulation of aerobic physical fitness and balance of burned patients

    OpenAIRE

    Ali, Zizi M. Ibrahim; El-Refay, Basant H.; Ali, Rania Reffat

    2015-01-01

    [Purpose] This study aimed to determine the impact of aerobic exercise on aerobic capacity, balance, and treadmill time in patients with thermal burn injury. [Subjects and Methods] Burned adult patients, aged 20–40 years (n=30), from both sexes, with second degree thermal burn injuries covering 20–40% of the total body surface area (TBSA), were enrolled in this trial for 3 months. Patients were randomly divided into; group A (n=15), which performed an aerobic exercise program 3 days/week for ...

  20. Rigorous, robust and systematic: Qualitative research and its contribution to burn care. An integrative review.

    Science.gov (United States)

    Kornhaber, Rachel Anne; de Jong, A E E; McLean, L

    2015-12-01

    Qualitative methods are progressively being implemented by researchers for exploration within healthcare. However, there has been a longstanding and wide-ranging debate concerning the relative merits of qualitative research within the health care literature. This integrative review aimed to exam the contribution of qualitative research in burns care and subsequent rehabilitation. Studies were identified using an electronic search strategy using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica database (EMBASE) and Scopus of peer reviewed primary research in English between 2009 to April 2014 using Whittemore and Knafl's integrative review method as a guide for analysis. From the 298 papers identified, 26 research papers met the inclusion criteria. Across all studies there was an average of 22 participants involved in each study with a range of 6-53 participants conducted across 12 nations that focussed on burns prevention, paediatric burns, appropriate acquisition and delivery of burns care, pain and psychosocial implications of burns trauma. Careful and rigorous application of qualitative methodologies promotes and enriches the development of burns knowledge. In particular, the key elements in qualitative methodological process and its publication are critical in disseminating credible and methodologically sound qualitative research.

  1. Primary cutaneous mucormycosis in a patient with burn wounds due to Lichtheimia ramosa.

    Science.gov (United States)

    Kaur, Ravinder; Bala, Kiran; Ahuja, Rajeev B; Srivastav, Prabhat; Bansal, Umesh

    2014-10-01

    Mucormycosis is usually an invasive mycotic disease caused by fungi in the class mucormycetes. Here we report a case of cutaneous mucormycosis due to Lichtheimia ramosa in a 20-year-old female patient with burn injuries. She was admitted to the hospital with accidental flame burns covering 60 % total burn surface area. After 15 days of admission to hospital, the burn wound showed features of fungal infection. Culture showed white cottony growth belonging to the Mucorales order. Morphological identification confirmed it as L. ramosa. She was managed surgically and medically with the help of amphotericin B. Patient survived due to prompt diagnosis and appropriate medical and surgical treatment. Early diagnosis is critical in prevention of morbidity and mortality associated with the disease. Fungal infection in burn wounds can be difficult to diagnose and manage.

  2. Efficacy of silver sulfadiazine phonophoresis on wound healing in acute burn patients

    DEFF Research Database (Denmark)

    Omar, Ghada Said Mohammed

    2003-01-01

    The purpose of the current study was to evaluate the efficacy of SSD phonophoresis approaches (continuous and pulsed modes on the rate of healing following acute burn injury . forty female patients with second degree burn in thrir anterior aspect of the dominant foream were divided randomly...... into two groups : patients in group I received pulsed SSD phonophoresis for 15 min with a frequency of 1MHz , intensity of 1 w/ cm2 , and with the pulse ratio was set at 1 : 4 , and the pulsed duration was set at 2 m.s., while pationts in group II received continuous SSD phonophoresis for 5 min...... with a frequency of 1 MHz , and intensity of 1 W/cm2 . the parameters investigated inclding 1.burn surface area measured by tracing the burn wound parameters , and 2.determination of glycosaminoglycan in urine by using cetylpyridinuin chloride turbidity method . both parameters are measured 24 hours post-burn...

  3. Self-inflicted burns in patients with chronic combat-related post-traumatic stress disorder.

    Science.gov (United States)

    Bras, Marijana; Loncar, Zoran; Boban, Maja; Gregurek, Rudolf; Brajković, Lovorka; Tomicić, Hrvoje; Muljacić, Ante; Micković, Vlatko; Kalenić, Barbara

    2007-12-01

    This study examined self-inflicted burns in case series of four patients with chronic combat-related post-traumatic stress disorder (PTSD). Those patients were hospitalized in the Burn Unit of the University Hospital of Traumatology in Zagreb because of severe burns and had a premorbid psychiatric history of PTSD. Demographic data and information regarding the circumstances surrounding the incident, burn severity, treatment and outcomes of these patients were collected. The authors have analyzed possible impacts of the sensationalistic way in which media present cases of self-inflicted burning that induce other, new cases of this suicide type, known in the literature as "Werther's syndrome". The importance of multidisciplinary approach in the treatment of burn patients is stressed with emphasis on the important role of liaison psychiatrist in treating these patients. It is necessary to educate media people to avoid sensational reporting on this kind of events. Continuous psychiatric treatment of vulnerable individuals could be useful in prevention of self-inflicted burns.

  4. Comparing the Workload Perceptions of Identifying Patient Condition and Priorities of Care Among Burn Providers in Three Burn ICUs.

    Science.gov (United States)

    McInnis, Ian; Murray, Sarah J; Serio-Melvin, Maria; Aden, James K; Mann-Salinas, Elizabeth; Chung, Kevin K; Huzar, Todd; Wolf, Steven; Nemeth, Christopher; Pamplin, Jeremy C

    Multidisciplinary rounds (MDRs) in the burn intensive care unit serve as an efficient means for clinicians to assess patient status and establish patient care priorities. Both tasks require significant cognitive work, the magnitude of which is relevant because increased cognitive work of task completion has been associated with increased error rates. We sought to quantify this workload during MDR using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Research staff at three academic regional referral burn centers administered the NASA-TLX to clinicians during MDR. Clinicians assessed their workload associated with 1) "Identify(ing) if the patient is better, same, or worse than yesterday" and 2) "Identify(ing) the most important objectives of care for the patient today." Data were collected on clinician type, years of experience, and hours of direct patient care. Surveys were administered to 116 total clinicians, 41 physicians, 25 nurses, 13 medical students, and 37 clinicians in other roles. Clinicians with less experience reported more cognitive work when completing both tasks (P Clinicians in the "others" group (respiratory therapists, dieticians, pharmacists, etc.) reported less cognitive work than all other groups for both tasks (P clinician type and experience level when completing two key tasks. Less experience was associated with increased perceived work, potentially increasing mental error rates, and increasing risk to patients. Creating tools or work processes to reduce cognitive work may improve clinician performance.

  5. A simple tool for mortality prediction in burns patients: APACHE III score and FTSA.

    Science.gov (United States)

    Moore, E C; Pilcher, D V; Bailey, M J; Cleland, H; McNamee, J

    2010-11-01

    Prediction of outcome for patients with major thermal injury is important to inform clinical decision making, alleviate individual suffering and improve hospital resource allocation. Age and burn size are widely accepted as the two largest contributors of mortality amongst burns patients. The APACHE (Acute Physiology and Chronic Health Evaluation) III-j score, which incorporates patient age, is also useful for mortality prediction, of intensive care populations. Validation for the burns specific cohort is unclear. A retrospective cohort study was performed on patients admitted to the Intensive Care Unit (ICU) via the Victorian Adult Burns Service (VABS), to compare observed mortality with burns specific markers of illness severity and APACHE III-j score. Our primary aim was to develop a mortality prediction tool for the burns population. Between January 1, 2002 and December 31, 2008, 228 patients were admitted to the ICU at The Alfred with acute burns. The mean age was 45.6 years and 81% (n=184) were male. Patients had severe injuries: the average percent TBSA (total body surface area) was 28% (IQR 10-40) and percent FTSA (full thickness surface area) was 18% (IQR 10-25). 86% (n=197) had airway involvement. Overall mortality in the 7-year period was 12% (n=27). Non-survivors were older, had larger and deeper burns, a higher incidence of deliberate self-harm, higher APACHE III-j scores and spent less time in hospital (but similar time in ICU), compared with survivors. Independent risk factors for death were percent FTSA (OR 1.03, 95% CI 1.01-1.05, p=0.01) and APACHE III-j score (OR 1.04, 95% CI 1.02-1.07, pAPACHE III-j score and percent FTSA. Prospective validation of our model on different burn populations is necessary.

  6. Comparison of the outcome of burn patients using acute-phase plasma base deficit.

    Science.gov (United States)

    Salehi, S H; As'adi, K; Mousavi, J

    2011-12-31

    Background. In recent years, plasma base deficit has been used as a marker to determine the status of tissue perfusion in trauma patients and also to predict the outcome of these patients. This study was performed to investigate the effect of plasma base deficit in predicting burn patient outcome. Methods. This prospective cohort study was performed from October 2009 to October 2010 in the acute phase of burn patients who were admitted within 6 h post-injury to Motahari Burn Hospital in Iran. The patients were divided into two groups based on the plasma base deficit in the first 24 h post-injury: group A, in which the mean plasma base deficit was less than or equal to -6 (more negative), and group B, in which the mean plasma base deficit greater than -6. Statistical analysis was performed using SPSS v.16 software. Results. Thirty-eight patients were enrolled in each group. The mean plasma base deficit in group A (-7.76 ± 2.18 mmol) was significantly less than that in group B (-1.19 ± 2.82) mmol (p 0.05) and despite removal of interfering factors, there were significant differences between the systemic inflammatory response syndrome and the multiple organ dysfunction syndrome score and the percentage of sepsis between the two groups (p 0.05). Conclusion. The plasma base deficit can be used as a valuable marker in the resuscitation of burn patients, along with clinical criteria. Physiological indicators (burn percentage, age, and mucosal burns) are not sufficient to predict mortality and morbidity in burn patients, and it is necessary to investigate the role of biochemical markers such as base deficit in determining the final outcome of burn patients.

  7. Serum Interleukin-6 in Patients with Burning Mouth Syndrome and Relationship with Depression and Perceived Pain

    Directory of Open Access Journals (Sweden)

    Qianming Chen

    2007-01-01

    Conclusions. Serum interleukin-6 in patients with burning mouth syndrome is decreased and negatively correlated to chronic pain. Both psychological and neuropathic disorders might act as precipitating factors in BMS etiopathogenesis.

  8. [Clinical application of grafts of cultured epidermis in burn patients. Apropos of 16 patients].

    Science.gov (United States)

    Foyatier, J L; Faure, M; Hezez, G; Masson, C; Paulus, C; Chomel, P; Latarjet, J; Delay, E; Thomas, L; Adam, C

    1990-01-01

    The authors report a series of 16 patients with extensive burns partially treated by epidermal culture between May 1985 and July 1988. This series consisted of 9 males and 7 females between the ages of 6 and 88 years (mean age: 34 years). The mean surface area of the burns was 66% (range: 30% to 92%). The technique of epidermis culture used was derived from that developed by Green and Rheinwald. A fragment of full-thickness skin taken from the patient was subjected to the action of trypsin. The keratinocytes were cultured on nutrient layers of 3T3 cells. After 10 days, the secondary cultures corresponded to stratified squamous epithelium with a differentiation similar to that of normal human epithelium. This cultured epithelium was used for autografts as well as allografts. Three deaths were related to septic or metabolic complications of the burn. The take rate of the initial graft was greater than 50% in 9 patients. In 3 patients the graft take rate was less than 50% and in 4 patients it was nil. The long-term evaluation of 12 patients revealed partial lysis of the grafts in 3 patients, a stable result in 6 patients and a healed surface greater than the grafted surface in three cases. The best results were obtained with autografts. The initial evaluation of taking of the graft is difficult, as the fine and shiny texture of the grafts is sometimes difficult to distinguish from non-covered zones. The good tolerance of cultured epidermis allografts is due to the fact that they are devoid of Langerhans cells. Although controversial, the reality of the taking of these allografts opens the way to establishing epidermis culture banks.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Successful treatment of severe burn patients with multiple organ dysfunction syndrome:A case rep ort

    Institute of Scientific and Technical Information of China (English)

    Lingfeng Wang ∗; Yongdong Li; Xiyuan Xu; Ji Chen; Weiqing Wang; Zaiqing Huang; Lihua Zhang

    2014-01-01

    Multiple organ dysfunction syndrome is the presence of altered organ function of two or more organ systems in acute ill patients with severe trauma, burn, shock and infection. In this case, the patient with burn area amounted to 95%and the third-degree burn was up to 90%. He underwent gastrointestinal tract, blood clotting, lung, brain, heart, liver dysfunction, and cardiac arrest for 30 minutes during the courses of treatment, and was discharged from the hospital after 108 days on the basis of comprehensive treatment and repeated skin grafting.

  10. Neuropsychological outcomes of pediatric burn patients who sustained hypoxic episodes.

    Science.gov (United States)

    Rosenberg, Marta; Robertson, Carrie; Murphy, Kevin D; Rosenberg, Laura; Mlcak, Ronald; Robert, Rhonda S; Herndon, David N; Meyer, Walter J

    2005-11-01

    The neuropsychological outcomes of children who suffered hypoxic episodes following their burns are not completely understood and vary depending on the nature and severity of the episode. A retrospective review of youth that were admitted to this acute burn care facility over the past 20 years was conducted to identify the extent of cognitive and affective difficulties. Thirty-nine children who sustained hypoxic injuries related to their burns were compared with 21 controls that were matched for age, TBSA, and time of injury. Approximately a third of the children who survived from the hypoxia group continued to have long-term cognitive and emotional difficulties. For those who recovered reasonably well, no differences were found from the matched burned controls. These results probably underestimate the true extent of neuropsychological difficulties experienced by these youth given that detailed cognitive testing was not routinely performed. Prospective studies are needed to further characterize the full nature of difficulties and outcomes associated with burn related hypoxic injuries.

  11. The effect of levamisole on mortality rate among patients with severe burn injuries

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Fatemi

    2013-01-01

    Full Text Available Background: Burn injuries are one of the main causes of mortality and morbidity throughout the world and burn patients have higher chances for infection due to their decreased immune resistance. Levamisole, as an immunomodulation agent, stimulates the immune response against infection. Materials and Methods: This randomized clinical trial was conducted in Motahari Burn Center, Tehran, Iran. Patients who had second- or third-degree burn with involvement of more than 50% of total body surface area (TBSA were studied. The levamisole group received levamisole tablet, 100 mg per day. Meantime, both the levamisole and control groups received the standard therapy of the Burn Center, based on a standard protocol. Then, the outcome of the patients was evaluated. Results: 237 patients entered the study. After excluding 42 patients with inhalation injury, electrical and chemical burns, and the patients who died in the first 72 h, 195 patients remained in the study, including 110 patients in the control group and 85 in the treatment group. The mean age of all patients (between 13 to 64 years was 33.29 ± 11.39 years (Mean ± SD, and it was 33.86 ± 11.45 years in the control group and 32.57 ± 11.32 years in the treatment group. The mean percentage of TBSA burn was 64.50 ± 14.34 and 68.58 ± 14.55 for the levamisole and control groups, respectively, with the range of 50-100% and 50-95% TBSA. The mortality rate was 68 (61.8% patients in the control group and 50 (58.8% patients in the treatment group (P = 0.8. Conclusion: According to this study, there was no significant relationship between improvement of mortality and levamisole consumption.

  12. The effect of levamisole on mortality rate among patients with severe burn injuries

    Science.gov (United States)

    Fatemi, Mohammad Javad; Salehi, Hamid; Akbari, Hossein; Alinejad, Faranak; Saberi, Mohsen; Mousavi, Seyed Jaber; Soltani, Majid; Taghavi, Shahrzad; Payandan, Hossein

    2013-01-01

    Background: Burn injuries are one of the main causes of mortality and morbidity throughout the world and burn patients have higher chances for infection due to their decreased immune resistance. Levamisole, as an immunomodulation agent, stimulates the immune response against infection. Materials and Methods: This randomized clinical trial was conducted in Motahari Burn Center, Tehran, Iran. Patients who had second- or third-degree burn with involvement of more than 50% of total body surface area (TBSA) were studied. The levamisole group received levamisole tablet, 100 mg per day. Meantime, both the levamisole and control groups received the standard therapy of the Burn Center, based on a standard protocol. Then, the outcome of the patients was evaluated. Results: 237 patients entered the study. After excluding 42 patients with inhalation injury, electrical and chemical burns, and the patients who died in the first 72 h, 195 patients remained in the study, including 110 patients in the control group and 85 in the treatment group. The mean age of all patients (between 13 to 64 years) was 33.29 ± 11.39 years (Mean ± SD), and it was 33.86 ± 11.45 years in the control group and 32.57 ± 11.32 years in the treatment group. The mean percentage of TBSA burn was 64.50 ± 14.34 and 68.58 ± 14.55 for the levamisole and control groups, respectively, with the range of 50-100% and 50-95% TBSA. The mortality rate was 68 (61.8%) patients in the control group and 50 (58.8%) patients in the treatment group (P = 0.8). Conclusion: According to this study, there was no significant relationship between improvement of mortality and levamisole consumption. PMID:24381625

  13. The dynamic experience of pain in burn patients: A phenomenological study.

    Science.gov (United States)

    Pérez Boluda, M T; Morales Asencio, J M; Carrera Vela, A; García Mayor, S; León Campos, A; López Leiva, I; Rengel Díaz, C; Kaknani-Uttumchandani, S

    2016-08-01

    Although pain is one of the main sources of suffering during the acute phase and rehabilitation in burn patients, it remains as a major challenge for burn care, and clinical management not always correlates with the experience felt by patients. The aim of this study was to understand the experience of pain from people who has suffered severe burns, to identify personal strategies used to cope with this challenging event. A qualitative phenomenological study with purposive sampling was carried out with severe burn patients admitted to a Burn Unit. Through individual in-depth interviews, verbatim transcription and content analysis, two main categories were isolated: a dynamic and changing experience of pain, from the onset to the hospital discharge, and diverse strategies developed by patients to cope with pain, being distraction the most frequently used. Pain experienced acquires its maximum intensity during wound care, and divergent patients' opinions about sedation are present. This study highlights how understanding subjective experiences is an invaluable aid to improve care in pain assessment and management. Furthermore, it points out the need to guarantee patient involvement in the organization and improvement of burn care, inasmuch as traditional professional centered approach is not ensuring an optimal management.

  14. The Fenix II study: A longitudinal study of psychopathology among burn patients.

    Science.gov (United States)

    Fidel-Kinori, Sara Guila; Eiroa-Orosa, Francisco Jose; Giannoni-Pastor, Anna; Tasqué-Cebrián, Ruth; Arguello, Jose Maria; Casas, Miguel

    2016-09-01

    Psychological symptoms are common among burn survivors. However, knowledge about epidemiology and predictors of psychopathology has shown great heterogeneity in this population. The Fenix-II Project was the first epidemiological study on the psychopathological consequences of burns developed in Spain, providing a detailed analysis of the progression of psychological symptoms during the first six months after injury. Three hundred and thirty-three patients were screened and 183 were included in this study. Posttraumatic, depression and anxiety symptoms showed a general decreasing tendency across time. At 6 months, 34 patients showed clinically significant Posttraumatic Stress Disorder (PTSD) symptoms (20.5% of 166 patients reached at 6 months) as assessed with the MINI Neuropsychiatric Interview. Within this group of patients, anxiety, depression and hyperarousal increased at 30 days, and avoidance 90 days after injury. The most accurate predictors of PTSD were found to be being burned in a Motor Vehicle Crash, risk of social exclusion, low body-image adjustment, anterior trunk location of the burn and life threat perception during the burn-shock period. Considering these factors, clinicians may identify patients at risk of PTSD development, allowing an adequate follow up and preventive interventions which may minimize the psychological consequences of burns.

  15. Gender differences in resilience and psychological distress of patients with burns.

    Science.gov (United States)

    Masood, Afsheen; Masud, Yusra; Mazahir, Shama

    2016-03-01

    This research explored the gender differences in resilience and psychological distress of patients with burns. In Pakistan, psychological states of patients with burns have not been widely studied, women making up as the neglected section of society lag far behind in availing the needful health facilities. It was hypothesized that there would be significant gender differences in resilience and psychological distress of patients with burns. The sample of the study consisted of 50 patients with burns, obtained from four different hospitals of Lahore. In order to investigate resilience and psychological distress, the State Trait Resilience Scales (Hiew, 2007) and Kessler Psychological Distress Scale (Kessler, 2001) were used. In addition to these, self-constructed demographic questionnaire was administered. The data was analyzed using SPSS version 16.0. Independent sample t-test was conducted to find gender differences in resilience and psychological distress. The findings from the current research revealed that there were significant gender differences in resilience and psychological distress of patients with burns. The insightful findings from the current research carry strong implications for the clinicians, psychologists and policy makers who can help to develop and implement the rehabilitation programs for the affected population and can launch resilience promoting programs that would help them in coping with burns in effective manner.

  16. Systematic care management: a comprehensive approach to catastrophic injury management applied to a catastrophic burn injury population--clinical, utilization, economic, and outcome data in support of the model.

    Science.gov (United States)

    Kucan, John; Bryant, Ernest; Dimick, Alan; Sundance, Paula; Cope, Nathan; Richards, Reginald; Anderson, Chris

    2010-01-01

    The new standard for successful burn care encompasses both patient survival and the burn patient's long-term quality of life. To provide optimal long-term recovery from catastrophic injuries, including catastrophic burns, an outcome-based model using a new technology called systematic care management (SCM) has been developed. SCM provides a highly organized system of management throughout the spectrum of care that provides access to outcome data, consistent oversight, broader access to expert providers, appropriate allocation of resources, and greater understanding of total costs. Data from a population of 209 workers' compensation catastrophic burn cases with a mean TBSA of 27.9% who were managed under the SCM model of care were analyzed. The data include treatment type, cost, return to work, and outcomes achieved. Mean duration of management to achieve all guaranteed outcomes was 20 months. Of the 209 injured workers, 152 (72.7%) achieved sufficient recovery to be released to return to work, of which 97 (46.8%) were both released and competitively employed. Assessment of 10 domains of functional independence indicated that 47.2% of injured workers required total assistance at initiation of SCM. However, at termination of SCM, 84% of those injured workers were fully independent in the 10 functional activities. When compared with other burn research outcome data, the results support the value of the SCM model of care.

  17. [A discussion regarding reconstruction and rehabilitation of patients with deep burn wound].

    Science.gov (United States)

    Hu, Da-hai

    2009-12-01

    With the advances in resuscitation, infection control, and metabolic management, the treatment strategies for burn patients have improved remarkably in the last half century. As a result, more patients with deep burn wound survived, and how to optimize the burn wound care aiming at recovery of the normal appearance and physiologic function of patients has been investigated and discussed widely through both the whole treatment strategy making and the new techniques performing. In the present discussion, early tissue reconstruction as well as early wound covering and repair are emphasized by summarizing the improved aesthetic and functional effects obtained by applying the principles of plastic surgery in early burn wound repair, the use of composite skin grafting, the grafting with split-thickness autografts on the preserved denatured dermis or on the preserved healthy fat tissue, etc. Besides these, more attention should be given to the repair and reconstruction in specialized functional parts of the body, such as head and face, neck, hand, female breast, perineum, and joint areas, after a deep burn. The role of rehabilitation during and after the burn wound treatment process is elucidated by demonstrating its potential biophysical mechanism and preventing scar deformity. Adequate treatment of deep burn wound demands a number of important measures including the timing of surgery, adoption of essential techniques, suitable types of wound covering materials, motivated rehabilitation, and necessary psychological therapy. The optimal recovery of damaged part of body after burn should depend on the similarity of rebuild tissue structure to simulate the nature of the original tissue in the cellular, histological, anatomic characteristics, which is the aim of all burn wound care and the basis of the appearance and function repair or reconstruction.

  18. Characteristics of and strategies for patients with severe burn-blast combined injury

    Institute of Scientific and Technical Information of China (English)

    CHAI Jia-ke; SHEN Chuan-an; TUO Xiao-ye; LIANG Li-ming; WANG Shu-jun; SHENG Zhi-yong; LU Jiang-yang; WEN Zhong-guang; YANG Hong-ming; JIA Xiao-ming; LI Li-gen; CAO Wei-hong; HAO Dai-feng

    2007-01-01

    Background Severe burn-blast combined injury is a great challenge to medical teams for its high mortality. The aim of this study was to elucidate the clinical characteristics of the injury and to present our clinical experiences on the treatment of such cases.Methods Five patients with severe burn-blast combined injuries were admitted to our hospital 77 hours post-injury on June 7, 2005. The burn extent ranged from 80% to 97% (89.6%±7.2%) of TBSA (full-thickness burns 75%-92%(83.4%±7.3%)). All the patients were diagnosed as having blast injury and moderate or severe inhalation injury. Functions of the heart, liver, kidney, lung, pancreas and coagulation were observed. Autopsy samples of the heart, liver, and lungs were taken from the deceased. Comprehensive measures were taken during the treatment, including protection of organ dys function, use of antibiotics, early anticoagulant treatment, early closure of burn wounds, etc. All the data were analyzed statistically with t test.Results One patient died of septic shock 23 hours after admission (four days after injury), the others survived.Dysfunction of the heart, liver, lungs, pancreas, and coagulation were found in all the patients on admission, and the functions were ameliorated after appropriate treatments.Conclusions Burn-blast combined injury may cause multiple organ dysfunctions, especially coagulopathy. Proper judgment of patients' condition, energetic anticoagulant treatment, early closure of burn wounds, rational use of antibiotics, nutritional support, intensive insulin treatment, timely and effective support and protection of organ function are the most important contributory factors in successful treatment of burn-blast combined injuries.

  19. SELECTIVE INTESTINAL DECONTAMINATION FOR PREVENTION OF WOUND COLONIZATION IN SEVERELY BURNED PATIENTS - A RETROSPECTIVE ANALYSIS

    NARCIS (Netherlands)

    MANSON, WL; KLASEN, HJ; SAUER, EW; OLIEMAN, A

    1992-01-01

    In this study the effect of selective intestinal decontamination of the digestive tract (SDD) on wound colonization was investigated. Ninety-one patients with at least 25 per cent total burned surface area (TBSA) were included in this study. All patients received oral polymyxin. In 63 patients oral

  20. Epidemiological and socio-cultural study of burn patients in M. Y. Hospital, Indore, India

    Directory of Open Access Journals (Sweden)

    Jaiswal Ashish

    2007-01-01

    Full Text Available Background: Developing countries have a high incidence of burn injuries, creating a formidable public health problem. The exact number of cases is difficult to determine: however in a country like India, with a population of over 1 billion, we would estimate 700,000 to 800,000 burn admissions annually. Objective: The study was done to investigate the epidemiology of various causations and their outcomes in terms of morbidity and mortality. Also, the effect of social stigma and cultural issues associated with burns on the victim and his family was assessed. Materials and Methods: All burn cases (n=412 admitted to the burns unit of M. Y. Hospital, Indore over a period of one year (2005-2006 were investigated. The data regarding sex, age predisposition, geographical origin, mode and nature of injury were obtained by questionnaire-interview with the patient themselves. Clinical assessment was done in the form of depth and extent of injury and complications. In case of mortality, again various factors like age, sex and cause of death were analyzed. The data was analyzed by SPSS 11.0 version. The interrelationship between various factors was studied using multivariate logistic regression analysis. Results: Burns were found more commonly in middle-aged groups. The incidence was more in females as an absolute number (70.3% as well as when stratified by age. Most burns were domestic, with cooking being the most prevalent activity. Flame (80.3% was the most common agent. Most of the cases of burn were accidental (67.7%. Moreover, the patients had third degree burn that leads to more mortality in our circumstances. Death occurred in more than one-half (62.3% of cases with septicaemia and disseminated intravascular coagulation (35.4% as the leading causes. When using logistic regression analysis, the outcome of the burn injury was significantly associated with degree, depth, extent and mode of injury. Conclusion: This series provides an overview of the most

  1. Treatment of patients with severe burns-costs and health-related quality of life outcome.

    Science.gov (United States)

    Koljonen, Virve; Laitila, Markku; Rissanen, Anne M; Sintonen, Harri; Roine, Risto P

    2013-01-01

    To study the effectiveness of the treatment of patients with severe burns, the authors collected health-related quality of life (HRQoL) data with the 15D instrument, 17 to 29 months after treatment had commenced at the national burns unit. The costs of each patient's secondary care treatment were followed for a mean of 66 months. During the 1-year study period, 107 patients were treated at the burns unit, eight for scar surgery, the remainder for primary treatment of a burn injury; 19 had died or could not be located during the time of the HRQoL survey. Of the remaining 88 patients, 43 (49%; mean [SD] age 45.7 [14.8] years; 70% men) returned the questionnaire. Their mean (SD) HRQoL score (0.909[0.113]) was only slightly, and not significantly, lower than that of the age- and sex- standardized general population (0.928[0.080]). The mean (SD) secondary care cost of burn treatment of for all the 107 patients, over the 60- to 72-month observation time, was 42,838 USD (73,569 USD; range 1319-34,8741 USD). The largest portion of the total cost was because of inpatient treatment (61%) followed by operations (22%), and outpatient visits. In addition to the costs of burns treatment, the patients consumed other secondary care services to a value of nearly 12,229 USD. The HRQoL in patients treated for severe burns is good, thus the observed high-treatment costs can be considered acceptable.

  2. A Comparison of Acute Respiratory Distress Syndrome Outcomes Between Military and Civilian Burn Patients

    Science.gov (United States)

    2015-03-01

    MILITARY MEDICINE, 180, 3:56, 2015 A Comparison of Acute Respiratory Distress Syndrome Outcomes Between Military and Civilian Burn Patients J Alan...Chung, MC USA*‡ ABSTRACT Background: The objective of this report was to compare the prevalence of acute respiratory distress syndrome (ARDS) and...Development of acute respiratory distress syndrome (ARDS) is a common complication of burn injury and is associated with poor outcomes. Previous reports using

  3. Long-Term Administration of Oxandrolone Improves Lung Function in Pediatric Burned Patients.

    Science.gov (United States)

    Sousse, Linda E; Herndon, David N; Mlcak, Ronald P; Lee, Jong O; Andersen, Clark R; Zovath, Andrew J; Finnerty, Celeste C; Suman, Oscar E

    2016-01-01

    Pulmonary dysfunction is a significant contributor to morbidity and mortality in the pediatric burned population. We have previously reported that the administration of a synthetic testosterone derivative, oxandrolone, significantly reduced hypermetabolism, and significantly increased height percentile, bone mineral content, lean body mass, and strength in pediatric burned patients. We hypothesize that the administration of oxandrolone will improve pulmonary function in burned pediatric subjects. A subset of severely burned pediatric subjects from a prospective clinical trial (n = 222) were included in our study (n = 54, 7-18 years, ≥30% TBSA burn). The subjects were previously randomized to either the control arm (n = 35) or the oxandrolone arm (0.1 mg/kg twice/day for 12 months, n = 19). Maximum voluntary ventilation, the ratio between forced expiratory volume and forced vital capacity, and diffusion capacity were measured 6 months following burn injury, and results were compared between burned subjects with and without oxandrolone administration. Maximum expired ventilation (VEmax) was also measured in a subset of burned subjects. Subjects treated with oxandrolone had a significantly higher maximum voluntary ventilation (98 ± 53 L/min vs 115 ± 56 with treatment, P = .03). During maximal exercise, subjects treated with oxandrolone had a significantly higher VEmax compared with untreated subjects (32.0 ± 8.7 L/min vs 43.7 ± 13.6 with treatment, P = .02). The administration of oxandrolone was associated with improved lung function in pediatric burned patients.

  4. Risk Factors for Hypotension in Urgently Intubated Burn Patients

    Science.gov (United States)

    2012-01-01

    superficial tissue damage, the recovery phase represents ischemia reperfusion injury relat ed to burn shock state and extensive intravenous fluid resuscitation...state is necessary to maintain adequate perfusion and heart filling in this shock state. It makes sense that propofol may have a dramatic and enhanced...massively edematous and thus by definition hypovolemic ; and multiple studies, including Hoka’s in 1998 [11], have associated hypovolemia with an

  5. Burn Rehabilitation

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    Koray Aydemir

    2011-07-01

    Full Text Available Burn injuries are important in terms of causing serious disability and threatening life. With the establishment of modern burn treatment units and advances in acute care management contributed to a reduced mortality rate over the last decades. As a result of improved outcome, more attention has to be given to a comprehensive burn rehabilitation program. Burn rehabilitation is a process that starts from day of admission and continues for months or sometimes years after the initial event. The term ‘burn rehabilitation’ incorporates the physical, physiological and social aspects of care. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. Burn rehabilitation aims to prevent the possible complications, minimalize joint contractures and deformities, increase range of motion, control hypertrophic scarring, achieve the best possible functional capacity and to regain the patients vocational and recreational activities. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 70-7

  6. Honey dressing versus silver sulfadiazene dressing for wound healing in burn patients: A retrospective study

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    Shilpi Singh Gupta

    2011-01-01

    Full Text Available Objective : The aim was to evaluate the effect of honey dressing and silver sulfadiazene (SSD dressing on wound healing in burn patients. Materials and Methods : We retrospectively reviewed the records of 108 patients (14-68 years of age, with first and second degree burns of less than 50% of the total body surface area admitted to our institution, over a period of 5 years (2004-2008. Fifty-one patients were treated with honey dressings and 57 with SSD. Time elapsed since burn, site, percentage, degree and depth of burns, results of culture sensitivity at various time intervals, duration of healing, formation of post-treatment hypertrophic scar, and/or contracture were recorded and analyzed. Results : The average duration of healing was 18.16 and 32.68 days for the honey and SSD group, respectively. Wounds of all patients reporting within 1 h of burns became sterile with the honey dressing in less than 7 days while there was none with SSD. All wounds treated with honey became sterile within 21 days while for SSD-treated wounds, this figure was 36.5%. A complete outcome was seen in 81% of all patients in the "honey group" while in only 37% patients in the "SSD group." Conclusion : Honey dressings make the wounds sterile in less time, enhance healing, and have a better outcome in terms of hypertropic scars and postburn contractures, as compared to SSD dressings.

  7. Establishment and assessment of new formulas for energy consumption estimation in adult burn patients.

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    Peng Xi

    Full Text Available An accurate knowledge of energy consumption in burn patients is a prerequisite for rational nutrition therapy. This study sought to create a formula that accounts for the metabolic characteristics of adult burn patients to accurately estimate energy consumption of patients with different areas and extents of burn and at different times after injury.Resting energy expenditure (REE data on 66 burn patients, with total body surface area (TBSA of burns ranging from 4% to 96%, were evaluated at different times after injury. REE values were determined in patients using indirect calorimetry at days 1, 2, 3, 7, 14, 21, and 28 after injury. We then constructed a mathematical model of REE changes post-burn. Next, established two new formulas (one non-linear and the other linear for energy consumption estimation using model-based analytical solution and regression analysis. The new formulas were compared with measured REE and commonly used formulas including those of Carlson, Xie, Curreri, and Milner to determine accuracy and reliability.Comparative analysis showed that the new formulas offered significantly higher accuracy and reliability than the Milner formula, which is considered the most accurate of commonly used burn energy consumption estimate formulas. The accuracy of the new nonlinear formula (94.29% and that of the linear formula (91.43% were significantly higher than that of Milner formula (72.86% when compared to measured REE (χ2  =  11.706, P  =  0.001; χ2  =  8.230, P  =  0.004, respectively. The reliabilities of the new estimation formulas were both 100% and that of Milner formula was 74.24% (χ2  =  19.513, P  =  0.000.The new formulas constructed in this study provide reliable simulation of the impact of the degree of burn and post-burn days on energy consumption and offer notably higher accuracy and reliability than other formulas. These formulas will help determine nutritional needs of burn patients.The study

  8. Association between PAI-1 polymorphisms and plasma PAI-1 level with sepsis in severely burned patients.

    Science.gov (United States)

    Chi, Y F; Chai, J K; Yu, Y M; Luo, H M; Zhang, Q X; Feng, R

    2015-08-21

    We investigated the association between plasminogen activator inhibitor-1 (PAI-1) polymorphisms and plasma PAI-1 level with sepsis in severely burned patients. A total of 182 patients with burn areas lager than 30% of the body surface area were enrolled in this study. Peripheral blood samples were obtained from 103 patients with sepsis (sepsis group) and 79 patients without sepsis (control group). An allele-specific polymerase chain reaction assay was used to determine PAI-1 polymorphism 4G/5G distribution. Plasma PAI-1 levels were detected using an enzyme-linked immunosorbent assay. The frequency of the 4G/4G genotype and the 4G allele frequency in the sepsis group were 42.7 and 62.1% respectively, which were significantly higher than those in the control group (P PAI-1 level than the control group (P PAI-1 concentrations were significantly higher in the 4G/4G genotype (P PAI-1 gene may be related to the susceptibility to burn sepsis and that the 4G/4G genotype may be an important genetic risk factor of burn sepsis. Additionally, PAI-1 concentrations in the serum are increased in patients with burn sepsis.

  9. Fluid management in burn patients: results from a European survey-more questions than answers.

    Science.gov (United States)

    Boldt, Joachim; Papsdorf, Michael

    2008-05-01

    Many strategies were proposed for fluid management in burn patients with different composition containing saline solution, colloids, or plasma. The actual clinical use of volume replacement regimen in burn patients in Europe was analysed by an international survey. A total of 187 questionnaires consisting of 20 multiple-choice questions were sent to 187 burn units listed by the European Burn Association. The response rate was 43%. The answers came from a total of 20 European countries. Volume replacement is mostly exclusively with crystalloids (always: 58%; often: 28%). The majority still use fixed formulae: 12% always use the traditional Baxter formula, in 50% modifications of this formula are used. The most often used colloid is albumin (always: 17%, often: 38%), followed by HES (always: 4%, often: 34%). Gelatins, dextrans, and hypertonic saline are used only very rarely. Fresh frozen plasma (FFP) is given in 12% of the units as the colloid of choice. Albumin was named most often to be able to improve patients' outcome (64%), followed by HES (53%), and the exclusive use of crystalloids (45%). Central venous pressure (CVP) is most often used to monitor volume therapy (35%), followed by the PiCCO-system (23%), and mixed-venous saturation (ScVO2; 10%). It is concluded that the kind of volume therapy differs widely among European burn units. This survey supported that no generally accepted volume replacement strategy in burn patients exists. New results, e.g. importance of goal-directed therapy or data concerning use of albumin in the critically ill, have not yet influenced strategies of volume replacement in the burn patient.

  10. ACCIDENTAL SUBCUTANEOUS INJECTION OF VECURONIUM BROMIDE IN A PATIENT WITH BURNS

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    Usha Dev

    2014-10-01

    Full Text Available BACKGROUND AND OBJECTIVES: In patients with burn injury drug pharmacology will be altered and this poses special anaesthetic challenge when an subcutaneous injection of a non- depolarizing muscle relaxant occurs in such a patient. Small studies remain an important source of knowledge and hence this study aims to provide information on the anaesthetic management in a case of accidental subcutaneous injection of vecuronium bromide in a burns patient. PRESENTATION, DIAGNOSIS & MANAGEMENT: A 22 year young male with 4 days old hot water induced grade 1 burns involving 45% of body surface area was posted for burns dressing. Anaesthesia was induced with propofol and vecuronium bromide through an external jugular vein to aid tracheal intubation. As the patient was not anaesthetized even after 10 minutes routine check lead to the discovery of fullness at the tip of the intravenous catheter indicating an extravasation of the drugs. Hence the other external jugular vein was cannulated and the patient induced and intubated using propofol, sevoflurane, nitrous oxide and oxygen. The action of vecuronium outlasted the duration of surgery. So the patient continued to receive support of mechanical ventilation with nitrous oxide and oxygen. It took 130 minutes for the clinical signs of recovery from the muscle relaxant to manifest. He was then reversed & extubated with subsequent good recovery. CONCLUSION: Subcutaneous injection of these drugs poses problems of delayed onset of action and prolonged duration of action. In an inadvertent accidental subcutaneous 0.1 mg/kg vecuronium bromide injection in a patient with 4 day old 45% burns showed delayed onset action and prolonged neuromuscular blockade due to subcutaneous deposition of the drug which was managed with mechanical ventilation .The reported resistance to the action of NDMR drugs in patient with burns was not noticed here probably because of the age of the thermal injury.

  11. [Controlling infection and spread of carbapenems-resistant Klebsiella pneumoniae among burn patients].

    Science.gov (United States)

    Huan, Jingning

    2015-02-01

    The emergence and spread of carbapenems-resistant Klebsiella pneumoniae (CRKP) in burn ward is an important threat to burn management. CRKP isolates are resistant to almost all available antibiotics and are susceptible only to polymyxins and tigecycline. The mechanism of the drug resistance of CRKP is associated with the plasmid-encoded carbapenemase Klebsiella pneumoniae carbapenemase (KPC), a carbapenem-hydrolyzing β-lactamase. Antibiotics which can currently be used to treat CRKP infection include polymyxins, tigecycline, and some aminoglycosides. The efficacy of using antibiotics in combination is better than that of single-agent therapy for the treatment of CRKP infection in bloodstream. In order to control CRKP infection in burn patients, strategies for preventing CRKP dissemination in burn ward are strongly advocated.

  12. Pain and anxiety experiences of South African adult burn injury patients during physiotherapy management

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    L.D. Morris

    2010-02-01

    Full Text Available A dequate management of procedural pain during physiotherapy management plays an important role in building a trusting relationship betweenthe burn victim and the physiotherapist, and in ensuring desirable functional outcomes. However, the burn pain management regimens currently utilized inburn units, primarily consist of traditional pharmacologic analgesics which areassociated with numerous side-effects and alone are often reported as inadequateto alleviate procedural pain, warranting safer and effective adjunct therapies.Prior to the introduction and implementation of adjunct therapies into a developing world, it is imperative that the current situation in a burn unit, in terms of whether or not the pain management regimens in place are adequate, is first assessed, due to cost concerns. The following short report exemplifies the pain and anxiety experiences of a small number of burn injury patients during physiotherapy at the Tygerberg Hospital adult burn unit, South A frica.  It was hypothesized that the results of this study would underpin whether adult burn injury patients in a developing countryrequire adjunct therapies during physiotherapy management to supplement traditional pharmacologic analgesics inmanaging their procedural pain and subsequent anxiety.

  13. Risk factors for burn-out in caregivers of stroke patients, and possibilities for intervention

    NARCIS (Netherlands)

    van den Heuvel, ETP; de Witte, LP; Schure, LM; Sanderman, R; Meyboom-de Jong, B

    2001-01-01

    Objective: To identify which caregivers of stroke patients living at home experience the highest levels of strain and are at risk of burn-out, and to investigate how support for caregivers of stroke patients could best be organized, and when this support should be offered. Design and setting: Caregi

  14. Inhalation injury in burn patients: establishing the link between diagnosis and prognosis.

    Science.gov (United States)

    You, Kicheol; Yang, Hyeong-Tae; Kym, Dohern; Yoon, Jaechul; HaejunYim; Cho, Yong-Suk; Hur, Jun; Chun, Wook; Kim, Jong-Hyun

    2014-12-01

    This study was to re-evaluate inhalation injury as a prognostic factor in burn patients and to determine the factors that should be considered when refining the definition of inhalation injury. A total of 192 burn patients (152 men, 40 women; mean age, 46.1±13.8 years) who were suspected to have an inhalation injury and underwent bronchoscopy between January 2010 and June 2012 were included in this prospective observational study. All patients underwent bronchoscopy within 24h of sustaining the burn. The bronchoscopic findings were classified as normal, mild, moderate, and severe. Mechanical ventilation was administered, when required. Age, percentage of TBSA burned, ABSI score, requirement of mechanical ventilation and PF ratio, but not inhalation injury, COHb level, and bronchoscopic grades, significantly differed between the survivors and non-survivors (pburns. Other components such as severity of inhalation injury determined using bronchoscopy, and administration of mechanical ventilation might help predict the morbidity and mortality of burn patients with inhalation injury and all of the factors should be considered when the definition of inhalation injury is refined.

  15. Pseudomonas aeruginosa, an emerging pathogen among burn patients in Kurdistan Province, Iran.

    Science.gov (United States)

    Kalantar, Enayat; Taherzadeh, Shadi; Ghadimi, Tayeb; Soheili, Fariborz; Salimizand, Heiman; Hedayatnejad, Alireza

    2012-05-01

    This study was conducted to determine the incidence of Pseudomonas aeruginosa infections among burn patients at Tohid Hospital, Iran. A total of 176 clinical specimens were obtained from 145 burn patients admitted to the burn unit of Tohid Hospital to detect the presence of P. aeruginosa. Antimicrobial susceptibility testing was conducted to detect extended spectrum beta-lactamase (ESBL) producing P. aeruginiosa using Clinical and Laboratory Standards Institute guidelines with the double disc synergy test (DDST). A polymerase chain reaction was used to detect PER-1 and OXA-10 among the isolates. The mean age, total body surface area and length of hospital stay among patients were 29 years, 37.7%, and 10 days, respectively. Kerosene was the commonest cause of burn (60%), followed by gas (30%). During the study, P. aeruginosa was detected in 100 isolates. The antibiotics they were most commonly resistant to were cefotaxime, ceftriaxone and ciprofloxacin. Of the 100 P. aeroginusa isolates, 28% were positive for ESBL production with the DDST, 48% and 52% were PER-1 and OXA-10 producers, respectively. The high frequency of PER-1 and OXA-10 producers at this hospital is of concern considering their potential spread among burn patients.

  16. Transfer of patients with severe burn injury%严重烧伤伤员的转运

    Institute of Scientific and Technical Information of China (English)

    彭毅志

    2015-01-01

    Transfer of patients with severe burn injury is an important issue during the rescue of mass casualties,as it may give rise to great influence on the prognosis of patients.Timing of transfer,preparation before transfer,and details for attention are elaborated in this article,aiming to further specify the procedures of transfer of patients with burn injury.

  17. A Retrospective Analysis of the Burn Injury Patients Records in the Emergency Department, an Epidemiologic Study

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    Nilgün Aksoy

    2014-08-01

    Full Text Available Introduction: Burns can be very destructive, and severely endanger the health and lives of humans. It maybe cause disability and even psychological trauma in individuals. . Such an event can also lead to economic burden on victim’s families and society. The aim of our study is to evaluate epidemiology and outcome of burn patients referring to emergency department. Methods: This is a cross-sectional study was conducted by evaluation of patients’ files and forensic reports of burned patients’ referred to the emergency department (ED of Akdeniz hospital, Turkey, 2008. Demographic data, the season, place, reason, anatomical sites, total body surface area, degrees, proceeding treatment, and admission time were recorded. Multinomial logistic regression was used to compare frequencies’ differences among single categorized variables. Stepwise logistic regression was applied to develop a predictive model for hospitalization. P<0.05 was defined as a significant level. Results: Two hundred thirty patients were enrolled (53.9% female. The mean of patients' ages was 25.3 ± 22.3 years. The most prevalence of burn were in the 0-6 age group and most of which was hot liquid scalding (71.3%. The most affected parts of the body were the left and right upper extremities. With increasing the severity of triage level (OR=2.2; 95% CI: 1.02-4.66; p=0.046, intentional burn (OR=4.7; 95% CI: 1.03-21.8; p=0.047, referring from other hospitals or clinics (OR=3.4; 95% CI: 1.7-6.6; p=0.001, and percentage of burn (OR=18.1; 95% CI: 5.42-62.6; p<0.001 were independent predictive factor for hospitalization. In addition, odds of hospitalization was lower in patients older than 15 years (OR=0.7; 95% CI: 0.5-0.91; p=0.035. Conclusion: This study revealed the most frequent burns are encountered in the age group of 0-6 years, percentage of <10%, second degree, upper extremities, indoor, and scalding from hot liquids. Increasing ESI severity, intentional burn, referring from

  18. A clinical observation of early short-term use of potent antibiotics in severely burned patients

    Institute of Scientific and Technical Information of China (English)

    RONG Xin-zhou; ZHANG Wen-zhen; REN Jia-liang; ZHOU Wei-ming

    2001-01-01

    Objective: To evaluate the effect of early and short-term use of potent antibiotics following extensive severe burn injury. Methods: Seventeen severely burned patients hospitalized in the same period (Nov.,1998 to Oct., 2000) wer esame treatment in Group 2 (n=8) was discontinued until day 15 postburn. The survival rate, blood bacterial culture, body temperature and white blood cell and platelet counts were compared between the 2 groups. Results: All the 17 patients survived and all blood bacterial cultures were negative. No significant difference of body temperature and white blood cell and platelet counts between the 2 groups was observed (P>0.05). Conclusion: Early use of high-potency antibiotics at short treatment course after extensive severe burn is effective to prevent infection and reduce the cost.

  19. Antibacterial susceptibility of bacteria isolated from burns and wounds of cancer patients

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    Sulaiman A. Alharbi

    2014-01-01

    Full Text Available In this study 540 burns and wound swabs were collected from cancer patients of some Egyptian hospitals. The single infection was detected from 210, and 70 cases among wounded and burned patients, while mixed infection was 30 and 45, respectively. We recovered where 60 isolates of Pseudomonas aeruginosa, 60 isolates of Staphylococcus aureus, 7 isolates of Staphylococcus epidermidis, 4 isolates of Streptococcus pyogenes, 25 isolates of Escherichia coli, 23 isolates of Klebsiella pneumoniae and 27 isolates of Proteus vulgaris from 355 burn and surgical wound infections . All bacterial isolates showed high resistance to the commonly used β-lactams (amoxycillin, cefaclor, ampicillin, vancomycin, amoxicillin/clavulonic, and low resistance to imepenim and ciprofloxacin. Plasmid analysis of six multidrug resistant and two susceptible bacterial isolates revealed the same plasmid pattern. This indicated that R-factor is not responsible for the resistance phenomenon among the isolated opportunistic bacteria. The effect of ultraviolet radiation on the isolated bacteria was studied.

  20. Molecular Typing of Pseudomonas aeruginosa Strains Isolated from Burn Patients in South of Iran

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    Aziz Japoni

    2016-01-01

    Full Text Available Background: Pseudomonas aeruginosa is one of the main etiological agents in burn infections which could be life threatening for the infected patients. The aim of the present study was to identify and track source of infections using two molecular typing methods. Materials and Methods: Seventy-four strains of P. aeruginosa were isolated from burn patients and hospital environment in Ghotbadden Burn Hospital, Shiraz, Iran. Isolates were typed by arbitrary primed-polymerase chain reaction (AP-PCR and plasmid profiling. Similarity and clustering of the strains was assessed using NTSYS-PC software and photo Capt Mw program. Results: Thirty eight plasmid profiles were obtained and classified them into: 2, 3and 5 clusters, based on 50%, 64.7% and 67.5% similarity on the plotted dendrogram, respectively. Drawn dendrogarm categorized AP-PCR products to 47 different types. Conclusion: Based on these results, a limited number of P. aeruginosa types are predominant in the hospitals which infect the burn patients. To control of the infections in patients with antibiotics, resistant isolates, strong disinfection of patients’ bathroom after scrubbing of patients wounds, should be implemented.

  1. Colonisation with toxigenic Corynebacterium diphtheriae in a Scottish burns patient, June 2015.

    Science.gov (United States)

    Deshpande, Ashutosh; Inkster, Teresa; Hamilton, Kate; Litt, David; Fry, Norman; Kennedy, Iain T R; Shookhye-Dickson, Jacqueline; Hill, Robert L R

    2015-01-01

    On 12 June 2015, Corynebacterium diphtheriae was identified in a skin swab from a burns patient in Scotland. The isolate was confirmed to be genotypically and phenotypically toxigenic. Multilocus sequence typing of three patient isolates yielded sequence type ST 125. The patient was clinically well. We summarise findings of this case, and results of close contact identification and screening: 12 family and close contacts and 32 hospital staff have been found negative for C. diphtheriae.

  2. The Effect of Massage on Anticipatory Anxiety and Procedural Pain in Patients with Burn Injury

    Science.gov (United States)

    Najafi Ghezeljeh, Tahereh; Mohades Ardebili, Fatimah; Rafii, Forough; Manafi, Farzad

    2017-01-01

    BACKGROUND Pain related to burn injuries is one of the most troublesome pain intensity. This study aimed to investigate the effect of massage on anticipatory anxiety, procedural pain intensity, vital signs and relaxation level of patients with burn injury. METHODS In this quasi-experimental study, through convenience sampling, 60 hospitalized adult burn patients were selected from a specialized burn and reconstructive hospital. Subjects were assigned to massage and control groups through simple randomization. Massage was offered by using non aromatic oil about 10-15 minutes before wound care on intact part of the body once a day for 20 minutes on patients’ bedside for 3 consecutive days. In the 3 days, the control group did not received any massage and were asked to stay at bed. Demographic and clinical characteristics and vital signs, Visual Analogue Scale and the Persian version of Burn Specific Pain Anxiety Scale were used to determine baseline and procedural pain, anxiety and relaxation levels and anticipatory anxiety. RESULTS No significant difference was noted between mean score of pain intensity, anxiety and relaxation level, and vital signs in massage and control groups after intervention following wound care. In massage and control groups, there was no significant differences between mean scores of anticipatory anxiety before and after intervention. There was no significant difference between the mean scores of anticipatory anxiety in massage and control groups after intervention prior wound care. CONCLUSION Massage was shown not to have any effect on anticipatory anxiety and procedural pain. PMID:28289612

  3. The Antibacterial Activity of Acetic Acid against Biofilm-Producing Pathogens of Relevance to Burns Patients.

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    Fenella D Halstead

    Full Text Available Localised infections, and burn wound sepsis are key concerns in the treatment of burns patients, and prevention of colonisation largely relies on biocides. Acetic acid has been shown to have good antibacterial activity against various planktonic organisms, however data is limited on efficacy, and few studies have been performed on biofilms.We sought to investigate the antibacterial activity of acetic acid against important burn wound colonising organisms growing planktonically and as biofilms.Laboratory experiments were performed to test the ability of acetic acid to inhibit growth of pathogens, inhibit the formation of biofilms, and eradicate pre-formed biofilms.Twenty-nine isolates of common wound-infecting pathogens were tested. Acetic acid was antibacterial against planktonic growth, with an minimum inhibitory concentration of 0.16-0.31% for all isolates, and was also able to prevent formation of biofilms (at 0.31%. Eradication of mature biofilms was observed for all isolates after three hours of exposure.This study provides evidence that acetic acid can inhibit growth of key burn wound pathogens when used at very dilute concentrations. Owing to current concerns of the reducing efficacy of systemic antibiotics, this novel biocide application offers great promise as a cheap and effective measure to treat infections in burns patients.

  4. The interaction between burn injury and vitamin D metabolism and consequences for the patient.

    Science.gov (United States)

    Klein, Gordon L

    2008-09-01

    The stress and inflammatory responses to burn injury are associated with bone loss. The stress response entails production of large amounts of endogenous glucocorticoids that decrease osteoblasts on the mineralization surface of bone and decreases differentiation of marrow stromal cells into osteoblasts, thereby decreasing the amount of bone formation. Deficiency of osteoblasts also blocks osteoclastogenesis thus leading to low bone turnover and bone loss. The inflammatory response generates cytokines such as interleukin 1-beta and interleukin-6, which normally increase osteoclastogenic bone resorption via stimulation of osteoblast production of RANK ligand. However, in the absence of osteoblasts as a target we postulate that they attack the parathyroid gland chief cells and up-regulate the calcium-sensing receptor. The consequence of this upregulation is the lowering of the circulating calcium necessary to suppress parathyroid hormone production and the development of hypocalcemia and urinary calcium wasting. It is the parathyroid hormone suppression that causes us to postulate acute deficiency of 1,25-dihydroxyvitamin D and the consequence of this for post-burn metabolism could include derepression of the gene that controls renin production, leading to elevated levels of angiotensin II, which can contribute to insulin resistance, as can vitamin D deficiency itself. Moreover, the skin from burned patients cannot synthesize vitamin D normally. Thus vitamin D supplementation is the only means by which to ensure vitamin D sufficiency for burn victims. The proper requirement for vitamin D in acutely burned patients remains unknown.

  5. Bacterial Respiratory Tract Infections are Promoted by Systemic Hyperglycemia after Severe Burn Injury in Pediatric Patients

    Science.gov (United States)

    Kraft, Robert; Herndon, David N; Mlcak, Ronald P; Finnerty, Celeste C; Cox, Robert A; Williams, Felicia N; Jeschke, Marc G

    2014-01-01

    Background Burn injuries are associated with hyperglycemia leading to increased incidence of infections with pneumonia being one of the most prominent and adverse complication. Recently, various studies in critically ill patients indicated that increased pulmonary glucose levels with airway/blood glucose threshold over 150 mg/dl lead to an overwhelming growth of bacteria in the broncho-pulmonary system, subsequently resulting in an increased risk of pulmonary infections. The aim of the present study was to determine whether a similar cutoff value exists for severely burned pediatric patients. Methods One-hundred six severely burned pediatric patients were enrolled in the study. Patients were divided in two groups: high (H) defined as daily average glucose levels >75% of LOS >150 mg/dl), and low (L) with daily average glucose levels >75% of the LOS pneumonia, atelectasis, and acute respiratory distress syndrome (ARDS) were assessed. Incidence of infections, sepsis, and respiratory parameters were recorded. Blood was analyzed for glucose and insulin levels. Statistical analysis was performed using Student’s t-test and chi-square test. Significance was set at pPatient groups were similar in demographics and injury characteristics. Pneumonia in patients on the mechanical ventilation (L: 21% H: 32%) and off mechanical ventilation (L: 5% H: 15%), as well as ARDS were significantly higher in the high group (L: 3% H: 19%), pPatients in the high group required significantly longer ventilation compared to low patients (ppneumonia confirming the previous studies in critically ill patients. PMID:24074819

  6. Development and evaluation of a DVD for the education of burn patients who were not admitted to hospital.

    Science.gov (United States)

    Finlay, Vidya; Davidoss, Nishant; Lei, Cory; Huangfu, Juhui; Burrows, Sally; Edgar, Dale Wesley; Rea, Suzanne; Wood, Fiona M

    2012-01-01

    Patient involvement is an important component of burn care and is necessary to produce good outcomes. Patient education using multimedia resources is useful in facilitating self-management and recovery from burn injury. The study aims to provide and evaluate an instructional DVD to assist burn patients with their self-management. The project was divided into three phases: 1) research about the needs of patients, 2) production of the DVD based on those needs, and 3) evaluation of the effectiveness of the DVD. In phase III, 49 burn patients (73% male; median age 32 years, median TBSA 3%) completed a survey on confidence in their burn care before development of an educational DVD, the results of which were compared with those of 55 burn patients (58% male; median age 35 years, median TBSA 3%) who completed the same survey questions after viewing a burn care DVD. Patient confidence in all self-management activities showed a statistically significant improvement (P DVD improves confidence in self-management of patients who have not been admitted to hospital and is a useful adjunct to current burn practice.

  7. Sensitivity and specificity of bronchoalveolar lavage and protected bronchial brush in the diagnosis of pneumonia in pediatric burn patients

    NARCIS (Netherlands)

    Barret, JP; Ramzy, PI; Wolf, SE; Herndon, DN

    1999-01-01

    Background: Infection is still one of the leading causes of death in burn patients. The diagnosis of respiratory tract infection in critically ill burn patients is still difficult. The diagnostic technique of choice remains uncertain, especially because of the lack of a criterion standard by which o

  8. Effect of extracorporeal shock wave therapy on scar pain in burn patients

    Science.gov (United States)

    Cho, Yoon Soo; Joo, So Young; Cui, Huisong; Cho, Sung-Rae; Yim, Haejun; Seo, Cheong Hoon

    2016-01-01

    Abstract Background: Extracorporeal shock wave therapy (ESWT) has been used to reduce pain in patients with various musculoskeletal diseases and wounds. We investigated the effect of ESWT on scar pain after complete wound epithelialization in burn patients. Methods: A prospective, single-blind, placebo-controlled study was conducted from February 2014 to 2015. Forty patients with burn scar pain despite standard therapy (medication, physical therapy, and burn rehabilitation massage therapy) were randomized into ESWT or control (sham ESWT) groups. ESWT was administered at 100 impulses/cm2 (0.05–0.15 mJ/mm2) once per week for 3 weeks. The treatment effects were assessed using the numerical rating scale (NRS), pain threshold, Nirschl pain phase system, and Roles and Maudsley scores. Results: The characteristics of patients between the 2 study groups were balanced (P >0.05) for age, sex, and total burn surface area (%). In both groups, the NRS, pain threshold (Ib/cm2), and Nirschl pain phase system values significantly improved (P therapy, and there were significant differences between the 2 groups in terms of these 3 variables (P <0.001, P <0.001, P = 0.013, respectively). The Roles and Maudsley scores significantly improved; among 20 patients, 17 reported a score of poor (85%) and 3 reported fair (15%) before ESWT, whereas 3 reported poor (15%), 8 reported fair (40%), 5 reported good (25%), and 4 reported excellent (20%) after ESWT (P = 0.004). The scores did not improve in the control group (P = 0.128). Conclusion: ESWT significantly reduced scar pain in burn patients after wound recovery. PMID:27512886

  9. Randomized-controlled trial of esomeprazole in functional dyspepsia patients with epigastric pain or burning

    DEFF Research Database (Denmark)

    Talley, N J; Vakil, N; Lauritsen, K;

    2007-01-01

    BACKGROUND: Early identification of true responders to acid suppression in functional dyspepsia patients with symptoms of epigastric pain or burning may enable clinicians to optimally tailor treatment. AIM: To evaluate whether a 1-w acid suppression trial is useful for identifying true responders...

  10. Fluid input control in burned patients with the aid of ultrasonic arterial blood pressure monitoring.

    Science.gov (United States)

    Banssillon, V; Latarjet, J

    1975-01-01

    Arterial blood pressure is nowadays easily and reliably measured with ultrasonic equipment. It correlates well with blood volume, and may therefore be used to guide fluid infusion in burned patients. Monitoring of blood pressure, instead of application of old-fashioned recipes, helps to avoid dangerous situations of hypovolemia or overload.

  11. Microfluidics for T- lymphocyte cell separation and inflammation monitoring in burn patients.

    Science.gov (United States)

    Rosenbach, Alan E; Koria, Piyush; Goverman, Jeremy; Kotz, Kenneth T; Gupta, Amit; Yu, Ming; Fagan, Shawn P; Irimia, Daniel; Tompkins, Ronald G

    2011-02-01

    Severe burns result in T lymphocyte specific immunologic changes. In addition to decreased levels of circulating lymphocytes, changes in cytokine secretion and receptor expression also take place. Our finer understanding of the inflammatory response has led to the development of immune-targeted therapeutics, requiring specialized gene-expression monitoring. The emerging field of bio-micro-electromechanical systems can be used to isolate highly pure T lymphocytes in a clinically relevant and timely manner for downstream genomic analysis. Blood samples from healthy volunteers and burn-injured patients were introduced into microfluidic devices developed in our laboratory. Utilizing cell-affinity chromatography for positive selection of T lymphocytes, the devices served as a platform for RNA extraction and downstream cytokine analysis via quantitative real-time polymerase chain reaction (PCR). From a 0.5-mL whole blood sample, the microfluidic devices captured highly pure T lymphocytes from healthy volunteers and burn-injured patients. Cell capture was of sufficient quantity, and extracted RNA was of sufficient quality, for evaluating the gene expression of cytokines: interferon-gamma, interleukin-2, interleukin-4, and interleukin-10. Microfluidics is a useful tool in processing blood from burn-injured patients. Though in its very early stages of development, cell-specific information obtained by this platform/technology will likely be an important component of near-patient molecular diagnostics and personalized medicine.

  12. A retrospective study of drug prescribing pattern in burns patients in a tertiary care rural hospital

    Directory of Open Access Journals (Sweden)

    Palak Agrawal

    2015-06-01

    Conclusions: Females are more vulnerable to burn injuries. Polypharmacy was observed in prescriptions. Systemic antibiotic should be used with caution to prevent emergence of resistant microorganisms. Results of the present study indicate that some aspects of drug treatment need to be rationalized in order to achieve better patient care. [Int J Res Med Sci 2015; 3(6.000: 1446-1452

  13. Selective decontamination of the digestive tract in severely burned pediatric patients

    NARCIS (Netherlands)

    Barret, JP; Jeschke, MG; Herndon, DN

    2001-01-01

    Infection is still one of the leading causes of morbidity and mortality in severely burned patients. Evidence suggests that many of the responsible organisms are endogenous. Systemic antibiotic prophylaxis is not effective, and produces resistant strains of microorganisms. SDD has been postulated to

  14. Divergent and dynamic activity of endogenous retroviruses in burn patients and their inflammatory potential.

    Science.gov (United States)

    Lee, Kang-Hoon; Rah, HyungChul; Green, Tajia; Lee, Young-Kwan; Lim, Debora; Nemzek, Jean; Wahl, Wendy; Greenhalgh, David; Cho, Kiho

    2014-04-01

    Genes constitute ~3% of the human genome, whereas human endogenous retroviruses (HERVs) represent ~8%. We examined post-burn HERV expression in patients' blood cells, and the inflammatory potentials of the burn-associated HERVs were evaluated. Buffy coat cells, collected at various time points from 11 patients, were screened for the expression of eight HERV families, and we identified their divergent expression profiles depending on patient, HERV, and time point. The population of expressed HERV sequences was patient-specific, suggesting HERVs' inherent genomic polymorphisms and/or differential expression potentials depending on characteristics of patients and courses of injury response. Some HERVs were shared among the patients, while the others were divergent. Interestingly, one burn-associated HERV gag gene from a patient's genome induced IL-6, IL-1β, Ptgs-2, and iNOS. These findings demonstrate that injury stressors initiate divergent HERV responses depending on patient, HERV, and disease course and implicate HERVs as genetic elements contributing to polymorphic injury pathophysiology.

  15. Effect of music intervention on burn patients' pain and anxiety during dressing changes.

    Science.gov (United States)

    Hsu, Kuo-Cheng; Chen, Li Fen; Hsiep, Pi Hsia

    2016-12-01

    For burn patients, the daily dressing process causes pain and anxiety. Although drugs can relieve them, the degree of pain during dressing changes is often moderate to severe. Therefore, relevant supporting interventions, like music as an ideal intervention, could alleviate the patient's pain. This study investigated the impact of music intervention at dressing change time on burn patients' pain and anxiety. This was a prospective, randomized clinical trial; patients were randomly assigned into control (standard intervention) and experimental groups (crystal music intervention) for five consecutive days (35 patients in each group). Patients' pain and anxiety measurements were collected before, during, and after dressing changes and morphine usage was recorded. The study period was October 2014 to September 2015. There was no difference in morphine dosage for both groups. By the fourth day of music intervention, burn patients' pain before, during, and after dressing changes had significantly decreased; anxiety on the fourth day during and after dressing changes had also significantly decreased. Nurses may use ordered prescription analgesics, but if non-pharmacological interventions are increased, such as providing timely music intervention and creating a friendly, comfortable hospital environment, patients' pain and anxiety will reduce.

  16. Outcomes of a shoulder treatment flowchart in patients with axillary burns.

    Science.gov (United States)

    Webb, Darren C; Byrne, Martin; Kolmus, Alison; Law, Henrietta Y; Holland, Anne E; Cleland, Heather

    2011-01-01

    The purpose of this study was to evaluate the effects of a structured shoulder treatment flowchart on range of motion (ROM) and function of the upper limb in patients at high and low risk of contracture after an axillary burn injury. Consecutive patients with axillary burns were managed according to a structured pathway based on risk of contracture. Those patients with deep partial- or full-thickness burns to more than one area of the axilla or requiring more than one split skin graft were classified as high risk; these patients underwent a more aggressive approach to splinting and exercise. Measurements of shoulder ROM and functional ability (upper extremity functional index) were made at admission, hospital discharge, and at 12 weeks postdischarge. Twenty patients (19 men) with an average age of 39 years and a median TBSA of 20% were recruited. Median length of stay was 18 days. Ten patients were classified as high risk. Both low-risk and high-risk patients showed good range of movement outcomes at discharge and 12 weeks, with no significant differences between risk groups (abduction at 12 weeks, mean [SD]: 168° [22°] vs 166° [28°], P = .60; flexion at 12 weeks, mean [SD]: 172° [20°] vs 167° [31°], P = .60, respectively). There were no differences in functional outcomes at 12 weeks postdischarge. Use of a shoulder treatment pathway was associated with good shoulder ROM and functional capacity in patients at high and low risk of axillary contracture.

  17. [Surgical therapy and critical care medicine in severely burned patients - Part 2: the basics in definite care].

    Science.gov (United States)

    Deisz, Robert; Kauczok, Jens; Dembinski, Rolf; Pallua, Norbert; Marx, Gernot

    2013-01-01

    Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial stabilization of the burn victim during the first 24 hours (Surgical therapy and critical care medicine in severely burned patients - Part 1: the first 24 ours, AINS 9/12) is followed by a long lasting reconstructive period. During this time calculated fluid replacement to compensate evaporative losses by large bourn wounds is as essential as reconstruction of the integrity of the skin and the modulation of metabolic consequences following severe burn injury. Special attention has to be paid to local and systemic infections.

  18. Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Joelle W Boeve

    2011-03-01

    Full Text Available Patrick K Boyle, John J Badal, Joelle W BoeveDepartment of Anesthesiology, Arizona Health Sciences Center, Tucson, AZ, USAAbstract: Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our hope that this case alerts physicians and others involved in the management of postoperative patients to the challenges of managing a blocked extremity after thermal cast placement and offers solutions that can be standardized.Keywords: Peripheral nerve block, cast burn, postoperative complication

  19. Management of a patient with thermal burns and para-chloronitrobenzene poisoning

    Directory of Open Access Journals (Sweden)

    Yuanhai Zhang

    2014-10-01

    Full Text Available Para-chloronitrobenzene (p-CNB, a hazardous and toxic substance, is widely used as an intermediary in chemical industries. p-CNB can cause methaemoglobinaemia due to electron-withdrawing properties of the nitro and chlorine groups. We present a case of a 23-year-old man suffering from thermal burns and p-CNB poisoning. In this case, severe methaemoglobinaemia was caused by the absorption of p-CNB through the burn wounds. Despite active treatment, such as the antidote of methylene blue, the patient’s methaemoglobinaemia progressed, with slowly increasing methaemoglobin (MetHb level. This case highlights the complexity and difficulty of managing this type of injury. To our knowledge, this case can be the first case report describing methaemoglobinaemia induced by p-CNB in a patient with thermal burns.

  20. Neutrophil dysfunction after thermal injury: alteration of phagolysosomal acidification in patients with large burns.

    Science.gov (United States)

    Bjerknes, R; Vindenes, H

    1989-04-01

    The neutrophil phagolysosomal acidification during phagocytosis of Staphylococcus aureus was examined in six patients with large burns, using a flow cytometric technique allowing the simultaneous measurement of phagocytosis and phagolysosomal pH. The kinetics of neutrophil phagolysosomal acidification were altered during the first 20 days following injury, as the initial alkalinization of the phagolysosomes documented in control neutrophils could not be demonstrated in patient cells. Only at discharge and follow-up were the kinetics of phagolysosomal acidification normal. In addition, measurements of neutrophil maximal phagolysosomal acidification showed a lower pH in patient phagolysosomes than in the controls during the first 5 days of hospitalization. The changes of phagolysosomal acidification did not correlate with the alterations of neutrophil maturity or phagocytic capacity. The results demonstrate alterations of an oxygen-independent microbicidal mechanism in neutrophils from patients with large burns, which may contribute to the reduced capacity of neutrophil intracellular killing following thermal injury.

  1. Aerobic exercise training in modulation of aerobic physical fitness and balance of burned patients.

    Science.gov (United States)

    Ali, Zizi M Ibrahim; El-Refay, Basant H; Ali, Rania Reffat

    2015-03-01

    [Purpose] This study aimed to determine the impact of aerobic exercise on aerobic capacity, balance, and treadmill time in patients with thermal burn injury. [Subjects and Methods] Burned adult patients, aged 20-40 years (n=30), from both sexes, with second degree thermal burn injuries covering 20-40% of the total body surface area (TBSA), were enrolled in this trial for 3 months. Patients were randomly divided into; group A (n=15), which performed an aerobic exercise program 3 days/week for 60 min and participated in a traditional physical therapy program, and group B (n=15), which only participated in a traditional exercise program 3 days/week. Maximal aerobic capacity, treadmill time, and Berg balance scale were measured before and after the study. [Results] In both groups, the results revealed significant improvements after treatment in all measurements; however, the improvement in group A was superior to that in group B. [Conclusion] The results provide evidence that aerobic exercises for adults with healed burn injuries improve aerobic physical fitness and balance.

  2. Central Nervous System Infections in Patients with Severe Burns

    Science.gov (United States)

    2010-01-01

    both patients had bacteremia with identical microorganisms as isolated from CSF ( Acinetobacter baumannii and methicillin resistant Staphylococcus...multiresistant Acinetobacter baumannii central nervous system infections with intraventricular or intrathecal colistin: case series and literature review. J

  3. Effects of Granulocyte-Macrophage Colony-Stimulating Factor in Burn Patients

    Science.gov (United States)

    1991-01-01

    aber- Although the specific cause of the immune dysfunction rant response was associated with a relative failure of granu - following thermal iriury is...during tended to have an increased percentage of band forms and postbum week 4 when treated patients had significantly fewer granu - myelocytes during...cell production of neutrophils, monocytes, cyte stem cells in nonsurviving patients with large burns, and eosinophils . Significant increases in

  4. Outbreak of infection in a burns unit due to Pseudomonas aeruginosa originating from contaminated tubing used for irrigation of patients

    DEFF Research Database (Denmark)

    Kolmos, H J; Thuesen, B; Nielsen, S V;

    1993-01-01

    Five patients with extensive deep burns developed septicaemia due to Pseudomonas aeruginosa serogroup O-7.8 and phage type 21 or 21/188 shortly after they had been admitted to hospital. Four other burned patients became colonized with the same strain. The source of infection was contaminated tap...... water used for irrigation of the burns, as part of the first-aid treatment which the patients received when entering the hospital. Contamination was restricted to showers and tubing that were permanently connected to the taps, and the outbreak stopped after they had been disinfected. Tubing and showers...... used for irrigation of burns should be dismantled and heat-disinfected after each patient and not reconnected to the taps until immediately before the next treatment. Taps used for irrigation of burns should be monitored regularly for the presence of P. aeruginosa and other potentially pathogenic...

  5. Patient risk factors for pressure ulcer development: Systematic review

    NARCIS (Netherlands)

    Coleman, S.; Gorecki, C.; Nelson, E.A.; Closs, S.J.; Defloor, T.; Halfens, R.; Farrin, A.; Brown, J.; Schoonhoven, L.; Nixon, J.

    2013-01-01

    OBJECTIVE: To identify risk factors independently predictive of pressure ulcer development in adult patient populations? DESIGN: A systematic review of primary research was undertaken, based upon methods recommended for effectiveness questions but adapted to identify observational risk factor studie

  6. Effect of nitrous oxide on fentanyl consumption in burned patients undergoing dressing change

    Directory of Open Access Journals (Sweden)

    Arthur Halley Barbosa do Vale

    2016-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Thermal injuries and injured areas management are important causes of pain in burned patients, requiring that these patients are constantly undergoing general anesthesia for dressing change. Nitrous oxide (N2O has analgesic and sedative properties; it is easy to use and widely available. Thus, the aim of this study was to evaluate the analgesic effect of N2O combined with fentanyl in burned patients during dressing change. METHOD: After approval by the institutional Ethics Committee, 15 adult burned patients requiring daily dressing change were evaluated. Patient analgesia was controlled with fentanyl 0.0005% administered by intravenous pump infusion on-demand. Randomly, in one of the days a mixture of 65% N2O in oxygen (O2 was associated via mask, with a flow of 10 L/min (N2O group and on the other day only O2 under the same flow (control group. RESULTS: No significant pain reduction was seen in N2O group compared to control group. VAS score before dressing change was 4.07 and 3.4, respectively, in N2O and control groups. Regarding pain at the end of the dressing, patients in N2O group reported pain severity of 2.8; while the control group reported 2.87. There was no significant difference in fentanyl consumption in both groups. CONCLUSIONS: The association of N2O was not effective in reducing opioid consumption during dressing changes.

  7. Health-related quality of life in Swedish pediatric burn patients and associations with burn and family characteristics.

    Science.gov (United States)

    Sveen, J; Sjöberg, F; Öster, C

    2014-08-01

    Although many children with burns recover well and have a satisfying quality of life after the burn, some children do not adjust as well. Health-related quality of life (HRQoL) focuses on the impact health status has on quality of life. The aim of this study was to assess HRQoL with the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire (BOQ) in a nationwide Swedish sample of children with burns 0.3-9.0 years after injury. Participants were parents (n=109) of children aged up to 18 years at the time of investigation who were treated at the Linköping or Uppsala Burn Center between 2000 and 2008. The majority of children did not have limitations in physical function and they did not seem to experience much pain. However, there were indications of psychosocial problems. Parents of preschool children reported most problems with the children's behavior and family disruption, whereas parents of children aged 5-18 years reported most problems with appearance and emotional health. There were mainly burn-related variables associated with suboptimal HRQoL in children aged 5-18 years, while family-related variables did not contribute as much.

  8. Severe burns as a consequence of seizures in patients with epilepsy.

    Science.gov (United States)

    Spitz, M C

    1992-01-01

    We report 10 seizure-related thermal injuries severe enough to require hospitalization in patients with epilepsy. Eight of the ten incidents were with patients who had had seizures with impaired consciousness two or more times a month. This suggests that seizure frequency is a risk factor and implies the importance of striving for optimal seizure control. Two burns each occurred from an electric iron, a hand-held hair dryer, and stove-top cooking. Minimizing these activities, especially in patients with frequent consciousness-altering seizures, may be useful. Three burns occurred while showering; these resulted in the most severe injuries, with hospital stays of 29, 30, and 41 days. Simple plumbing devices may have prevented these injuries.

  9. Application of spiral nasointestinal tube in enteral nutrition support for patients with extensive burn

    Institute of Scientific and Technical Information of China (English)

    Lai-Ping Wang; Hong-Fei Jia; Yan-Li Cao

    2016-01-01

    Objective:To observe the effect of spiral nasointestinal tube on enteral nutrition support in patients with extensive burn.Methods: A total of 60 patients with extensive burn who were admitted in our hospital from January, 2014 to June, 2015 were included in the study and divided into the observation group and the control group with 30 cases in each group according to different catheter indwelling methods. The patients in the observation group were given spiral nasointestinal tube for enteral nutrition support, while the patients in the control group were given routine gastric tube for enteral nutrition support. The nutrition status and the occurrence rate of complications before catheter indwelling, 3, 6, and 10 d after catheter indwelling in the two groups were recorded.Results:The levels of ALB, HB, PA, and Scr 6, 10 d after catheter indwelling in the observation group were significantly higher than those in the control group (P<0.05). The occurrence rate of complications during the treatment period in the observation group was significantly lower than that in the control group (P<0.05). Conclusions:The spiral nasointestinal tube can provide the patients with extensive burn a better effective enteral nutrition support and improve the nutrition support, with a lower occurrence rate of complications, which is beneficial for the patients’ rehabilitation.

  10. Persistent candidemia in major burn patients: radiologic findings of the thorax

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eil Seong; Lee, Kwan Seop; Kang, Ik Won [Hallym Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-04-01

    To describe radiologic findings of burn-associated persistent candidemia of the thorax. This study included 42 patients with major burns in whom blood culture had shown the presence for more than 24 hours of persistent candidemia. The duration of positive culture for candidiasis ranged from two to 67 days(mean, 15 days). Radiographic(n=42) and thin-section CT findings(n=13) were retrospectively analyzed. The onset, pattern, size, distribution and persistence of parenchymal abnormalities as well as the presence or absence of pleural effusions, mediastinal lymphadenopathy and cardiomegaly were assessed. On chest radiographs, positive findings were noticed in 61.9%(26/42) and on thin-section CT, in 76.9%(10/13). The most frequent radiographic finding was pulmonary nodule(s), observed in 14 patients(33.3%); in 13, these were bilateral. Bronchovascular bundle thickening(n=6, 14.3%), consolidation(n=4, 9.5%), cardiomegaly(n=6, 14.3%) and pleural effusion(n=4, 9.5%) were also observed. Those lesions appeared eight to 129 days(mean, 33 days) after the burn. Radiographic abnormalities persisted for seven to 115(mean, 35) days, regardless of the treatment. Thin-section CT showed parenchymal abnormalities in 10/13 patients(76.9%) and subpleural nodules of less than 1cm in diameter and without halo in all patients. Cardiomegaly, pleural effusion and mediastinal adenopathy were observed on CT in 5(38.5%), 4(30.8%) and 2(15.4%) of the 13 patients, respectively. In a high proportion of patients with burn-associated candidemia, chest radiograph and thin-section CT findings were positive. The most frequent radiographic parenchymal abnormality was multiple bilateral nodules.

  11. Pharmacokinetic-pharmacodynamic correlation of imipenem in pediatric burn patients using a bioanalytical liquid chromatographic method

    Directory of Open Access Journals (Sweden)

    Silvia Regina Cavani Jorge Santos

    2015-06-01

    Full Text Available A bioanalytical method was developed and applied to quantify the free imipenem concentrations for pharmacokinetics and PK/PD correlation studies of the dose adjustments required to maintain antimicrobial effectiveness in pediatric burn patients. A reverse-phase Supelcosil LC18 column (250 x 4.6 mm 5 micra, binary mobile phase consisting of 0.01 M, pH 7.0 phosphate buffer and acetonitrile (99:1, v/v, flow rate of 0.8 mL/min, was applied. The method showed good absolute recovery (above 90%, good linearity (0.25-100.0 µg/mL, r2=0.999, good sensitivity (LLOQ: 0.25 µg/mL; LLOD: 0.12 µg/mL and acceptable stability. Inter/intraday precision values were 7.3/5.9%, and mean accuracy was 92.9%. A bioanalytical method was applied to quantify free drug concentrations in children with burns. Six pediatric burn patients (median 7.0 years old, 27.5 kg, normal renal function, and 33% total burn surface area were prospectively investigated; inhalation injuries were present in 4/6 (67% of the patients. Plasma monitoring and PK assessments were performed using a serial blood sample collection for each set, totaling 10 sets. The PK/PD target attained (40%T>MIC for each minimum inhibitory concentration (MIC: 0.5, 1.0, 2.0, 4.0 mg/L occurred at a percentage higher than 80% of the sets investigated and 100% after dose adjustment. In conclusion, the purification of plasma samples using an ultrafiltration technique followed by quantification of imipenem plasma measurements using the LC method is quite simple, useful, and requires small volumes for blood sampling. In addition, a small amount of plasma (0.25 mL is needed to guarantee drug effectiveness in pediatric burn patients. There is also a low risk of neurotoxicity, which is important because pharmacokinetics are unpredictable in these critical patients with severe hospital infection. Finally, the PK/PD target was attained for imipenem in the control of sepsis in pediatric patients with burns.

  12. Live sibling skin allografts for severe burns in a paediatric patient: A viable option in developing countries

    Directory of Open Access Journals (Sweden)

    Basil Leodoro

    2014-11-01

    Full Text Available Severe burns in the paediatric population are associated with high mortality and morbidity in any developing countries. Children with more than 40% total body surface area burns in Fiji will succumb from complications and as a direct result of inadequate treatment and lack of resources. The surgical treatment of any severely burnt patient is not only laborious but very costly to the Fiji health system and depletes existing resources with few options for skin coverage. This is the first case report of live sibling skin allograft for severe paediatric burns and one of only few patients to have survived more than 50% burns in Fiji. We describe the technique and the role of using live sibling skin allograft as an option to improve survival in patients with severe burns in a developing country.

  13. Humoral-Phagocyte Axis of Immune Defense in Burn Patients

    Science.gov (United States)

    1982-02-01

    specimen contained 21.800 leukocytes per microliter with 58% segmented end 7% band neutrophils, 3% eosinophils , 4% monocytes. and 28% lymphocytes. Twenty...minute Fig 3.-Plot of integral chemoluminescence (CL) for 117-minute interval following stimulation plotted against total number of granu - interval...occurred in three nonsurviving opsonic capacity can be expressed as the rate of activation patients, as well as changes in total leukocyte and granu - of

  14. Prestorage leukocyte filtration may reduce leukocyte-derived bioactive substance accumulation in patients operated for burn trauma

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen; Hammer, J H; Krarup, Annabel Lee;

    1999-01-01

    for burn trauma are investigated. 24 consecutive patients were randomly selected to receive transfusion with non-filtered blood components (group A, n = 12) or similar products, which were prestorage leukofiltered (group B, n = 12). The burn injury was scored using the Bull and Fischer index of age...

  15. Urban-Rural Dichotomy of Burn Patients in Georgia and South Carolina: A Geographic Information System Study.

    Science.gov (United States)

    Mian, Mohammad Anwarul Huq; Haque, Akhlaque; Mullins, Robert Fred; Fiebiger, Barbara; Hassan, Zaheed

    2015-01-01

    This study uses a 4-year (2006-2009) cross-section of epidemiological burn injury data from Georgia and South Carolina. The results from the study show that the burn patients from rural areas differ from their urban counterparts in terms of relative burn injury incidence. Younger population groups that live in lower socioeconomic status communities especially in the urban areas are at a higher risk than other population groups. The differences in the types of burns in the urban-rural communities can give us further insights to the patients' association with injury sites. The presence of fewer burn injury treatment and care facilities in rural areas and the high incidence of burn in low-income communities in the urban areas should carry important policy implications for health planners. This study will enable researchers to understand the epidemiology of burn injuries at the local and national levels in the United States. It also carries important implications for using Geographic Information Systems for studying spatial distribution of burn injuries for disaster planning and mitigation of burn injuries.

  16. Comparison of three cooling methods for burn patients: A randomized clinical trial.

    Science.gov (United States)

    Cho, Young Soon; Choi, Young Hwan

    2016-10-01

    Tap water may not be readily available in numerous places as a first aid for burns and, therefore, tea tree oil products are recommended alternatives. Our aim in this study was to compare the cooling effects of three burn-cooling methodologies, running tap water, Burnshield(®), and Burn Cool Spray(®), and suggest indications for each cooling method. This randomized, controlled, study enrolled patients with burns who used the emergency service of Seoul Bestian Hospital from June 2015 to October 2015. The allocation of the cooling methods was randomly generated using a computer. We cooled the burn wounds by applying one of the three methods and measured the skin surface temperature and pain level using a visual analog scale (VAS) scoring. Ninety-six patients were enrolled in this study. The variability in the median(IQR) skin temperatures of the three groups was from 33.5°C (31.5-35.0) to 28.7°C (25.9-30.9), 33.8°C (32.0-35.4) to 33.2°C (30.5-35.0), and 34.0°C (32.0-35.1) to 34.4°C (32.7-35.6) for the tap water, Burn Cool Spray(®), and Burnshield(®), respectively. The variability of the mean VAS pain scores was 6.9 to 4.8 (tap water), 5.6 to 4.5 (Burn Cool Spray(®)), and 5.5 to 3.3 (Burnshield(®)). The reduction of skin surface temperature by tap water was significantly greater than that by the other two methods. All three methods reduced the VAS pain score after 20min of treatment (p<0.001). The tap water had a similar effect to that of the Burn Cool Spray(®) but significantly better than that of Burnshield(®). There was a significant difference in the skin surface temperature and VAS pain score reduction (p=0.014 and p=0.007, respectively) between the groups cooled by tap water below and above 24°C. The patients who visited the center within 30min showed a significantly higher skin temperature than those who came after 30min did (p=0.033). Tap water and Burn Cool Spray(®) reduced the skin surface temperature, but the Burnshield(®) slightly

  17. The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive Care Unit

    Science.gov (United States)

    2016-04-01

    AWARD NUMBER: W81XWH-13-2-0011 TITLE: The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive...2016 4. TITLE AND SUBTITLE “The Phase of Illness Paradigm: A Checklist Centric Model to 5a. CONTRACT NUMBER Improve Patient Care in the Burn...shared mental model of patient care amongst clinicians in the BICU and thus enhance distributed cognition (Hutchins 2000) and assist the work of the

  18. Catheter-related infections in a northwestern São Paulo reference unit for burned patients care

    Directory of Open Access Journals (Sweden)

    Cláudio Penido Campos Júnior

    2010-04-01

    Full Text Available Despite improvements in care and rehabilitation of burned patients, infections still remain the main complication and death cause. Catheter-related infections are among the four most common infections and are associated with skin damage and insertion site colonization. There are few studies evaluating this kind of infection worldwide in this special group of patients. Padre Albino Hospital Burn Care Unit (PAHBCU is the only reference center in the Northwestern São Paulo for treatment of burned patients. This paper presents the results of a retrospective study aiming at describing the epidemiological and clinical features of catheter-related infections at PAHBCU.

  19. Diabetes Does Not Influence Selected Clinical Outcomes in Critically Ill Burn Patients

    Science.gov (United States)

    2011-01-01

    non-diabetic. Diabetics (n=57) were compared to non-diabetics (n=405). Admission glucose levels were obtained from chemistries . Point-of-care devices...blood glucose values were collected from admission chemistry and electrolyte laboratory panels. All other Dahagam et al. Page 2 J Burn Care Res. Author...admission glycosylated hemoglobin level in patients with acute myocardial infarction. The Canadian Journal of Cardiology . 2008; 24(5):375– 378. [PubMed

  20. Fournier's gangrene in a patient after third-degree burns: a case report

    Directory of Open Access Journals (Sweden)

    Iavazzo Christos

    2009-05-01

    Full Text Available Abstract Introduction Fournier's gangrene is characterized by tissue ischemia leading to rapidly progressing necrotizing fasciitis. Case presentation We present the case of a patient with Fournier's gangrene after third-degree burns. Clinical manifestations, laboratory results and treatment options are discussed. Conclusion Fournier's gangrene is a surgical emergency. Although it can be lethal, it is still a challenging situation in the field of surgical infections.

  1. Correlation of American Burn Association Sepsis Criteria With the Presence of Bacteremia in Burned Patients Admitted to the Intensive Care Unit

    Science.gov (United States)

    2012-06-01

    documentation by the physi- cians and nurses who took care of the patients. There was also no clear guidance on ventilator modes such as HFPV and how their...Presence of Bacteremia in Burned Patients Admitted to the Intensive Care Unit Brian K. Hogan, MD,*†‡ Steven E. Wolf, MD,*‡§ Duane R. Hospenthal, MD...criteria’s correlation with bacteremia because bacteremia is not associated with inherent issues of diagnosis as occurs with pneumonia or soft tissue

  2. Analysis of predictor factors of limb amputation in patients with high-voltage electrical burns

    Directory of Open Access Journals (Sweden)

    Guillermo García Álvarez

    2015-09-01

    Full Text Available Background: Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients. Methods: Eighty-two high-voltage electrically injured patients were admitted to the Department of Plastic and Reconstructive Surgery and Burns of National Arzobispo Loayza Hospital on a 5 year period. A retrospective analysis of the possible related risk factors between amputation and non-amputation patients was performed. Results: A total of 68 patients were enrolled for analysis. Thirteen patients underwent limb amputations. Multivariate analysis of the risk factors between amputation and non-amputation groups showed statistical significance for first 24 hour creatine kinase-isoenzyme MB (CKMB level. A serum CK-MB level above 14,955 U/L predicted high risk of limb amputation with high specificity (84% and sensitivity (77%. Only one patient with a remarkable decrease of creatine kinase (CPKt and CK-MB levels after fasciotomy avoided a major limb amputation. Conclusion: Our results suggest that CPK-MB level is an independent factor for prediction of limb amputation in patients with high-voltage electrical burns. We suggest that the addition of CPK-MB evaluation to clinical symptom screening may be a valuable method for early detection of muscle damage.

  3. 重度烧伤病人的睡眠管理%Sleep management of severe burn patients

    Institute of Scientific and Technical Information of China (English)

    刘志宣

    2013-01-01

    Based on the observation and analysis of the factors of severe burn patients sleep effect, summed up the effective management method of sleep quality of severe burn patients. To improve the sleep quality of patients with severe burn, promote early recovery of patients with severe burn, and decrease the rate of disability, and even death, has a very important significance.%本文通过对重度烧伤病人睡眠影响因素的观察与分析,总结出对重度烧伤病人睡眠质量的有效管理方法。对提高重度烧伤病人的睡眠质量,促进重度重度烧伤病人早日康复,并降低其致残率,甚至死亡率,具有非常重要的意义。

  4. Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification

    Directory of Open Access Journals (Sweden)

    Goutos Ioannis

    2010-10-01

    Full Text Available To review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analysed by a multidisciplinary panel of burns specialists following the GRADE classification to rate individual agents. Following the collation of results and panel discussion, consensus protocols are presented. Twenty-three studies appraising therapeutic agents in the burns literature were identified. The majority of these studies (16 out of 23 are of an observational nature, making an evidence-based approach to defining optimal therapy not feasible. Our multidisciplinary approach employing the GRADE classification recommends the use of antihistamines (cetirizine and cimetidine and gabapentin as the first-line pharmacological agents for both adult and paediatric patients. Ondansetron and loratadine are the second-line medications in our protocols. We additionally recommend a variety of non-pharmacological adjuncts for the perusal of clinicians in order to maximise symptomatic relief in patients troubled with postburn itch. Most studies in the subject area lack sufficient statistical power to dictate a ′gold standard′ treatment agent for burns itch. We encourage clinicians to employ the GRADE system in order to delineate the most appropriate therapeutic approach for burns pruritus until further research elucidates the most efficacious interventions. This widely adopted classification empowers burns clinicians to tailor therapeutic regimens according to current evidence, patient values, risks and resource considerations in different medical environments.

  5. [Surgical therapy and critical care medicine in severely burned patients - Part 1: the first 24 ours].

    Science.gov (United States)

    Dembinski, Rolf; Kauczok, Jens; Deisz, Robert; Pallua, Norbert; Marx, Gernot

    2012-09-01

    Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial wound care comprises topical treatment of less severely injured skin and surgical debridement of severely burned areas. The first 24 hours of intensive care are focused on calculated fluid delivery to provide stable hemodynamics and avoid progression of local edema formation. In the further course wound treatment with split-thickness skin grafts is the major aim of surgical therapy. Critical care is focused on the avoidance of complications like infections and ventilator associated lung injury. Therefore, lung-protective ventilation strategies, weaning and sedation protocols, and early enteral nutrition are important cornerstones of the treatment.

  6. Association of Rhabdomyolysis with Renal Outcomes and Mortality in Burn Patients

    Science.gov (United States)

    2013-05-01

    estimates of rates of AKI in the burn population widely varied, in part because of differences in both definitions of AKI and inclusion criteria...and AKIN-3 as a >3-fold increase from baseline (or an increase of 0.5 mg/dl when the baseline was more than 4 mg/dl).10 By definition , all patients...patients requiring RRT who survived to discharge, only one required maintenance hemodialysis . The prevalence of AKIN-2 or AKIN-3, death, and RRT

  7. Decellularized human amniotic membrane: more is needed for an efficient dressing for protection of burns against antibiotic-resistant bacteria isolated from burn patients.

    Science.gov (United States)

    Gholipourmalekabadi, M; Bandehpour, M; Mozafari, M; Hashemi, A; Ghanbarian, H; Sameni, M; Salimi, M; Gholami, M; Samadikuchaksaraei, A

    2015-11-01

    Human amniotic membranes (HAMs) have attracted the attention of burn surgeons for decades due to favorable properties such as their antibacterial activity and promising support of cell proliferation. On the other hand, as a major implication in the health of burn patients, the prevalence of bacteria resistant to multiple antibiotics is increasing due to overuse of antibiotics. The aim of this study was to investigate whether HAMs (both fresh and acellular) are an effective antibacterial agent against antibiotic-resistant bacteria isolated from burn patients. Therefore, a HAM was decellularized and tested for its antibacterial activity. Decellularization of the tissue was confirmed by hematoxylin and eosin (H&E) and 4,6-diamidino-2-phenylindole (DAPI) staining. In addition, the cyto-biocompatibility of the acellular HAM was proven by the cell viability test (3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide, MTT) and scanning electron microscopy (SEM). The resistant bacteria were isolated from burns, identified, and tested for their susceptibility to antibiotics using both the antibiogram and polymerase chain reaction (PCR) techniques. Among the isolated bacteria, three blaIMP gene-positive Pseudomonas aeruginosa strains were chosen for their high resistance to the tested antibiotics. The antibacterial activity of the HAM was also tested for Klebsiella pneumoniae (American Type Culture Collection (ATCC) 700603) as a resistant ATCC bacterium; Staphylococcus aureus (mecA positive); and three standard strains of ATCC bacteria including Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27833), and S. aureus (ATCC 25923). Antibacterial assay revealed that only the latter three bacteria were susceptible to the HAM. All the data obtained from this study suggest that an alternative strategy is required to complement HAM grafting in order to fully protect burns from nosocomial infections.

  8. Systematic Suicide Risk Assessment for Patients With Schizophrenia

    DEFF Research Database (Denmark)

    Gjørup Pedersen, Charlotte; Wallenstein Jensen, Signe Olrik; Gradus, Jaimie;

    2014-01-01

    Objectives: Systematic suicide risk assessment is recommended for patients with schizophrenia; however, little is known about the implementation of suicide risk assessment in routine clinical practice. The study aimed to determine the use of systematic suicide risk assessment at discharge...... and predictors of suicide attempt among hospitalized patients with schizophrenia in Denmark. Methods: A one-year follow-up study was conducted of 9,745 patients with schizophrenia who were discharged from psychiatric wards and registered in a national population-based schizophrenia registry between 2005 and 2009....... Results: The proportion of patients receiving suicide risk assessment at discharge from a psychiatric ward increased from 72% (95% confidence interval [CI]=71%-74%) in 2005, when the national monitoring began, to 89% (CI.89%-90%) in 2009. Within one year after discharge, 1% of all registered patients had...

  9. Ablative fractional photothermolysis for the treatment of hypertrophic burn scars in adult and pediatric patients: a single surgeon's experience.

    Science.gov (United States)

    Khandelwal, Anjay; Yelvington, Miranda; Tang, Xinyu; Brown, Susan

    2014-01-01

    Many patients develop hypertrophic scarring after a burn injury. Numerous treatment modalities have been described and are currently in practice. Photothermolysis or laser therapy has been recently described as an adjunct for management of hypertrophic burn scars. This study is a retrospective chart review of adult and pediatric patients undergoing fractional photothermolysis at a verified burn center examining treatment parameters as well as pre- and post-Vancouver Scar Scale scores. Forty-four patients underwent fractional photothermolysis during the study period of 8 months. Mean pretreatment score was 7.6, and mean posttreatment score was 5.4. The mean decrease in score was 2.2, which was found to be statistically significant. There were no complications. Fractional photothermolysis is a safe and efficacious adjunct therapy for hypertrophic burn scars. Prospective trials would be beneficial to determine optimal therapeutic strategies.

  10. Clinical characteristics and therapeutic response in patients with Burning Mouth Syndrome: accompanying 2 years

    Directory of Open Access Journals (Sweden)

    Vanessa Juliana Gomes CARVALHO

    Full Text Available Abstract Introduction Burning Mouth Syndrome (BMS is a condition characterized by burning symptom of the oral mucosa in the absence of clinical signs. Its etiology is still unknown and, and to date there is no effective treatment. Purpose The aim of this study was to evaluate patients with BMS profile and the therapies results in a retrospective study. Material and method Clinical and therapeutic data were collected from records of patients with BMS diagnosed between January 2013 to April 2015 at the Clinic of Stomatology Clinic, Faculdade de Odontologia of Universidade de São Paulo, according to the criteria established by the International Headache Society in 2013. The therapies used for BMS control were also evaluated. Result Twelve patients were diagnosed with BMS at this period. All of them were women with a mean age of 61.18 years and the apex of the tongue was the most common affected site and the duration of the burning sensation ranged from 6 months to 25 years. Many therapies were prescribed for BMS control, such as topical capsaicin, topical clonazepan, low level laser therapy and homeopathy. Among the established therapies, capsaicin has immediate effect in reducing symptoms. Conclusion The present study showed that the challenges towards an effective treatment for BMS are varied and are mainly related to the lack knowing of the pathogenesis of this disease. The demographic profile of patients studied here was similar to that described in the available literature, however, the variables represented by secondary symptoms (medical history, anxiety and depression levels may be modifying factors of therapeutic response and the pathogenesis of the disease itself.

  11. Correlation between Burning Mouth Syndrome and Psychological Symptoms in Patients Attending to Zahedan Dental School

    Directory of Open Access Journals (Sweden)

    NM Bakhshan

    2012-06-01

    Full Text Available Introduction: Burning mouth syndrome is characterized by an oral burning sensation , usually in the absence of clinical and laboratory findings. BMS is estimated to involve 1 to 5% of the adult population and is mostly reported within middle-aged women. The etiology of this disease is not thoroughly identified yet and there is a debate over the significance of Psychological factors in creating BMS. This study intended to examine the relationship between psychological factors with pain reports and psychosocial profiles of BMS patients to determine whether psychological factors are related to pain reports and burning mouth of patients. Therefore frequencies of psychological factors were analyzed. Methods: 30 patients with BMS participated in this study. They were homogenous regarding age, sex with the control group. In addition, education was possibly homogenized. The participants completed SCL-90 questionnaire for their anxiety, depression, somatic and psychotic symptoms to be scrutinized. Then, t-test was applied to analyze the research data. Results: Mean of anxiety(case20/8, control 9/53, depression(case 26/53, control 13/40, somatic(case 23/7, control 15/26 and psychotic(case 19/60, control 8/10 symptoms were higher in BMS group rather than in control groups. T-test results indicated there was no statically significant difference between BMS and control group in regard to psychological symptoms(p< 0.0001. Conclusion: The study findings indicate that psychological disorders may predispose the patients to the development of BMS.

  12. Tratamento da dor em queimados Tratamiento del dolor en quemados Pain management in burn patients

    Directory of Open Access Journals (Sweden)

    Rodrigo José Alencar de Castro

    2013-02-01

    paciente en tratamiento de quemadura es el primer paso para alcanzar el éxito en su manejo analgésico.BACKGROUND AND OBJECTIVES: Despite advances, inappropriate analgesic treatment for burn patients is still seen. The objective of this review was to collect data on pain management in burn patients. CONTENT: We reviewed the mechanisms of pain, burn patient assessment, as well as pharmacological and non-pharmacological treatment. CONCLUSION: Pain management in burn patients is still a challenge for the multidisciplinary team. Frequent and continuous evaluation of the patient's response is very important due to the various stages that the hospitalized burn patient goes through, as well as a combination therapy with analgesic and non-pharmacological measures. Understanding the complexity of the pathophysiological, psychological, and biochemical changes a burn patient presents is the first step to achieve success in analgesic management.

  13. Care for the Critically Injured Burn Patient Modulation of Burn Scars Through Laser Deliver of Stem Cells

    Science.gov (United States)

    2013-10-01

    Nucleic acid analysis would rely on development of porcine specific primers. We have developed and verified porcine specific primers for Collagen ...effectiveness of these novel delivery systems and cell-based therapies for third degree burns in a porcine model. We will test the hypothesis that...treated samples. There was a tendency to observe thickened (keloidal) collagen bundles throughout the superficial, mid and deep dermis in control

  14. Perioperative use of cuffed endotracheal tubes is advantageous in young pediatric burn patients.

    Science.gov (United States)

    Dorsey, David P; Bowman, Stephen M; Klein, Matthew B; Archer, Dennis; Sharar, Sam R

    2010-09-01

    Uncuffed endotracheal tubes traditionally have been preferred over cuffed endotracheal tubes in young pediatric patients. However, recent evidence in elective pediatric surgical populations suggests otherwise. Because young pediatric burn patients can pose unique airway and ventilation challenges, we reviewed adverse events associated with the perioperative use of cuffed and uncuffed endotracheal tubes. We retrospectively reviewed 327 cases of operating room endotracheal intubation for general anesthesia in burned children 0-10 years of age over a 10-year period. Clinical airway outcomes were compared using multivariable logistic regression, controlling for relevant patient and injury characteristics. Compared to those receiving cuffed tubes, children receiving uncuffed tubes were significantly more likely to demonstrate clinically significant loss of tidal volume (odds ratio 10.62, 95% confidence interval 2.2-50.5) and require immediate reintubation to change tube size/type (odds ratio 5.54, 95% confidence interval 2.1-13.6). No significant differences were noted for rates of post-extubation stridor. Our data suggest that operating room use of uncuffed endotracheal tubes in such patients is associated with increased rates of tidal volume loss and reintubation. Due to the frequent challenge of airway management in this population, strategies should emphasize cuffed endotracheal tube use that is associated with lower rates of airway manipulation.

  15. Cognitive impairment in transient ischemic attack patients: A systematic review

    NARCIS (Netherlands)

    Rooij, F.G. van; Kessels, R.P.C.; Richard, E.; Leeuw, H.F. de; Dijk, E.J. van

    2016-01-01

    Background: Although by definition a transient ischemic attack (TIA) lasts less than 24 h, many patients experience cognitive complaints beyond focal symptom resolution. However, their prevalence, causes and profile are unclear. We therefore performed a systematic review on cognitive impairment afte

  16. Assessment of patient empowerment - a systematic review of measures

    NARCIS (Netherlands)

    Barr, P.J.; Scholl, I.; Bravo, P.; Faber, M.J.; Elwyn, G.; Mcallister, M.

    2015-01-01

    BACKGROUND: Patient empowerment has gained considerable importance but uncertainty remains about the best way to define and measure it. The validity of empirical findings depends on the quality of measures used. This systematic review aims to provide an overview of studies assessing psychometric pro

  17. Depression Screening and Patient Outcomes in Cancer : A Systematic Review

    NARCIS (Netherlands)

    Meijer, Anna; Roseman, Michelle; Milette, Katherine; Coyne, James C.; Stefanek, Michael E.; Ziegelstein, Roy C.; Arthurs, Erin; Leavens, Allison; Palmer, Steven C.; Stewart, Donna E.; de Jonge, Peter; Thombs, Brett D.

    2011-01-01

    Background: Several practice guidelines recommend screening for depression in cancer care, but no systematic reviews have examined whether there is evidence that depression screening benefits cancer patients. The objective was to evaluate the potential benefits of depression screening in cancer pati

  18. Acute physiology, age, and chronic health evaluation (APACHE) III score is an alternative efficient predictor of mortality in burn patients.

    Science.gov (United States)

    Tanaka, Yohei; Shimizu, Mikio; Hirabayashi, Hidemitsu

    2007-05-01

    The present study was performed to evaluate the prognostic value of the acute physiology, age, chronic health evaluation (APACHE) III score in burn patients. We hypothesised that APACHE III score efficiently predicts mortality of burn patients as it reflects the physiological changes in the acute phase and the severity of the underlying illness. Data such as age, gender, inhalation injury, total burn surface area (TBSA), burn index (BI), prognostic burn index (PBI), APACHE III score and outcome of 105 hospitalised patients were analysed retrospectively. TBSA, BI, PBI, and APACHE III score in the mortality group were significantly higher than those of surviving group. The mean scores of surviving versus mortality groups were as follows: TBSA, 19.2+/-17.8% versus 69.1+/-28.4%, pAPACHE III score, 28.4+/-22.2% versus 71.3+/-32.1%, pAPACHE III score showed marked associations between higher scores and higher mortality. APACHE III score showed a significant correlation with PBI (pAPACHE III score could be used as an alternative efficient predictor of mortality in burn patients.

  19. Risk factors for nosocomial infection and mortality in burn patients: 10 years of experience at a university hospital.

    Science.gov (United States)

    Alp, Emine; Coruh, Atilla; Gunay, Galip K; Yontar, Yalcin; Doganay, Mehmet

    2012-01-01

    To evaluate the risk factors for nosocomial infection (NI) and mortality in a university hospital, 10-year data of burn patients were assessed retrospectively. The study was conducted at Erciyes University's Burn Center during 2000 and 2009. The records of 1190 patients were obtained. Overall, 131 (11%) patients had 206 NIs with an incidence density of 14.7 infections/1000 patient days. Burn wound infection (n = 109, 53%) was the most common NI. High (%TBSA burned) and late excision were found to be the most significant risk factors for the development of NI. Pseudomonas aeruginosa was the most frequent causative microorganism. However, the prevalence of multidrug-resistant Acinetobacter baumannii has increased in recent years with a prevalence of 47% in 2009. The carbapenem resistance of P. aeruginosa has decreased in recent years, whereas that of A. baumannii increased and it had a prevalence of 94% in the last year. Conversely, the most important risk factors for mortality were advanced age, high %TBSA and having an underlying disease. Prevention of NI is an important issue in burn units to reduce mortality rates. Early excision and wound closure are important therapeutic approaches for the prevention of burn wound infection.

  20. Emergency in Burn; Burn in Emergency

    Directory of Open Access Journals (Sweden)

    Yalcin Bayram

    2012-06-01

    Full Text Available Physicians who first meet with burned patients are often emergency service employees. When the patient was admitted to emergency service, especially in patients with major burn injury, is a matter should be dealt with strongly. Before sending the patients to a burn center, some interventions could became life saving which should be done as a first line treatment. Herein, review of the literature related to emergency burn treatment was performed and presented to all physicians as a summary guide. In addition, some questions such as how should be physician, who first meet with the burned patient, evaluated the patient, what should be physician paid attention, which principles should be employed for fluid replacement, how should be approached to burn wound are tried to be addressed. [TAF Prev Med Bull 2012; 11(3.000: 365-368

  1. A STUDY OF METALLO-BETA-LACTAMASE PRODUCING PSEUDOMONAS AERUGINOSA IN BLOOD SAMPLES OF BURNED PATIENTS

    Directory of Open Access Journals (Sweden)

    Piyali

    2014-11-01

    Full Text Available : BACKGROUND: Septicaemia is a life threatening complication of severely burned patients. Among many organisms invading blood stream Pseudomonas aeruginosa is a well-known for its powerful antibiotic resistance mechanisms which increasingly limit the choices for treatment. Among many such resistance mechanisms it is the metallo-beta-lactamase (MBL which confers resistance to Carbapenem group of antibiotics, one of the final resorts to fight them. The present study was undertaken to detect MBL producing P. aeruginosa using phenotypic method from blood samples of burned patients as well as to know their drug sensitivity pattern. MATERIALS AND METHODS: For this purpose 67 Pseudomonas aeruginosa isolates from blood samples of admitted burned patients were subjected to susceptibility testing to antipseudomonal drugs by disc diffusion test and those found to be Carbapenem resistant were subjected to Imipenem - EDTA combined disk synergy test for MBL detection. RESULT: Out of 67 isolates of P.aeruginosa, 19 (28.4% were found to be Carbapenem resistant and 11 (16.4% were MBL producers. A particularly important feature was that the MBL producers were highly resistant to the antibiotics tested than the non-producers. However all of them were susceptible to Colistin and Polymixin B. CONCLUSION: This study has made us to think that a constant vigil and careful selection of antibiotics are necessary to keep prevalence of MBL producing P.aeruginosa in check. The accurate identification and reporting of MBL producing P. aeruginosa will aid infection control practitioners in preventing the spread of these multidrug-resistant isolates

  2. Optimization of burn referrals

    DEFF Research Database (Denmark)

    Reiband, Hanna K; Lundin, Kira; Alsbjørn, Bjarne

    2014-01-01

    INTRODUCTION: Correct estimation of the severity of burns is important to obtain the right treatment of the patient and to avoid over- and undertriage. In this study we aimed to assess how often the guidelines for referral of burn injured patients are met at the national burn centre (NBC), Denmar...

  3. Glucose metabolism in burn patients: the role of insulin and other endocrine hormones.

    Science.gov (United States)

    Ballian, Nikiforos; Rabiee, Atoosa; Andersen, Dana K; Elahi, Dariush; Gibson, B Robert

    2010-08-01

    Severe burn causes a catabolic response with profound effects on glucose and muscle protein metabolism. This response is characterized by hyperglycemia and loss of muscle mass, both of which have been associated with significantly increased morbidity and mortality. In critically ill surgical patients, obtaining tight glycemic control with intensive insulin therapy was shown to reduce morbidity and mortality and has increasingly become the standard of care. In addition to its well-known anti-hyperglycemic action and reduction in infections, insulin promotes muscle anabolism and regulates the systemic inflammatory response. Despite a demonstrated benefit of insulin administration on the maintenance of skeletal muscle mass, it is unknown if this effect translates to improved clinical outcomes in the thermally injured. Further, insulin therapy has the potential to cause hypoglycemia and requires frequent monitoring of blood glucose levels. A better understanding of the clinical benefit associated with tight glycemic control in the burned patient, as well as newer strategies to achieve and maintain that control, may provide improved methods to reduce the clinical morbidity and mortality in the thermally injured patient.

  4. Association between early airway damage-associated molecular patterns and subsequent bacterial infection in patients with inhalational and burn injury.

    Science.gov (United States)

    Maile, Robert; Jones, Samuel; Pan, Yinghao; Zhou, Haibo; Jaspers, Ilona; Peden, David B; Cairns, Bruce A; Noah, Terry L

    2015-05-01

    Bacterial infection is a major cause of morbidity affecting outcome following burn and inhalation injury. While experimental burn and inhalation injury animal models have suggested that mediators of cell damage and inflammation increase the risk of infection, few studies have been done on humans. This is a prospective, observational study of patients admitted to the North Carolina Jaycee Burn Center at the University of North Carolina who were intubated and on mechanical ventilation for treatment of burn and inhalational injury. Subjects were enrolled over a 2-yr period and followed till discharge or death. Serial bronchial washings from clinically indicated bronchoscopies were collected and analyzed for markers of tissue injury and inflammation. These include damage-associated molecular patterns (DAMPs) such as hyaluronic acid (HA), double-stranded DNA (dsDNA), heat-shock protein 70 (HSP-70), and high-mobility group protein B-1 (HMGB-1). The study population was comprised of 72 patients who had bacterial cultures obtained for clinical indications. Elevated HA, dsDNA, and IL-10 levels in bronchial washings obtained early (the first 72 h after injury) were significantly associated with positive bacterial respiratory cultures obtained during the first 14 days postinjury. Independent of initial inhalation injury severity and extent of surface burn, elevated levels of HA dsDNA and IL-10 in the central airways obtained early after injury are associated with subsequent positive bacterial respiratory cultures in patients intubated after acute burn/inhalation injury.

  5. Injuria inhalatoria en pacientes quemados: Revisión Inhalation injury in burned patient: A review

    Directory of Open Access Journals (Sweden)

    CESAR PEDREROS P

    2007-06-01

    Full Text Available Cada año casi tres mil personas sufren quemaduras en Chile. En la población adulta se estima que este número se incrementará en los próximos años. En este grupo, cerca del 40% de las quemaduras graves se asocian a injuria inhalatoria. la injuria inhalatoria aumenta significativamente la mortalidad en los pacientes quemados. la prevalencia, fisiopatologia, cuadro clínico, manejo y pronóstico de esta patología no han sido incorporados en los estudios de pregrado de las escuelas de medicina y son temas desconocidos para la mayoría de los médicos. En el contexto de la próxima incorporación de este tipo de dolencias en el plan de garantías explícitas en la salud chilena hemos realizado una actualización del temaEvery year almost three thousand people get burned in Chile. In this group, about 40% of the critical burned patients also suffer inhalation injury. This number is expected to grow bigger among the adult population in the next few years. Inhalation injury significantly increases mortality in burned patients. The prevalence, pathophysiology, clinical characteristics, treatment, and prognosis of this pathology have not been incorporated in the undergraduate curses of Chilean medical schools. Therefore, this subject is pooly known by most of our physicians. Because this disease will be included in the explicit warranties health plan of the public health care system in Chile, we decide to write this review about this pathological condition

  6. The interrelationships between wound management, thermal stress, energy metabolism, and temperature profiles of patients with burns.

    Science.gov (United States)

    Wallace, B H; Caldwell, F T; Cone, J B

    1994-01-01

    This prospective randomized study was performed to evaluate the metabolic and thermal responsiveness of patients with burns to thermal stress with three protocols of wound care: group I (n = 7) treated with dressings and variable ambient temperature selected for patients subjective comfort; group II (n = 7) treated without dressings and variable ambient temperature for patient comfort; group III (n = 6) treated without dressings and ambient temperature of 25 degrees C, electromagnetic heaters were set to achieve patient subjective comfort; and group IV (n = 6) healthy volunteers. After baseline partitional calorimetry was performed, individual patients were cold-challenged while subjectively comfortable by sequentially lowering either the ambient temperature or the output from the electromagnetic heaters. Heat balance and temperatures were obtained after each perturbation in external energy support. For patients in groups I and II, subjective perception of thermal comfort (warm, neutral, neutral and fed, cool, or cold) was more strongly correlated (p temperature. For patients treated with electromagnetic heaters, changes in heat production were most strongly correlated with the energy output from the electromagnetic heaters. Even though the environmental conditions required to achieve a particular level of comfort are quite different between treatment groups, the difference in temperature between the patient's surface and ambient is approximately the same for groups I, II, and IV for each subjective state.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. 糖尿病烧伤患者15例的康复护理介入体会%Experience in rehabilitation care intervention to 15 burned patients with diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    韩淑芬; 李朱仙

    2002-01-01

    @@ Objective: Analysis the rehabilitation care condition of burn patients with diabetes mellitus. @@ Unit: 175th Hospital of PLA. Subjects:15 burn patients with diabetes mellitus received during January 1995 to December 2001,11 males and 4 females aged from 36~ 74 years.Burn area varied from 1% to 56% . Burn of faces and trunk,3 cases;burn of articular area(including hand,elbow,shoulder,ankle,knee and coxae),10 cases;Burn of perineal region,2 cases.

  8. The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature.

    Science.gov (United States)

    Goodwin, Nicholas S; Spinks, Anneliese; Wasiak, Jason

    2016-08-01

    The aim of this systematic review was to determine the supporting evidence for the clinical use of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting. Two authors searched three databases (Ovid Medline, Ovid Embase and The Cochrane Library) for relevant English language articles published through September 2014. Reference lists, conference proceedings and non-indexed academic journals were manually searched. A separate search was conducted using the Internet search engine Google to source additional studies from burns advisory agencies, first aid bodies, military institutions, manufacturer and paramedic websites. Two authors independently assessed study eligibility and relevance of non-traditional data forms for inclusion. Studies were independently assessed and included if Hydrogel-based burn dressings (HBD) were examined in first aid practices in the pre-hospital setting. A total of 129 studies were considered for inclusion, of which no pre-hospital studies were identified. The review highlights that current use of HBD in the pre-hospital setting appears to be driven by sources of information that do not reflect the paramedic environment. We recommend researchers in the pre-hospital settings undertake clinical trials in this field. More so, the review supports the need for expert consensus to identify key demographic, clinical and injury outcomes for clinicians and researchers undertaking further research into the use of dressings as a first aid measure.

  9. Grey matter changes of the pain matrix in patients with burning mouth syndrome.

    Science.gov (United States)

    Sinding, Charlotte; Gransjøen, Anne Mari; Schlumberger, Gina; Grushka, Miriam; Frasnelli, Johannes; Singh, Preet Bano

    2016-04-01

    Burning mouth syndrome (BMS) is characterized by a burning sensation in the mouth, usually in the absence of clinical and laboratory findings. Latest findings indicate that BMS could result from neuropathic trigeminal conditions. While many investigations have focused on the periphery, very few have examined possible central dysfunctions. To highlight changes of the central system of subjects with BMS, we analysed the grey matter concentration in 12 subjects using voxel-based morphometry. Data were compared with a control group (Ct). To better understand the brain mechanisms underlying BMS, the grey matter concentration of patients was also compared with those of dysgeusic patients (Dys). Dysgeusia is another oral dysfunction condition, characterized by a distorted sense of taste and accompanied by a reduced taste function. We found that a major part of the 'pain matrix' presented modifications of the grey matter concentration in subjects with BMS. Six regions out of eight were affected [anterior and posterior cingulate gyrus, lobules of the cerebellum, insula/frontal operculum, inferior temporal area, primary motor cortex, dorsolateral pre-frontal cortex (DLPFC)]. In the anterior cingulate gyrus, the lobules of the cerebellum, the inferior temporal lobe and the DLPFC, pain intensity correlated with grey matter concentration. Dys also presented changes in grey matter concentration but in different areas of the brain. Our results suggest that a deficiency in the control of pain could in part be a cause of BMS and that BMS and dysgeusia conditions are not linked to similar structural changes in the brain.

  10. Characteristics of Patients Who Admitted to the Emergency Department Because of Burns Due to Dens Liquids Such as Hot Milk/Oil

    Science.gov (United States)

    Bayramoglu, Atif; Sener, M. Talip; Cakir, Zeynep; Aslan, Sahin; Emet, Mucahit; Akoz, Ayhan

    2016-01-01

    Objective: Burn is the tissue damage on body caused due to various reasons. Although all burns caused by hot liquids are investigated as scalding burns, dense liquid burns (DLB) caused by such as milk and oil are different from other burns. The aim of this study was to report the properties of DLB. Materials and Methods: Patients admitted to the Emergency Service of Atatürk University Hospital, with DLB from June 2003 to December 2008, were examined retrospectively. Results: During the study, 28 DLB patients were admitted to the emergency service. The most common admission were found in autumn 28.6% (n=8), and in May and June, 17.9% (n=5). The frequency of burns on the right upper extremity was seen in 50% (n=14) of the patients. The burn degree of all patients was determined as 2nd degree. Seventy-five percent (n=21) of the patients were discharged, 14.3% (n=4) were hospitalized. None of the patients died. Conclusion: Dense liquid burns is a burn type that is commonly seen in women, absolutely causing 2nd degree burns, frequently reported in upper extremity and head/neck regions, and in contrast to other studies, in our region it is completely seen in patients living in city centre. PMID:27026759

  11. Correlation of American Burn Association sepsis criteria with the presence of bacteremia in burned patients admitted to the intensive care unit.

    Science.gov (United States)

    Hogan, Brian K; Wolf, Steven E; Hospenthal, Duane R; D'Avignon, Laurie C; Chung, Kevin K; Yun, Heather C; Mann, Elizabeth A; Murray, Clinton K

    2012-01-01

    Severe burn injury is accompanied by a systemic inflammatory response, making traditional indicators of sepsis both insensitive and nonspecific. To address this, the American Burn Association (ABA) published diagnostic criteria in 2007 to standardize the definition of sepsis in these patients. These criteria include temperature (>39°C or 110 beats per minute), progressive tachypnea (>25 breaths per minute not ventilated or minute ventilation >12 L/minute ventilated), thrombocytopenia (200 mg/dl, >7 units of insulin/hr intravenous drip, or >25% increase in insulin requirements over 24 hours), and feed intolerance >24 hours (abdominal distension, residuals two times the feeding rate, or diarrhea >2500 ml/day). Meeting >3 of these criteria should "trigger" concern for infection. In this initial assessment of the ABA sepsis criteria correlation with infection, the authors evaluated the ABA sepsis criteria's correlation with bacteremia because bacteremia is not associated with inherent issues of diagnosis as occurs with pneumonia or soft tissue infections, and blood cultures are typically obtained due to concern for ongoing infections falling within the definition of "septic." A retrospective electronic records review was performed to evaluate episodes of bacteremia in the United States Army Institute of Research from 2006 through 2007. A total of 196 patients were admitted during the study period who met inclusion criteria. The first positive and negative cultures, if present, from each patient were evaluated. This totaled 101 positive and 181 negative cultures. Temperature, heart rate, insulin resistance, and feed intolerance criteria were significant on univariate analysis. Only heart rate and temperature were found to significantly correlate with bacteremia on multivariate analysis. The receiver operating characteristic curve area for meeting >3 ABA sepsis criteria is 0.638 (95% confidence interval 0.573-0.704; P burn patients, the ABA trigger for sepsis did not

  12. Critical issues in burn care.

    Science.gov (United States)

    Holmes, James H

    2008-01-01

    Burn care, especially for serious burn injuries, represents a considerable challenge for the healthcare system. The American Burn Association has established a number of strategies for the management of burn patients and dedicates its efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention, often in collaboration with other organizations. The American Burn Association has recommended that patients with serious burns be referred to a designated burn center, ie, a hospital outfitted with specialized personnel and equipment dedicated to burn care. Burn centers have been operational for over 50 years, but the complexity and costs of providing specialized burn care have given rise to a number of critical administrative and political issues. These include logistical limitations imposed by the uneven national distribution of burn centers and a potential shortage of burn beds, both during everyday conditions and in the event of a mass disaster. Burn surgeon shortages have also been identified, stemming, in part, from a lack of specialized burn care training opportunities. There is currently a lack of quality outcome data to support evidence-based recommendations for burn care, and burn care centers are compromised by problems obtaining reimbursement for the care of uninsured and publicly insured out-of-state burn patients. Initiatives are underway to maintain efficient burn care facilities that are fully funded, easily accessible, and most importantly, provide optimal, evidence-based care on a daily basis, and are well-equipped to handle a surge of patients during a disaster situation.

  13. MRI induced second-degree burn in a patient with extremely large uterine leiomyomas: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chul Min; Kang, Bo Kyeong; Song, Soon Young; Koh, Byung Hee; Choi, Joong Sub; Lee, Won Moo [Hanyang University Medical Center, Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2015-12-15

    Burns and thermal injuries related with magnetic resonance imaging (MRI) are rare. Previous literature indicates that medical devices with cable, cosmetics or tattoo are known as risk factors for burns and thermal injuries. However, there is no report of MRI-related burns in Korea. Herein, we reported a case of deep second degree burn after MRI in a 38-year-old female patient with multiple uterine leiomyomas including some that were large and degenerated. The large uterine leiomyoma-induced protruded anterior abdominal wall in direct contact with the body coil during MRI was suspected as the cause of injury, by retrospective analysis. Therefore, awareness of MRI related thermal injury is necessary to prevent this hazard, together with extreme care during MRI.

  14. Application of silver sulfadiazine cream with early surgical intervention in patients suffering from combined burn-blast injury facial tattoos.

    Science.gov (United States)

    Ebrahimi, Ali; Kalantar Motamedi, Mohammad Hosein

    2012-01-01

    Severe combined burn-blast injury is a great challenge to surgical teams due to its high mortality. It also results in unsightly traumatic tattoos. The aims of these case reports were to clarify the clinical characteristic of the dynamite explosion burn-blast facial injuries and discuss appropriate management of these patients. We report two patients suffering from facial burn-blast injury following dynamite explosion in which after primary stabilization, silver sulfadiazine cream was applied to the wounds and 12 hours later the wounds were cleaned under general anesthesia with vigorous saline solution irrigation and brushing. The foreign particles were meticulously removed from wounds and simultaneous repairing of defects was done with nylon 6-0 sutures. We conclude application of silver sulfadiazine cream on facial burn-blast injury tattoos several hours before surgical removal of particles is highly efficacious in facilitating particle removal and attaining a good result following surgical intervention, and primary repair. Treatment of combined burn-blast tattoos is different from other types of tattoos not associated with burns. Debridement and removal of foreign particles under general anesthesia from skin immediately and primary reconstruction of wounds is essential. We recommend application of the topical agent silver sulfadiazine to wounds about 12 hours before surgical intervention.

  15. Prevalence of whiplash trauma in TMD patients: a systematic review.

    Science.gov (United States)

    Häggman-Henrikson, B; Rezvani, M; List, T

    2014-01-01

    The purpose of this systematic review was to describe the prevalence of whiplash trauma in patients with temporomandibular disorders (TMDs) and to describe clinical signs and symptoms in comorbid TMD/whiplash compared with TMD localised to the facial region. A systematic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 31 December 2012. The systematic search identified 129 articles. After the initial screening of abstracts, 32 articles were reviewed in full text applying inclusion and exclusion criteria. Six studies on the prevalence of neck trauma in patients with TMD met the inclusion criteria and were included in the review. Two of the authors evaluated the methodological quality of the included studies. The reported prevalence of whiplash trauma ranged from 8·4% to 70% (median 35%) in TMD populations, compared with 1·7-13% in the non-TMD control groups. Compared with patients with TMD localised to the facial region, TMD patients with a history of whiplash trauma reported more TMD symptoms, such as limited jaw opening and more TMD pain, and also more headaches and stress symptoms. In conclusion, the prevalence of whiplash trauma is higher in patients with TMD compared with non-TMD controls. Furthermore, patients with comorbid TMD/whiplash present with more jaw pain and more severe jaw dysfunction compared with TMD patients without a history of head-neck trauma. These results suggest that whiplash trauma might be an initiating and/or aggravating factor as well as a comorbid condition for TMD.

  16. The "stegosaurus" dressing: a simple and effective method of securing skin grafts in the burn patient.

    Science.gov (United States)

    Fullerton, J K; Smith, C E; Milner, S M

    2000-10-01

    Skin grafts are vulnerable to shear stress, infection, and hematoma formation during the postoperative period, all of which reduce graft survival. Various methods of dressing application and materials have been described in the literature to try and prevent graft loss. The authors report the use of the "stegosaurus dressing" (Eggcrate Pad) in 6 patients to secure skin grafts. Patients chosen were those who were either noncompliant or who sustained burns in unfavorable anatomic sites. All grafts demonstrated complete take without infection and hematoma formation. This foam dressing provides an even pressure to the recipient bed, absorbs drainage, and protects the graft from shearing. It also demonstrates the versatility to be used in difficult nonburn skin graft areas. The stegosaurus dressing is easy to apply, inexpensive, and provides a very secure dressing over the skin graft.

  17. Glutamine and immunonutrition for burn patients%谷氨酰胺与烧伤免疫营养

    Institute of Scientific and Technical Information of China (English)

    彭曦; 汪仕良

    2009-01-01

    Nutritional therapy is an important determi-nant of immune function in burn patients. However, common nutritional supplement given to patients with extensive deep burn is still therapeutically inefficient to block nutrients utilization due to metabolic disorder. Immunonutrition, a new nutrition thera-peutic modality, has been used in severely burned patients for regulating cell function, improving metabolic state, and enhan-cing immune function. Glutamine (Gln) is often considered to be a prime immunonutrient in immunonutrition therapy for criti-cally ill patients including those with serious burns. Our series of experimental and clinical studies have demonstrated that Gln administered in animals or patients could abate intestinal injury, accelerate repair of intestinal mucosa, improve nitrogen balance, abate immunosuppression, maintain immune homeostasis, amel-iorate wound healing, and shorten hospital stay. Although the use of Gln for supportive care of severely burned patients is now well established, the science of its use is still in its infancy. There are some disputes in regard to its indication, dosage, and course of treatment, and the way of its supplementation, admin-istration opportunity especially. These questions will be dis-cussed in this paper, and we wish to propose the principle and method of administration of Gln in severely burned patients.%@@ 严重烧伤患者持续的高分解代谢导致营养物质利用障碍,单纯补充营养素不能完全抑制高分解代谢,机体仍存在自身消耗、自噬代谢等病理反应[1].

  18. [Standardisation of the Initial Treatment of Severely Burned Patients: The Necessary Transfer of Concepts from Trauma Care].

    Science.gov (United States)

    Münzberg, M; Harbers, T; Kneser, U; Grützner, P A; Reichert, B; Kremer, T; Wölfl, C G; Horter, J; Hirche, C

    2016-12-01

    The initial treatment of severely burned patients remains a huge challenge for first responders in emergency services as well as emergency doctors who do not work in a centre for severe burn injuries. The reason for this is the low number of cases in developed countries and a lack of training concepts for the specific aspects of the initial treatment of severe burn injuries. Because of guidelines with limited evidence (S1, S2k) and a lack of structured treatment approaches, uncertainties with respect to initial treatment are still visible. Even within the professional societies and on international comparison, controversial aspects remain. In contrast, optimised and standardised procedures are available for the treatment of severely injured (trauma) patients, based on PHTLS® (Pre Hospital Trauma Life Support) for preclinical and ATLS® (Advanced Trauma Life Support) for in-hospital first aid. This article takes stock of the current structure of care and the relevant evidence for the initial treatment of severe burns. Also it discusses a possible transfer and further development of concepts for primary trauma care by all disciplines involved. Nine essential steps in the primary care of burned patients are identified and evaluated. The need for the introduction of a uniform treatment algorithm is illustrated. The treatment algorithm presented in this article addresses all first responders who are faced with initial treatment in the first 24 hours outside of burn centres. As an essential, new aspect, it offers a transfer and adaptation of concepts from trauma care to standardise the care of severely burned patients.

  19. Closed-Loop and Decision-Assist Resuscitation of Burn Patients

    Science.gov (United States)

    2008-04-01

    contemporary methods of burn resuscitation, we performed a metaanalysis of the last 26 years of burn resuscitation. We searched Medline for all...Ringer solution to induce mean 24-hour UOs exceeding 1.0 mL/kg/hr. The primary conclu- sions from the metaanalysis are1 total volumes infused typi- cally... metaanalysis did not analyze whether burn centers are infusing more fluid than is optimal, or if the Brooke and Parkland burn formulas specify inadequate

  20. The role of exercise in the rehabilitation of patients with severe burns.

    Science.gov (United States)

    Porter, Craig; Hardee, Justin P; Herndon, David N; Suman, Oscar E

    2015-01-01

    Severe burn trauma results in persistent skeletal muscle catabolism and prolonged immobilization. We hypothesize that structured rehabilitative exercise is a safe and efficacious strategy to restore lean body mass and physical function in burn victims. Here, we review the evidence for the utility of rehabilitative exercise training in restoring physiological function in burn survivors.

  1. Selection of antifungal agents for burn patients%烧伤患者抗真菌药物的选择

    Institute of Scientific and Technical Information of China (English)

    郇京宁

    2013-01-01

    Fungal infection is one of the serious complications of severely burned patients with high mortality.Application of antifungal agents timely and rationally is very important to control the infection.Antifungal agents including polyenes,triazoles,and echinocandins have been used widely in burned patients and are proved to be effective.Since diagnosis of fungal infection remains difficult,prophylactic and empirical therapies appear to be particularly necessary.In order to improve the efficacy and safety of antifungal agents,the factors of fungal strains,infection sites,hepatic and renal functions,and age,etc.should be considered in selecting antifungal agents.

  2. Comparison of the nutritional status and outcome in thermal burn patients receiving vegetarian and non-vegetarian diets

    Directory of Open Access Journals (Sweden)

    Samira Sharma

    2014-01-01

    Full Text Available Background: The importance of adequate nutritional support in burned patients cannot be overemphasised. For adequate long-term compliance by the patients, diet should be formulated in accordance with their pre-burn dietary habits, religious beliefs, and tastes. Patients and Methods: A study was conducted in 42 consecutive patients suffering from 10% to 50% of 2 nd and 3 rd degree thermal burns with the aim to compare nutritional status, clinical outcome, and cost-effectiveness of vegetarian and non-vegetarian diets. The patients were divided into two groups depending upon their pre-injury food habits. Total calories were calculated by Curreri formula. Both groups were compared by various biochemical parameters, microbiological investigations, weight , status of wound healing, graft take, and hospital stay and they were followed for at least 60 days postburn. Results: The results were comparable in both groups. Vegetarian diet was found to be more palatable and cost-effective. Conclusion: Vegetarian diet is a safe and viable option for the patients suffering from burn injury. The common belief that non-vegetarian diet is superior to vegetarian diet is a myth.

  3. Suplementação de antioxidantes: enfoque em queimados Antioxidant supplementation: focusing on burned patients

    Directory of Open Access Journals (Sweden)

    Eliana Barbosa

    2007-12-01

    increases the production of free radicals but it is also capable of impairing the antioxidant defense mechanism, subjecting the burned patient to oxidative stress, which can be a perpetuating factor of the inflammatory response and lead to progressive metabolic deterioration. Therefore, the purpose of this work is to provide updated information on antioxidant supplementation in burned patients and describe the benefits of this intervention.

  4. Burn Pits

    Science.gov (United States)

    ... Enter ZIP code here Enter ZIP code here Burn Pits Burn Pits Registry Studies Photo: U.S. Department ... the health of deployed Veterans. Health effects from burn pit smoke Toxins in burn pit smoke may ...

  5. Burn Institute

    Science.gov (United States)

    ... Now Help keep local seniors safe from fire! Burn Survivor Support If you are reading this, chances ... year – a burn injury. Learn more Fire and Burn Prevention Each year, the Burn Institute provides fire ...

  6. Expressive writing interventions in cancer patients: a systematic review.

    Science.gov (United States)

    Merz, Erin L; Fox, Rina S; Malcarne, Vanessa L

    2014-01-01

    Decades of research have suggested that expressive writing produces physical and psychological benefits in controlled laboratory experiments among healthy college students. This work has been extended to clinical and medical populations, including cancer patients. Although expressive writing could be a promising and inexpensive intervention for this population, the effects have not been systematically examined in oncology samples. A systematic review using PRISMA guidelines was conducted for experimental trials of cancer patients who participated in an expressive writing intervention. PsycINFO and PubMed/Medline were searched for peer-reviewed studies. Thirteen articles met the inclusion/exclusion criteria. Although the majority of the intervention effects were null, there were several main effects for expressive writing on sleep, pain, and general physical and psychological symptoms. Several moderators were identified, suggesting that expressive writing may be more or less beneficial based on individual characteristics such as social constraints. The reviewed studies were limited due to representativeness of the samples, performance, detection and patient-reported outcomes biases, and heterogeneity of the intervention protocol and writing prompts. Future studies with rigorous designs are needed to determine whether expressive writing is therapeutically effective in cancer patients.

  7. Severe Burns and Amputation of Both Arms in the First Psychotic Episode of a Schizophrenic Patient

    Directory of Open Access Journals (Sweden)

    Lizardo Cruzado

    2015-01-01

    Full Text Available An alleged reduction of sensitivity to pain in people with schizophrenia has been reported, but the nature of this complex phenomenon has not been elucidated yet. Reports of insensitivity to burns from people with schizophrenia are extremely rare. We report the case of a 24-year-old man who set both of his arms on fire during the first break of paranoid schizophrenia. As a result of severe tissue damage, both of his limbs had to be amputated. Today, at the age of 59, the patient is physically and mentally rehabilitated and is adherent to treatment. Additionally, given the uncertainty about the true nature of the alleged hypoalgesia in schizophrenia, we postulate the need for a comprehensive phenomenological approach in the study of embodiment in people with this condition.

  8. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review

    Science.gov (United States)

    Hall, Louise H.; Johnson, Judith; Watt, Ian; Tsipa, Anastasia; O’Connor, Daryl B.

    2016-01-01

    Objective To determine whether there is an association between healthcare professionals’ wellbeing and burnout, with patient safety. Design Systematic research review. Data Sources PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles. Eligibility Criteria for Selecting Studies Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations. Results Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety. Conclusions Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed. Implications This review illustrates the need for healthcare organisations to consider improving employees’ mental health as well as creating safer work environments when planning interventions to improve patient safety. Systematic Review Registration PROSPERO registration number: CRD42015023340. PMID:27391946

  9. Antibiotic Resistance Pattern of Pseudomonas Aeruginosa, Isolated from Patient with Burn Wound Infection in Guilan,Iran

    Directory of Open Access Journals (Sweden)

    Iraj Nikokar

    2013-03-01

    Full Text Available Background and Objectives: Antibiotic resistance of Pseudomonas aeruginosa remains a major problem in burn patients. The main objective of this study was to determine the antibiotic resistance pattern and frequency of class 1 integrons among P. aeruginosa strains isolated from patients with burn wound infections in a new Burn Centre in Guilan, Iran.Materials and Methods: The bacterial isolates were collected from 182 patients with burn wound infections and P. aeruginosa species were identified by standard bacteriological methods. The drug susceptibility test, using 11 antimicrobial agents, was performed for all the isolates via agar disk diffusion method. PCR was carried out for the detection of integrons.Results: Out of a total of 182 hospitalized patients in the burn center assessed, 86 (47% found to have P. aeruginosa in their isolates. Resistance rates to various antibiotics were as follows: cloxacillin (91.8%, cotrimoxazole (86%, cephazolin (83.7%, carbenicillin (74.4%, piperacillin (69.9%, ceftazidime (68.8%, ciprofloxacin (66.3%, tobramycin (58.2%, amikacin (48.8% and gentamicin (37.2%, while the most effective antibiotic was imipenem with a resistance rate of 23.3%. Thirty nine (45.3% isolates were detected as multi-drug resistant. The PCR results showed that 37 (43% P. aeruginosa isolates and 27 (69.2% multi-drug resistant strains harbored class 1 integrons. A significant correlation was obtained between the presence of integrons and resistance against imipenem, ceftazidime, piperacillin and ciprofloxacin (P < 0.001.Conclusion: Optimization of using antimicrobial agents and control of infection is recommended to prevent the increasing population of drug resistant organisms in the new burn centre setting in this study. Furthermore, the high frequency of class 1 integrons among multi-drug resistant strains might be responsible for dissemination of antibiotic resistance gene.

  10. Emerging Carbapenem-Resistant Pseudomonas aeruginosa Isolates Carrying blaIMP Among Burn Patients in Isfahan, Iran

    Science.gov (United States)

    Radan, Mohsen; Moniri, Rezvan; Khorshidi, Ahmad; Gilasi, Hamidreza; Norouzi, Zohreh; Beigi, Fahimeh; Dasteh Goli, Yasaman

    2016-01-01

    Background Metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa is a significant pathogen in burn patients. Objectives The aim of this study was to determine the prevalence of carbapenem-resistant P. aeruginosa isolates, including those resistant to imipenemase (IMP), in a burn unit in Isfahan, Iran. Patients and Methods One hundred and fifty P. aeruginosa isolates from burn patients were tested for antibiotic susceptibility by the disc diffusion method in accordance with CLSI guidelines. Production of MBL was identified with the EDTA disk method. DNA was purified from the MBL-positive isolates, and detection of the blaIMP gene was performed with PCR. Results Fifty-seven out of 150 (38%) isolates were multi-drug resistant (MDR), and 93 (62%) were extensively-drug resistant (XDR). Among all isolates, the resistance rate to ciprofloxacin, tobramycin, imipenem, meropenem, amikacin, ceftazidime, and cefepime was higher than 90%, while the resistance rates to piperacillin/tazobactam and aztreonam were 70.7% and 86%, respectively. Colistin and polymyxin B remained the most effective studied antibiotics. All of the imipenem-resistant P. aeruginosa isolates were MBL-positive, and 107 out of 144 (74.3%) of the MBL isolates were positive for the blaIMP gene. Conclusions The results of this study show that the rate of P. aeruginosa-caused burn wound infections was very high, and many of the isolates were resistant to three or more classes of antimicrobials. Such extensive resistance to antimicrobial classes is important because few treatment options remain for patients with burn wound infections. blaIMP-producing P. aeruginosa isolates are a rising threat in burn-care units, and should be controlled by conducting infection-control assessments.

  11. Effectiveness of Music Therapy in Alzheimer Patients: Systematic Review

    Directory of Open Access Journals (Sweden)

    Neslihan Lok

    Full Text Available The incidence of Alzheimers disease increases with advancing age. This increase cause significant economic and emotional burden on family and national health care system which makes Alzheimers disease a national issue to be considered. Music therapy could be an alternative treatment approach in Alzheimer's disease. Especially in the second stage of Alzheimers disease, growth and expansion of amyloid plaques results in anger and aggression among patients. Calming effects of music might be beneficial in management of patients during this period. This study is a systematic review of researches conducted to determine the effects of music therapy in Alzheimer's diseases. In sum results have supported possible positive effects of music therapy on Alzheimer patients. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(3.000: 266-274

  12. Opportunistic intestinal parasites in hemodialysis patients - a systematic literature review

    Directory of Open Access Journals (Sweden)

    Solimar Almeida de Oliveira

    2013-12-01

    Full Text Available The objective of this systematic literature review was to identify the occurrence of opportunistic enteric parasites in chronic kidney patient undergoing hemodialysis. The review consisted on searching articles published on MEDLINE, LILACS, SciELO, and PubMed databases between 1991 and 2013. A total 178 articles were identified, ten of which were considered relevant for the present study. In the referred studies, the researchers demonstrated that immunosuppressed patients undergoing hemodialysis are potentially infected by opportunistic enteric agents. Further studies are needed on this topic, as there is a growing global concern with chronic kidney diseases and the potential for these patients contracting opportunistic diseases, which, inclusively, could contaminate hospital environments with opportunistic enteric protozoa. Descriptors: Renal Dialysis; Blastocystis hominis; Cryptosporidium; Cyclospora; Isospora.

  13. Heart disease in patients with osteogenesis imperfecta - A systematic review

    DEFF Research Database (Denmark)

    Ashournia, Hamoun; Johansen, Frank Ted; Folkestad, Lars

    2015-01-01

    INTRODUCTION: Osteogenesis imperfecta (OI) is a rare, inherited systemic connective tissue disease that causes decreased bioavailability of collagen type 1. Collagen type 1 is the most abundant connective tissue in the body and a key part of many organs. While the bone phenotype in OI is well...... described, less is known about the effects of decreased collagen on other organs. In the heart, collagen type 1 is present in the heart valves, chordae tendineae, annuli fibrosi and the interventricular septum. It is thus likely that the heart is affected in OI. OBJECTIVES: The aim of this systematic...... of 68 studies were included in the review, comprising 51 case reports, 8 small case series (ncase series (n≥10 patients) and 5 cross-sectional studies comparing patients and controls. Together, the papers comprised 499 patients and covered 45years of medical literature. The most...

  14. Training doctors to manage patients with multimorbidity: a systematic review

    Directory of Open Access Journals (Sweden)

    Cliona Lewis

    2016-08-01

    Full Text Available Background: Patients with multimorbidity (two or more chronic conditions are now the norm in clinical practice, and place an increasing burden on the healthcare system. Management of these patients is challenging, and requires doctors who are skilled in the complexity of multiple chronic diseases. Objective: To perform a systematic review of the literature to ascertain whether there are education and training formats which have been used to train postgraduate medical doctors in the management of patients with multimorbidity in primary and/or secondary care, and which have been shown to improve knowledge, skills, attitudes, and/or patient outcomes. Methods: Overall, 75,110 citations were screened, of which 65 full-text articles were then independently assessed for eligibility by two reviewers, and two studies met the inclusion criteria for the review. Results: The two included studies implemented and evaluated multimorbidity workshops, and highlight the need for further research addressing the learning needs of doctors tasked with managing patients with multimorbidity in their daily practice. Conclusion: While much has been published about the challenges presented to medical staff by patients with multimorbidity, published research regarding education of doctors to manage these problems is lacking. Further research is required to determine whether there is a need for, or benefit from, specific training for doctors to manage patients with multimorbidity. PROSPERO registration number: CRD42013004010. Journal of Comorbidity 2016;6(2:85–94

  15. Measurement of physician-patient communication--a systematic review.

    Directory of Open Access Journals (Sweden)

    Jördis M Zill

    Full Text Available BACKGROUND: Effective communication with health care providers has been found as relevant for physical and psychological health outcomes as well as the patients' adherence. However, the validity of the findings depends on the quality of the applied measures. This study aimed to provide an overview of measures of physician-patient communication and to evaluate the methodological quality of psychometric studies and the quality of psychometric properties of the identified measures. METHODS: A systematic review was performed to identify psychometrically tested instruments which measure physician-patient communication. The search strategy included three databases (EMBASE, PsycINFO, PubMed, reference and citation tracking and personal knowledge. Studies that report the psychometric properties of physician-patient communication measures were included. Two independent raters assessed the methodological quality of the selected studies with the COSMIN (COnsensus based Standards for the selection of health status Measurement INtruments checklist. The quality of psychometric properties was evaluated with the quality criteria of Terwee and colleagues. RESULTS: Data of 25 studies on 20 measures of physician-patient communication were extracted, mainly from primary care samples in Europe and the USA. Included studies reported a median of 3 out of the nine COSMIN criteria. Scores for internal consistency and content validity were mainly fair or poor. Reliability and structural validity were rated mainly of fair quality. Hypothesis testing scored mostly poor. The quality of psychometric properties of measures evaluated with Terwee et al.'s criteria was rated mainly intermediate or positive. DISCUSSION: This systematic review identified a number of measures of physician-patient communication. However, further psychometric evaluation of the measures is strongly recommended. The application of quality criteria like the COSMIN checklist could improve the

  16. Measurement of Physician-Patient Communication—A Systematic Review

    Science.gov (United States)

    Zill, Jördis M.; Christalle, Eva; Müller, Evamaria; Härter, Martin; Dirmaier, Jörg; Scholl, Isabelle

    2014-01-01

    Background Effective communication with health care providers has been found as relevant for physical and psychological health outcomes as well as the patients' adherence. However, the validity of the findings depends on the quality of the applied measures. This study aimed to provide an overview of measures of physician-patient communication and to evaluate the methodological quality of psychometric studies and the quality of psychometric properties of the identified measures. Methods A systematic review was performed to identify psychometrically tested instruments which measure physician-patient communication. The search strategy included three databases (EMBASE, PsycINFO, PubMed), reference and citation tracking and personal knowledge. Studies that report the psychometric properties of physician-patient communication measures were included. Two independent raters assessed the methodological quality of the selected studies with the COSMIN (COnsensus based Standards for the selection of health status Measurement INtruments) checklist. The quality of psychometric properties was evaluated with the quality criteria of Terwee and colleagues. Results Data of 25 studies on 20 measures of physician-patient communication were extracted, mainly from primary care samples in Europe and the USA. Included studies reported a median of 3 out of the nine COSMIN criteria. Scores for internal consistency and content validity were mainly fair or poor. Reliability and structural validity were rated mainly of fair quality. Hypothesis testing scored mostly poor. The quality of psychometric properties of measures evaluated with Terwee et al.'s criteria was rated mainly intermediate or positive. Discussion This systematic review identified a number of measures of physician-patient communication. However, further psychometric evaluation of the measures is strongly recommended. The application of quality criteria like the COSMIN checklist could improve the methodological quality of

  17. Safety and efficacy of excision and direct closure in acute burns surgery: outcome analysis in a prospective series of 100 patients and a survey of UK burns surgeons' attitudes.

    Science.gov (United States)

    Bain, Charles J; Wang, Tim; McArthur, Gordon; Williams, Greg; Atkins, Joanne; Jones, Isabel

    2014-12-01

    Many burns surgeons avoid excision and direct closure of acute burns owing to concerns over wound dehiscence, scarring and infection. There is no evidence in the literature to support this practice. We present outcomes of a prospective series of 100 patients who underwent excision and direct closure of 138 burns over a 2-year period, along with results from a survey sent to 33 senior burns surgeons to gauge attitudes towards direct closure in burns surgery. 47% of survey respondents never perform direct closure. Dehiscence was cited as the most common concern, followed by hypertrophic scarring (HTS). In our cohort, the superficial dehiscence rate was 12% and the HTS rate was 16%, with no scarring contractures. Patients with healing time greater than 14 days were more likely to develop HTS (p=0.008), as were those with wound dehiscence (p=0.014). Patients undergoing part-grafting in addition to direct closure took significantly longer to heal than those undergoing direct closure alone (p=0.0002), with the donor site or graft delaying healing in the majority. Excision and direct closure of acute burn wounds avoids donor site morbidity and has an acceptable complication rate. It is a safe and effective treatment for full thickness burns in selected cases.

  18. Genome Sequence of a Virulent Pseudomonas aeruginosa Strain, 12-4-4(59), Isolated from the Blood Culture of a Burn Patient.

    Science.gov (United States)

    Karna, S L Rajasekhar; Chen, Tsute; Chen, Ping; Peacock, Trent J; Abercrombie, Johnathan J; Leung, Kai P

    2016-03-03

    Pseudomonas aeruginosa is an opportunistic pathogen that frequently infects wounds, significantly impairs wound healing, and causes morbidity and mortality in burn patients. Here, we report the genome sequence of a virulent strain of P. aeruginosa, 12-4-4(59), isolated from the blood culture of a burn patient.

  19. Osteopathy for primary headache patients: a systematic review

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    Cerritelli F

    2017-03-01

    Full Text Available Francesco Cerritelli,1–3 Eleonora Lacorte,4 Nuria Ruffini,1 Nicola Vanacore4 1Clinical-based Human Research Department, Centre for Osteopathic Medicine Collaboration, 2Department of Neuroscience, Imaging and Clinical Sciences, 3ITAB – Institute for Advanced Biomedical Technologies, G. D’Annunzio University of Chieti, Pescara, 4National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy Objective: This systematic review aimed to assess the efficacy, effectiveness, safety, and tolerability of osteopathic manipulative treatment (OMT in patients with headache. Background: Migraine is one of the most common and disabling medical conditions. It affects more than 15% of the general population, causing high global socioeconomic costs, and the currently available treatment options are inadequate.Methods: We systematically reviewed all available studies investigating the use of OMT in patients with migraine and other forms of headache.Results: The search of literature produced six studies, five of which were eligible for review. The reviewed papers collectively support the notion that patients with migraine can benefit from OMT. OMT could most likely reduce the number of episodes per month as well as drug use. None of the included studies, however, was classified as low risk of bias according to the Cochrane Collaboration’s tool for assessing risk of bias.Conclusion: The results from this systematic review show a preliminary low level of evidence that OMT is effective in the management of headache. However, studies with more rigorous designs and methodology are needed to strengthen this evidence. Moreover, this review suggests that new manual interventions for the treatment of acute migraine are available and developing. Keywords: osteopathic manipulative treatment, tension type headache, pain, migraine, disability 

  20. Evaluation of oral-motor movements and facial mimic in patients with head and neck burns by a public service in Brazil

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    Dicarla Motta Magnani

    2015-05-01

    Full Text Available OBJECTIVES: The purpose of this study was to analyze the characteristics of oral-motor movements and facial mimic in patients with head and neck burns. METHODS: An observational descriptive cross-sectional study was conducted with patients who suffered burns to the head and neck and who were referred to the Division of Orofacial Myology of a public hospital for assessment and rehabilitation. Only patients presenting deep partial-thickness and full-thickness burns to areas of the face and neck were included in the study. Patients underwent clinical assessment that involved an oral-motor evaluation, mandibular range of movement assessment, and facial mimic assessment. Patients were divided into two groups: G1 - patients with deep partial-thickness burns; G2 - patients with full-thickness burns. RESULTS: Our final study sample comprised 40 patients: G1 with 19 individuals and G2 with 21 individuals. The overall scores obtained in the clinical assessment of oral-motor organs indicated that patients with both second- and third-degree burns presented deficits related to posture, position and mobility of the oral-motor organs. Considering facial mimic, groups significantly differed when performing voluntary facial movements. Patients also presented limited maximal incisor opening. Deficits were greater for individuals in G2 in all assessments. CONCLUSION: Patients with head and neck burns present significant deficits related to posture, position and mobility of the oral myofunctional structures, including facial movements.

  1. Low Intensity laser therapy in patients with burning mouth syndrome: a randomized, placebo-controlled study

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    Norberto Nobuo SUGAYA

    Full Text Available Abstract The aim of this study was to assess the effectiveness of low intensity laser therapy in patients with Burning Mouth Syndrome (BMS. Thirty BMS subjects were randomized into two groups – Laser (LG and Placebo (CG. Seven patients dropped out, leaving 13 patients in LG and 10 patients in CG. Each patient received 4 irradiations (laser or placebo twice a week, for two consecutive weeks (blinded to the type of irradiation received. Infrared laser (AsGaAI irradiations were applied to the affected mucosa in scanning mode, wavelength of 790 nm, output power of 20 mW and fluence of 6 J/cm2. A visual analogue scale (VAS was used to assess the therapeutic effect before and after each irradiation, and at all the control time periods: 7, 14, 30, 60 and 90 days after the last irradiation. One researcher delivered irradiation and another recorded the results. Both researchers were blinded, the first to the results, and the second to the type of radiation applied. The results were categorized according to the percentage of symptom level variation, and showed a statistically better response in LG in only two categories of the control checkpoints (p=0.02; Fisher’s Exact Test. According to the protocol used in this study, low intensity laser therapy is as beneficial to patients with BMS as placebo treatment, indicating a great emotional component of involvement in BMS symptomatology. Nevertheless, there were positive results in some statistical analyses, thus encouraging further research in BMS laser therapy with other irradiation parameters.

  2. Gynecomastia in Patients with Prostate Cancer: A Systematic Review.

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    Anders Fagerlund

    Full Text Available Gynecomastia and/or mastodynia is a common medical problem in patients receiving antiandrogen (bicalutamide or flutamide treatment for prostate cancer; up to 70% of these patients result to be affected; furthermore, this can jeopardise patients' quality of life.To systematically review the quality of evidence of the current literature regarding treatment options for bicalutamide-induced gynecomastia, including efficacy, safety and patients' quality of life.The PubMed, Medline, Scopus, The Cochrane Library and SveMed+ databases were systematically searched between January 1, 2000 and December 31, 2014. All searches were undertaken between January and February 2015. The search phrase used was:"gynecomastia AND treatment AND prostate cancer". Two reviewers assessed 762 titles and abstracts identified. The search and review process was done in accordance with the PRISMA statement. The PICOS (patients, intervention, comparator, outcomes and study design process was used to specify inclusion criteria. Quality of evidence was rated according to GRADE.Primary outcomes were: treatment effects, number of complications and side effects. Secondary outcome was: Quality of Life.Eleven studies met the inclusion criteria and are analysed in this review. Five studies reported pharmacological intervention with tamoxifen and/or anastrozole, either as prophylactic or therapeutic treatment. Four studies reported radiotherapy as prophylactic and/or therapeutic treatment. Two studies compared pharmacological treatment to radiotherapy. Most of the studies were randomized with varying risk of bias. According to GRADE, quality of evidence was moderate to high.Bicalutamide-induced gynecomastia and/or mastodynia can effectively be managed by oral tamoxifen (10-20 mg daily or radiotherapy without relevant side effects. Prophylaxis or therapeutic treatment with tamoxifen results to be more effective than radiotherapy.

  3. Patient safety education for undergraduate medical students: a systematic review

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    Zhang Mingming

    2011-06-01

    Full Text Available Abstract Background To reduce harm caused by health care is a global priority. Medical students should be able to recognize unsafe conditions, systematically report errors and near misses, investigate and improve such systems with a thorough understanding of human fallibility, and disclose errors to patients. Incorporating the knowledge of how to do this into the medical student curriculum is an urgent necessity. This paper aims to systematically review the literature about patient safety education for undergraduate medical students in terms of its content, teaching strategies, faculty availability and resources provided so as to identify evidence on how to promote patient safety in the curriculum for medical schools. This paper includes a perspective from the faculty of a medical school, a major hospital and an Evidence Based Medicine Centre in Sichuan Province, China. Methods We searched MEDLINE, ERIC, Academic Source Premier(ASP, EMBASE and three Chinese Databases (Chinese Biomedical Literature Database, CBM; China National Knowledge Infrastructure, CNKI; Wangfang Data from 1980 to Dec. 2009. The pre-specified form of inclusion and exclusion criteria were developed for literature screening. The quality of included studies was assessed using Darcy Reed and Gemma Flores-Mateo criteria. Two reviewers selected the studies, undertook quality assessment, and data extraction independently. Differing opinions were resolved by consensus or with help from the third person. Results This was a descriptive study of a total of seven studies that met the selection criteria. There were no relevant Chinese studies to be included. Only one study included patient safety education in the medical curriculum and the remaining studies integrated patient safety into clinical rotations or medical clerkships. Seven studies were of a pre and post study design, of which there was only one controlled study. There was considerable variation in relation to contents

  4. A STUDY ON ROLE OF VARIOUS TYPES OF TOPICAL OINTMENT AND ITS OUTCOME AMONG BURN PATIENTS : AN INTERESTING FOLLOW UP STUDY

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    Sunita

    2015-08-01

    Full Text Available Burn injury causes major bulk of the surgical emergencies. Burn infection makes the burn wound complicated causes considerable mortality and morbidity. Timely and effective use of antimicrobial and topical dressings revolutionizes burn care by decreasing invasive wound infection. The administration of broad - spectrum antibiotics on routine basis is likely to en courage. The emergence of resistant organism therefore, timely and judicial use of antibiotics is essential for better result. MATERIAL AND METHOD S: The present study was carried out in 160 burns and scald admitted in surgical wards in Department of General Surgery, SGMH and S.S. Medical College, Rewa ( M. P. during period of one year. The cases are fully recorded and thoroughly studied with the aim of establishing the incidence, mode of burn and causes of burn, source of burn, clothing at timed incidence, time and place of incidence and detail clinical assessment. On admission resuscitation started with intravenous fluid, calculated according to the Parkland formula and prophylactic antibiotic giv en in all the patients after sampling for culture and sensitivity. Symptomatic and supportive treatment added as per need. RESULTS : Out of 160 patients, majority of the patient belong to 21 – 40 year 48.1%. Majority of patient ( 34.4% had total body surfac e burn area burnt between 21 - 40% and 12.5% patient had burnt area 61 - 80%. Maximum ( 50.0% complain of irritation was reported by the patients to whom Silver sulphadizine was applied while least ( 10% by the patients to whom nadoxin e was applied. CONCLUSION : The incident of invasive infection and overall mortality was significantly reduced after the introduction into clinical practice of topical burn wound anti - microbial agent, our study shows that the most effective topical antimicrobial agent in burn patie nt is Nadoxine.

  5. Blood transfusion indications in neurosurgical patients: A systematic review.

    Science.gov (United States)

    Bagwe, Shefali; Chung, Lawrance K; Lagman, Carlito; Voth, Brittany L; Barnette, Natalie E; Elhajjmoussa, Lekaa; Yang, Isaac

    2017-04-01

    Neurosurgical procedures can be complicated by significant blood losses that have the potential to decrease tissue perfusion to critical brain tissue. Red blood cell transfusion is used in a variety of capacities both inside, and outside, of the operating room to prevent untoward neurologic damage. However, evidence-based guidelines concerning thresholds and indications for transfusion in neurosurgery remain limited. Consequently, transfusion practices in neurosurgical patients are highly variable and based on institutional experiences. Recently, a paradigm shift has occurred in neurocritical intensive care units, whereby restrictive transfusion is increasingly favored over liberal transfusion but the ideal strategy remains in clinical equipoise. The authors of this study perform a systematic review of the literature with the objective of capturing the changing landscape of blood transfusion indications in neurosurgical patients.

  6. Pharmacokinetics of drugs in cachectic patients: a systematic review.

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    Katja Trobec

    Full Text Available Cachexia is a weight-loss process caused by an underlying chronic disease such as cancer, chronic heart failure, chronic obstructive pulmonary disease, or rheumatoid arthritis. It leads to changes in body structure and function that may influence the pharmacokinetics of drugs. Changes in gut function and decreased subcutaneous tissue may influence the absorption of orally and transdermally applied drugs. Altered body composition and plasma protein concentration may affect drug distribution. Changes in the expression and function of metabolic enzymes could influence the metabolism of drugs, and their renal excretion could be affected by possible reduction in kidney function. Because no general guidelines exist for drug dose adjustments in cachectic patients, we conducted a systematic search to identify articles that investigated the pharmacokinetics of drugs in cachectic patients.

  7. Nutritional and Pharmacological Modulation of the Metabolic Response of Severely Burned Patients: Review of the Literature (Part II)*.

    Science.gov (United States)

    Atiyeh, B S; Gunn, S W A; Dibo, S A

    2008-09-30

    Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society. Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

  8. Nutritional and pharmacological modulation of the metabolic response of severely burned patients: review of the literature (part 1).

    Science.gov (United States)

    Atiyeh, B S; Gunn, S W A; Dibo, S A

    2008-06-30

    Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society. Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

  9. Nutritional and Pharmacological Modulation of the Metabolic Response of Severely Burned Patients: Review of the Literature (Part III)*.

    Science.gov (United States)

    Atiyeh, B S; Gunn, S W A; Dibo, S A

    2008-12-31

    Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society.Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

  10. Personality disorders in euthymic bipolar patients: a systematic review

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    Severino Bezerra-Filho

    2015-06-01

    Full Text Available Objective:To identify, by means of a systematic review, the frequency with which comorbid personality disorders (PDs have been assessed in studies of euthymic bipolar patients.Methods:PubMed, ciELO and PsychINFO databases were searched for eligible articles published between 1997 and 2013. After screening 1,249 empirical papers, two independent reviewers identified three articles evaluating the frequency of PDs in patients with bipolar disorders assessed in a state of euthymia.Results:The total sample comprised 376 euthymic bipolar patients, of whom 155 (41.2% had at least one comorbid PD. Among them, we found 87 (23.1% in cluster B, 55 (14.6% in cluster C, and 25 (6.6% in cluster A. The frequencies of PD subtypes were: borderline, 38 (10.1%; histrionic, 29 (7.7%; obsessive-compulsive, 28 (7.4%; dependent, 19 (5%; narcissistic, 17 (4.5%; schizoid, schizotypal, and avoidant, 11 patients each (2.95%; paranoid, five (1.3%; and antisocial, three (0.79%.Conclusion:The frequency of comorbid PD was high across the spectrum of euthymic bipolar patients. In this population, the most common PDs were those in cluster B, and the most frequent PD subtype was borderline, followed by histrionic and obsessive-compulsive.

  11. Burns and epilepsy.

    Science.gov (United States)

    Berrocal, M

    1997-01-01

    This is a report of the first descriptive analytic study of a group of 183 burn patients, treated in the Burn Unit at the University Hospital of Cartagena, Colombia during the period since January 1985 until December 1990. There is presented experience with the selected group of 24 patients in whom the diagnosis of burn was associated with epilepsy. There is also analysed and described the gravity of the scars sequels, neurological disorders, the complication of the burn and an impact of this problem on the patient, his (her) family and the community. It is very important to report that there was found Neurocisticercosis in 66.6% of the group of burn patients with epilepsy, and it is probably the first risk factor of burn in this group.

  12. Disaster planning: the past, present, and future concepts and principles of managing a surge of burn injured patients for those involved in hospital facility planning and preparedness.

    Science.gov (United States)

    Kearns, Randy D; Holmes, James H; Alson, Roy L; Cairns, Bruce A

    2014-01-01

    The 9/11 attacks reframed the narrative regarding disaster medicine. Bypass strategies have been replaced with absorption strategies and are more specifically described as "surge capacity." In the succeeding years, a consensus has coalesced around stratifying the surge capacity into three distinct tiers: conventional, contingency, and crisis surge capacities. For the purpose of this work, these three distinct tiers were adapted specifically to burn surge for disaster planning activities at hospitals where burn centers are not located. A review was conducted involving published plans, other related academic works, and findings from actual disasters as well as modeling. The aim was to create burn-specific definitions for surge capacity for hospitals where a burn center is not located. The three-tier consensus description of surge capacity is delineated in their respective stratifications by what will hereinafter be referred to as the three "S's"; staff, space, and supplies (also referred to as supplies, pharmaceuticals, and equipment). This effort also included the creation of a checklist for nonburn center hospitals to assist in their development of a burn surge plan. Patients with serious burn injuries should always be moved to and managed at burn centers, but during a medical disaster with significant numbers of burn injured patients, there may be impediments to meeting this goal. It may be necessary for burn injured patients to remain for hours in an outlying hospital until being moved to a burn center. This work was aimed at aiding local and regional hospitals in developing an extemporizing measure until their burn injured patients can be moved to and managed at a burn center(s).

  13. 儿童烧伤脓毒症的临床特点及诊断%Clinical characteristics and diagnosis of sepsis in pediatric burn patients

    Institute of Scientific and Technical Information of China (English)

    彭毅志

    2013-01-01

    Pediatric burn patients account for more than 1/3 of the inpatients in the same period,and its incidence surpasses that of burn patients in other age groups.However,it brings about much difficulty to treat pediatric burn patients complicated by sepsis,which brings a significantly higher mortality than that of the adult.Moreover,the physiological characteristics,development of organs,drug metabolism,and body response to burn injury in children are obviously different from those of the adult.Therefore,it is clinically important to understand the clinical characteristics of sepsis in pediatric burn patients in order to improve the diagnosis and treatment of this ailment.

  14. Patient Safety Learning Systems: A Systematic Review and Qualitative Synthesis

    Science.gov (United States)

    Lambrinos, Anna; Holubowich, Corinne

    2017-01-01

    Background A patient safety learning system (sometimes called a critical incident reporting system) refers to structured reporting, collation, and analysis of critical incidents. To inform a provincial working group's recommendations for an Ontario Patient Safety Event Learning System, a systematic review was undertaken to determine design features that would optimize its adoption into the health care system and would inform implementation strategies. Methods The objective of this review was to address two research questions: (a) what are the barriers to and facilitators of successful adoption of a patient safety learning system reported by health professionals and (b) what design components maximize successful adoption and implementation? To answer the first question, we used a published systematic review. To answer the second question, we used scoping study methodology. Results Common barriers reported in the literature by health care professionals included fear of blame, legal penalties, the perception that incident reporting does not improve patient safety, lack of organizational support, inadequate feedback, lack of knowledge about incident reporting systems, and lack of understanding about what constitutes an error. Common facilitators included a non-accusatory environment, the perception that incident reporting improves safety, clarification of the route of reporting and of how the system uses reports, enhanced feedback, role models (such as managers) using and promoting reporting, legislated protection of those who report, ability to report anonymously, education and training opportunities, and clear guidelines on what to report. Components of a patient safety learning system that increased successful adoption and implementation were emphasis on a blame-free culture that encourages reporting and learning, clear guidelines on how and what to report, making sure the system is user-friendly, organizational development support for data analysis to generate

  15. Itch in burn areas after skin transplantation : Patient characteristics, influencing factors and therapy

    NARCIS (Netherlands)

    Kuipers, Hester C.; Bremer, Marc; Braem, Lee; Goemanne, Anne Sofi; Middelkoop, Esthe; Van Loey, Nancy E E

    2015-01-01

    Pruritus is a frequently encountered symptom following burns. Higher intensity of itching has been associated with depth of the wounds and specific body locations but these differences are not well understood. Our aim was to investigate the intensity of post burn pruritus in grafted and non-grafted

  16. Burning vasculitis.

    Science.gov (United States)

    Chadha, Priyanka; Hobday, Dorian; O'Connor, Edmund Fitzgerald; D'Cruz, David

    2016-04-26

    We present the case of a 69-year-old man who was found collapsed close to a heat source and admitted to hospital for severe sepsis. He was also found to have widespread blistering and ulceration of his right leg; however, a history was unobtainable due to reduced consciousness levels. The leg lesions had the initial appearance of mixed depth burns and a management plan was made to transfer the patient to a burns unit for debridement. It was subsequently noted that the patient had a previous diagnosis of seropositive erosive rheumatoid arthritis. A biopsy of the leg lesion was performed and a diagnosis of rheumatoid vasculitis confirmed. Treatment with systemic steroids, intravenous antibiotics and intravenous immunoglobulin therapy for severe hypogammaglobulinaemia was started, and the patient was not transferred for surgical debridement. Rheumatoid vasculitis is a rare and extremely serious complication of rheumatoid arthritis that can manifest in a number of ways, occasionally mimicking other conditions. This case is essential to raise awareness of rare, severe rheumatoid vasculitis and of the potential for its misdiagnosis as a mixed depth burn.

  17. A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients

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    Baghel P

    2009-01-01

    Full Text Available To compare the effect of honey dressing and silver-sulfadiazene (SSD dressing on wound healing in burn patients. Patients (n=78 of both sexes, with age group between 10 and 50 years and with first and second degree of burn of less than 50% of TBSA (Total body surface area were included in the study, over a period of 2 years (2006-08. After stabilization, patients were randomly attributed into two groups: ′honey group′ and ′SSD group′. Time elapsed since burn was recorded. After washing with normal saline, undiluted pure honey was applied over the wounds of patients in the honey group (n=37 and SSD cream over the wounds of patients in SSD group (n=41, everyday. Wound was dressed with sterile gauze, cotton pads and bandaged. Status of the wound was assessed every third and seventh day and on the day of completion of study. Patients were followed up every fortnight till epithelialization. The bacteriological examination of the wound was done every seventh day. The mean age for case (honey group and control (SSD group was 34.5 years and 28.5 years, respectively. Wound swab culture was positive in 29 out of 36 patients who came within 8 hours of burn and in all patients who came after 24 hours. The average duration of healing in patients treated with honey and SSD dressing at any time of admission was 18.16 and 32.68 days, respectively. Wound of all those patients (100% who reported within 1 hour became sterile with honey dressing in less than 7 days while none with SSD. All of the wounds became sterile in less than 21 days with honey, while tthis was so in only 36.5% with SSD treated wounds. The honey group included 33 patients reported within 24 hour of injury, and 26 out of them had complete outcome at 2 months of follow-up, while numbers for the SSD group were 32 and 12. Complete outcome for any admission point of time after 2 months was noted in 81% and 37% of patients in the honey group and the SSD group. Honey dressing improves wound

  18. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review.

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    Louise H Hall

    Full Text Available To determine whether there is an association between healthcare professionals' wellbeing and burnout, with patient safety.Systematic research review.PsychInfo (1806 to July 2015, Medline (1946 to July 2015, Embase (1947 to July 2015 and Scopus (1823 to July 2015 were searched, along with reference lists of eligible articles.Quantitative, empirical studies that included i either a measure of wellbeing or burnout, and ii patient safety, in healthcare staff populations.Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all subscales of the burnout measures employed, and patient safety.Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed.This review illustrates the need for healthcare organisations to consider improving employees' mental health as well as creating safer work environments when planning interventions to improve patient safety.PROSPERO registration number: CRD42015023340.

  19. [Anesthetic management in a patient with head and neck burn by asphalt].

    Science.gov (United States)

    Suzuki, Nao; Niiyama, Yukitoshi; Tokinaga, Yasuyuki; Yamakage, Michiaki

    2013-10-01

    In cases of facial burns caused by molten asphalt, examination for possible airway burns and early removal of the asphalt should be carried out to prevent chemical-induced tissue damage and infection. However, asphalt that has adhered to tissues is difficult to remove. A 35-year-old male with burns caused by molten asphalt was scheduled for emergency debridement. He had 6% body surface area burns on his face and neck. He was not able to open his eyes due to the adherence of asphalt. His respiratory condition was stable and a perioperative fiberoptic view revealed no airway burns. After awake intubation, orange peel oil was used to remove the asphalt from his face and eyes. Since orange peel oil does not contain any harmful substances, it is effective for removing asphalt without causing tissue damage.

  20. Patient-based radiographic exposure factor selection: a systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Ching, William; Robinson, John; McEntee, Mark, E-mail: mark.mcentee@sydney.edu.au [Discipline of Medical Radiation Sciences, University of Sydney, Lidcombe, New South Wales (Australia)

    2014-09-15

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system.

  1. Knowledge tests in patient education: a systematic review.

    Science.gov (United States)

    Kesänen, Jukka; Leino-Kilpi, Helena; Arifulla, Dinah; Siekkinen, Mervi; Valkeapää, Kirsi

    2014-06-01

    This study describes knowledge tests in patient education through a systematic review of the Medline, Cinahl, PsycINFO, and ERIC databases with the guidance of the PRISMA Statement. Forty-nine knowledge tests were identified. The contents were health-problem related, focusing on biophysiological and functional knowledge. The mean number of items was 20, with true-false or multiple-choice scales. Most of the tests were purposely designed for the studies included in the review. The most frequently reported quality assessments of knowledge tests were content validity and internal consistency. The outcome measurements for patient-education needs were comprehensive, validating knowledge tests that cover multidimensional aspects of knowledge. Besides the measurement of the outcomes of patient education, knowledge tests could be used for several purposes in patient education: to guide the content of education as checklists, to monitor the learning process, and as educational tools. There is a need for more efficient content and health problem-specific knowledge-test assessments.

  2. Comparative Analysis of Early Excision and Grafting vs Delayed Grafting in Burn Patients in a Developing Country.

    Science.gov (United States)

    Puri, Vinita; Khare, Nishant A; Chandramouli, M V; Shende, Nilesh; Bharadwaj, Sumit

    2016-01-01

    The present study attempts to compare how the patients who undergo early excision and grafting behave as compared with patients who are treated along usual conservative lines of management in centers where the resources are less than optimal. The data of 20 female patients were analyzed. Age of the patients ranged between 20 and 30 years, percentage area burn ranged between 20 and 40%, and percentage area resurfaced by skin grafting 5 to 10%. The patients were divided into two groups of 10 patients each. Group I included those patients who underwent early excision and grafting within 5 days of burn injury. Group II included those patients who were treated conservatively and the residual raw area was grafted 3 weeks or more after sustaining the burn. The two groups were compared for the amount of blood loss, transfusion requirement, graft take, and the total hospital stay. Statistical significance was tested by the application of Mann-Whitney U test. The mean percentage area burn was 29.1 ± 5.6% in group I and 24.7 ± 4.9% in group II. Mean percentage area resurfaced by skin grafting in group I was 9.4 ± 2.3% and 8.1 ± 1.6% in group II. Graft take in group I was 90 ± 7.8%, whereas that in group II was 95 ± 6.7%. Mean blood loss in group I and group II was 346 ± 17.6 ml and 241 ± 14.7 ml respectively. (P = .001). Mean transfusion requirement in the perioperative period was 1.6 pints in group I and 1.1 pints in group II. The mean hospital stay in the patients who underwent early excision and grafting was 15.1 ± 4.1 days, whereas that in the patients who underwent delayed grafting was 36.2 ± 6.3 days (P = .001). Early excision and grafting decreases the hospital stay of burn patients. The present study suggests that it has a definite applicability even in places where the resources might be less than optimal.

  3. Use of cyanide antidotes in burn patients with suspected inhalation injuries in North America: a cross-sectional survey.

    Science.gov (United States)

    Dumestre, Danielle; Nickerson, Duncan

    2014-01-01

    This study aimed to assess the use of cyanide antidotes and the determine the opinion on empiric administration of hydroxocobalamin in North American burn patients with suspected smoke inhalation injuries. An online cross-sectional survey was sent to directors of 90 major burn centers in North America, which were listed on the American Burn Association Web site. A multiple-choice format was used to determine the percentage of patients tested for cyanide poisoning on admission, the current administration of a cyanide antidote based solely on clinical suspicion of poisoning, and the antidote used. To ascertain views on immediate administration of hydroxocobalamin before confirmation of cyanide poisoning an option was included to expand the response in written format. Twenty-nine of 90 burn directors (32%) completed the survey. For the population of interest, the majority of burn centers (59%) do not test for cyanide poisoning on admission and do not administer an antidote based solely on clinical suspicion of cyanide poisoning (58%). The most commonly available antidote is hydroxocobalamin (50%), followed by the cyanide antidote kit (29%). The opinion regarding instant administration of hydroxocobalamin when inhalation injury is suspected is mixed: 31% support its empiric use, 17% do not, and the remaining 52% have varying degrees of confidence in its utility. In North America, most patients burnt in closed-space fires with inhalation injuries are neither tested for cyanide poisoning in a timely manner nor empirically treated with a cyanide antidote. Although studies have shown the safety and efficacy of empiric and immediate administration of hydroxocobalamin, most centers are not willing to do so.

  4. Mass spectrometry based data of the blister fluid proteome of paediatric burn patients

    Directory of Open Access Journals (Sweden)

    Tuo Zang

    2016-09-01

    Full Text Available The data presented here are associated with the article “The blister fluid proteome of paediatric burns” (Zang et al., 2016 [1]. Burn injury is a highly traumatic event for children. The degree of burn severity (superficial-, deep-, or full-thickness injury often dictates the extent of later scar formation which may require long term surgical operation or skin grafting. The data were obtained by fractionating paediatric burn blister fluid samples, which were pooled according to burn depth and then analysed using data dependent acquisition LC–MS/MS. The data includes a table of all proteins identified, in which burn depth category they were found, the percentage sequence coverage for each protein and the number of high confidence peptide identifications for each protein. Further Gene Ontology enrichment analysis shows the significantly over-represented biological processes, molecular functions, and cellular components of the burn blister fluid proteome. In addition, tables include the proteins associated with the biological processes of “wound healing” and “response to stress” as examples of highly relevant processes that occur in burn wounds.

  5. Investigated of ampC in Carbapenem Resistant Gram-Negative Bacteria Isolated from Burned Patients

    Directory of Open Access Journals (Sweden)

    Leila Azimi

    2015-10-01

    Full Text Available Background: Gram-Negative bacteria are the most cause of nosocomial infection especially in burned patients. Carbapenem resistant strains can limit seriously the choice of antibiotic therapy. AmpC can make resistance to carbapenem and detection of that can be useful for identification ofcarbapenem resistant. The aim of this study was identification of ampC in most prevalent cause of nosocomial infection.Methods: boronic acid combined with meropenem in combination disc method was used for phenotypic method and PCR was used for molecular identification of ampC.Results: Fifty one strains showed positive results in phenotypic method but 119 strains were harbored ampC gene. Combination disc method with meropenem and boronic acid showed 34.4% sensitivity and 78.5% specificity according to the results of this study.Conclusions: the results of this study were indicated the more prevalent of ampC in carbapenem resistant Gram-Negative bacteria. On the other hand use of boronic acid combined with meropenem showed low sensitivity for detection of ampC.

  6. Burns Caused by Medical Therapy

    Science.gov (United States)

    2016-06-07

    fear of litigation, patients with such injuries, even if the injuries are minor, arc often referred to a burn center for care. Burn injury...the potential burn hazards found elsewhere in the hospital. Even fewer studies have addressed the burn risks posed by medical therapy administered...35. Mills GH, Ralph S). Bums due to pulse oximetry [ letter ]. Anaesthesia 1992j47:276·7. 36. Shdlock: FG, Kana! E. Burns associated with the use of

  7. [Exercise in haemodyalisis patients: a literature systematic review].

    Science.gov (United States)

    Segura-Ortí, Eva

    2010-01-01

    Exercise as a therapeutic tool used in End-stage renal disease patients (ESRD) in hemodialysis (HD) is not routinately applied, as it occurs with cardiac or respiratory patients. Lack of awareness of research in this field may contribute to the current situation. Thus, the aims of this review are: 1) to systematically review the literature of exercise training on adult HD patients or patients at a pre-HD stage; 2) to show the evidence on the benefits of exercise for counteracting physiological, functional and psychological impairments found even in older ESRD patients; 3) to recommend requirements of future research in order to include exercise prescription in the HD patients treatment. The Data bases reviewed from 2005 to 2009 were: MEDLINE (Ovid), CINAHL (EBSCOHost), SportDicus (EBSCOHost), Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), MedicLatina (EBSCOHost), PEDro y PubMed. Additionally, references from identified articles, several reviews on ESRD and abstracts to Nephrology Congresses were also reviewed. Randomized Controlled Trials on aerobic, strength and combined programs for HD patients were selected. Data from the studies was compiled and Van Tulder criteria were used for methodological quality assessment. Metanalysis included 6 studies on aerobic exercise, 2 on strength exercise and 5 on combined exercise programs. 640 patients were included in 16 included studies. Effects on physical function, health related quality of life and other secondary measurements were summarized by the Standardized Mean Difference (SMD) Moderate evidence exists on positive effects of aerobic training on peak oxygen consumption at the graded exercise test (SMD 6.55; CI 95%: 4.31-8.78). There is high evidence on positive effects of strength training on health related quality of life (SMD 11.03; CI 95%: 5.63-16.43). Finally, moderate evidence exists on positive effects of combined exercise on peak oxygen consumption at the graded exercise test (SMD 5.57; CI

  8. Analysis of 810 elderly burn patients%老年烧伤810例临床分析

    Institute of Scientific and Technical Information of China (English)

    吕涛; 邱啸臣; 李树仁; 王和平; 陈志坚; 娄季鹤

    2012-01-01

    [Objective] To evaluate clinical characters, prevention and treatment for the elderly burn patients. [Methods] A prospective case series observation was performed from January 2002 to December 2010 in 810 elderly burn patients with age over 60 years from the Changhai hospital and the First People's Hospital in Zhengzhou City. The information such as demographics, clinical diagnosis, treatment, causes of injury, mortality rate and causes of death were recorded. [Results] The rate of burn at home was 66. 91%. The average age of onset was 72. 53 in 2002 and increased to 73. 58 in 2010. The clinical cure rate for elderly burn patients was 91.49% and the mortality rate was 8.51%. The leading cause of mortality was organ dysfunction. [ Conclusions] Most of the burns happened at patient home and the age of onset was continually increased in last 10 years. For treatment of elderly burn patients, we should pay great attention to the protection of organ dysfunction and handling of wound.%[目的]探讨60岁以上老年烧伤患者的临床特点及治疗经验.[方法]收集整理了郑州市第一人民医院和上海长海医院2002年1月-2010年12月间810例年龄在60岁以上老年烧伤患者,对病人的年龄,性别,致伤原因,死亡率及死亡原因进行回顾性分析.[结果]在810例老年烧伤患者中,家庭烧伤的比率占66.91%;患者的平均年龄从2002年的72.53岁到2011年的73.58岁.老年烧伤的临床治愈好转率为91.49%,死亡率为8.51%.死亡的主要原因是多脏器功能衰竭.[结论]家庭生活烧伤是老年烧伤的主要因素,老年烧伤患者的患病年龄逐步提高.对于老年烧伤患者的救治,要注重脏器功能的保护和创面的处理.

  9. 重度烧伤22例临床分析%Clinical Analysis of 22 Patients with Severe Burn

    Institute of Scientific and Technical Information of China (English)

    杨宏伟

    2013-01-01

    目的:总结重度烧伤及特重度烧伤的救治经验,寻找存在的问题,为进一步实施救治提供依据.方法:对通辽市科尔沁区第一人民医院自2010年10月-2012年10月收治的22例重度及特重度烧伤患者的临床资料进行回顾性分析.结果:22例中除2例死于多器官衰竭外,其余均治愈,治愈率90.90%.结论:如何减少或避免烧伤早期损害及并发症的防治仍是烧伤救治的关键.%Objective:To provide a basis for clinical treatment through summarizing the experience in treatment of se-vere burn and extraordinarily severe burn patients, finding out the existing problems. Methods: The general clinical data of 22 patients with severe burn and extraordinarily severe burn who were treated in the First People’s Hospital of Korqin District from October 2010 to October 2012 were retrospectively analyzed. Results: In 22 cases, 2 died of multi-organ failure, the others were cured, the cure rate was 90.90%. Conclusion:How to reduce or avoid early dam-age, prevent complications is the key to treat burn.

  10. The early enteral feeding and rehabilitation of severely burned patients%严重烧伤患者的早期肠道营养与康复

    Institute of Scientific and Technical Information of China (English)

    邢德荣

    2002-01-01

    Objective To explore the effect of rehabilitation through analysis the early enteral feeding on the prevention of enteral infection in severely burned patients .Method A total of 22 patients with severe burns were randomly divided into an early enteral feeding group (EF) and a delayed enteral feeding group (DF). The levels of serum endotoxin were detected in the members of both groups in 1, 3, and 5 days .Result The levels of serum endotoxin in severely burned patients were significantly higher than in normal subjects (P< 0.01) . The levels of serum endotoxin in the EF group were significantly lower than in the DF group (P< 0.01). Conclusion Early enteral feeding may decrease enterogenic infection and it helps the nutrition support, improve the patient resistance, facilitate the repair of damaged tissue , so it contributes to the rehabilitation of burned patients.

  11. 浅谈我国儿童烧伤康复%On the rehabilitation of pediatric burn patients in China

    Institute of Scientific and Technical Information of China (English)

    贾赤宇

    2013-01-01

    Rehabilitation medicine is an emerging discipline.At present,there are many problems in rehabilitation of pediatric burn patients in China,including idea lag,weak technical force,lack of standardized technology,disunity in evaluation indexes,etc.The new era of reformation of health system and development and flourish of medical insurance business bring good opportunity for the development of rehabilitation medicine.

  12. Acoustic rhinometry in mouth breathing patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Ana Carolina Cardoso de Melo

    2015-04-01

    Full Text Available INTRODUCTION: When there is a change in the physiological pattern of nasal breathing, mouth breathing may already be present. The diagnosis of mouth breathing is related to nasal patency. One way to access nasal patency is by acoustic rhinometry.OBJECTIVE: To systematically review the effectiveness of acoustic rhinometry for the diagnosis of patients with mouth breathing.METHODS: Electronic databases LILACS, MEDLINE via PubMed and Bireme, SciELO, Web of Science, Scopus, PsycInfo, CINAHL, and Science Direct, from August to December 2013, were consulted. 11,439 articles were found: 30 from LILACS, 54 from MEDLINE via Bireme, 5558 from MEDLINE via PubMed, 11 from SciELO, 2056 from Web of Science, 1734 from Scopus, 13 from PsycInfo, 1108 from CINAHL, and 875 from Science Direct. Of these, two articles were selected.RESULTS: The heterogeneity in the use of equipment and materials for the assessment of respiratory mode in these studies reveals that there is not yet consensus in the assessment and diagnosis of patients with mouth breathing.CONCLUSION: According to the articles, acoustic rhinometry has been used for almost twenty years, but controlled studies attesting to the efficacy of measuring the geometry of nasal cavities for complementary diagnosis of respiratory mode are warranted.

  13. Observation of anesthesia depth in severe burn patients with target controlled infusion of propofol and remifentanil by bispectral index

    Directory of Open Access Journals (Sweden)

    Zheng-gang GUO

    2012-04-01

    Full Text Available Objective To evaluate the feasibility and efficiency of bispectral index (BIS for monitoring the anesthesia depth of severe burn patients with target controlled infusion (TCI of propofol and remifentanil. Methods A total of 80 severe burns patients undergoing eschar excision ( < 1week were randomly divided into BIS group (group A and control group (group B, with 40 cases assigned in each group. These patients were 18 years to 65 years old, ASAⅡ-Ⅲ. Their total burn surface areas (TBSA were from 31% to 50%, or 11% to 20% with three-degree burns. All patients received remifentanil and propofol for TCI intravenous anesthesia. The mean arterial pressure (MAP and heart rate (HR were determined at following time points, namely, entrance to the operation room, loss of consciousness, 2min after intubation, before surgery, 2, 15, and 30min after the start of surgery, end of surgery, eye opening, and period when Aldrete score reaching 9 points, as well as the target concentrations of remifentanil and propofol. The time frames from stoppage of drug infusion to eye opening and the period when Aldrete score reaching 9 points were also recorded. Results Compared with group B, the target concentrations of remifentanil (2.12±0.35ng/ml vs. 2.50±0.21ng/ml and propofol (2.54±0.22μg/ml vs. 2.86±0.31μg/ml were significantly lower in group A during anesthetic maintenance (P < 0.01. The time interval from stoppage of drug infusion to eye opening (7.90±0.58min vs. 8.35±0.66min and period when Aldrete score reaching 9 points (9.15±0.69min vs. 11.13±0.96min were significantly reduced in group A. The MAP of both groups from loss of consciousness at all time points, except 2min after intubation, was significantly lower than the basic values upon entrance into the operation room (P < 0.05. The HR at all time points were significantly lower compared with the basic data (P < 0.05. Conclusion BIS for monitoring the anesthetic depth of severe burns patients

  14. Vitamin B12 status in metformin treated patients: systematic review.

    Directory of Open Access Journals (Sweden)

    Qilin Liu

    Full Text Available OBJECTIVE: Randomized controlled trials and observational studies have yielded inconsistent results on the effects of metformin on vitamin B12 reduction. We therefore performed a systematic review to analyze the effects of metformin on vitamin B12 concentration. METHODS: PubMed, Medline, Embase, and the Cochrane central registry of controlled trials were searched to identify randomized controlled trials and observational studies exploring the association between metformin and vitamin B12 concentration in patients with type 2 diabetes mellitus or polycystic ovary syndrome. The main outcome measure was changes in serum vitamin B12 concentration after 6-208 weeks of treatment with metformin, as compared with placebo or other anti-hyperglycemic therapy. RESULTS: Six randomized controlled trials met the inclusion criteria. Serum vitamin B12 concentrations were significantly lower in patients treated with metformin than in those who received placebo or rosiglitazone (mean difference [MD], -53.93 pmol/L; 95% confidence interval [CI], -81.44 to -26.42 pmol/L, P = 0.0001. Subgroup analysis identified four trials in which patients received a lower dose of metformin (<2000 mg/d and two in which they received a higher dose (≥2000 mg/d, with MDs in vitamin B12 concentration after metformin treatment of -37.99 pmol/L (95% CI, -57.44 to -18.54 pmol/L, P = 0.0001 and -78.62 pmol/L (95% CI, -106.37 to -50.86 pmol/L, P<0.00001, respectively. CONCLUSIONS: The reduction of vitamin B12 may be induced by metformin in a dose dependent manner.

  15. An evaluation of the safety and efficacy of an anti-inflammatory, pulmonary enteral formula in the treatment of pediatric burn patients with respiratory failure.

    Science.gov (United States)

    Mayes, Theresa; Gottschlich, Michele M; Kagan, Richard J

    2008-01-01

    Respiratory failure is associated with a high mortality rate in burned children. Recently, a specialized pulmonary enteral formula (SPEF) was commercially introduced as an adjunct intervention in acute lung injury management. SPEF contains condition-specific nutrients to modulate the inflammatory response. The study examined SPEF impact in critically ill, pediatric burn patients with respiratory failure. Medical records of acute burn patients admitted December 1997 to October 2006 were reviewed for SPEF treatment. Respiratory and renal indices were compared on the first and final days of SPEF use. Nineteen patients with respiratory failure received SPEF for a mean of 10.8 +/- 0.9 days during their acute burn course. Mean age was 5.3 +/- 1.5 years. Mean total body surface area burn was 44.3 +/- 5.4% with 32.5 +/- 6.4% full thickness. Patients were admitted 2.3 +/- 0.9 days postburn. Significant improvements in peak pressure, PEEP, FiO2, P:F ratio, Pco2, Po2, and ETco2 were noted. Seventeen of the 19 patients survived despite the fact that 9 of the 19 patients developed severe barotrauma requiring multiple tube thoracotomies, and all 19 had extremely poor prognoses at SPEF initiation. Adult SPEF formula for critically ill, pediatric burn patients with respiratory failure is safe and well tolerated. SPEF seems to facilitate recovery from acute lung injury as evidenced by improvements in oxygenation and pulmonary compliance.

  16. A systematic review of the physical and chemical characteristics of pollutants from biomass burning and combustion of fossil fuels and health effects in Brazil.

    Science.gov (United States)

    Oliveira, Beatriz Fátima Alves de; Ignotti, Eliane; Hacon, Sandra S

    2011-09-01

    The aim of this study was to carry out a review of scientific literature published in Brazil between 2000 and 2009 on the characteristics of air pollutants from different emission sources, especially particulate matter (PM) and its effects on respiratory health. Using electronic databases, a systematic literature review was performed of all research related to air pollutant emissions. Publications were analyzed to identify the physical and chemical characteristics of pollutants from different emission sources and their related effects on the respiratory system. The PM2.5 is composed predominantly of organic compounds with 20% of inorganic elements. Higher concentrations of metals were detected in metropolitan areas than in biomass burning regions. The relative risk of hospital admissions due to respiratory diseases in children was higher than in the elderly population. The results of studies of health effects of air pollution are specific to the region where the emissions occurred and should not be used to depict the situation in other areas with different emission sources.

  17. A systematic review of the physical and chemical characteristics of pollutants from biomass burning and combustion of fossil fuels and health effects in Brazil

    Directory of Open Access Journals (Sweden)

    Beatriz Fátima Alves de Oliveira

    2011-09-01

    Full Text Available The aim of this study was to carry out a review of scientific literature published in Brazil between 2000 and 2009 on the characteristics of air pollutants from different emission sources, especially particulate matter (PM and its effects on respiratory health. Using electronic databases, a systematic literature review was performed of all research related to air pollutant emissions. Publications were analyzed to identify the physical and chemical characteristics of pollutants from different emission sources and their related effects on the respiratory system. The PM2.5 is composed predominantly of organic compounds with 20% of inorganic elements. Higher concentrations of metals were detected in metropolitan areas than in biomass burning regions. The relative risk of hospital admissions due to respiratory diseases in children was higher than in the elderly population. The results of studies of health effects of air pollution are specific to the region where the emissions occurred and should not be used to depict the situation in other areas with different emission sources.

  18. Increased poly(ADP-ribosyl)ation in skeletal muscle tissue of pediatric patients with severe burn injury: prevention by propranolol treatment.

    Science.gov (United States)

    Oláh, Gábor; Finnerty, Celeste C; Sbrana, Elena; Elijah, Itoro; Gerö, Domokos; Herndon, David N; Szabó, Csaba

    2011-07-01

    Activation of the nuclear enzyme poly(ADP-ribose) polymerase (PARP) has been shown to promote cellular energetic collapse and cellular necrosis in various forms of critical illness. Most of the evidence implicating the PARP pathway in disease processes is derived from preclinical studies. With respect to PARP and burns, studies in rodent and large animal models of burn injury have demonstrated the activation of PARP in various tissues and the beneficial effect of its pharmacological inhibition. The aims of the current study were to measure the activation of PARP in human skeletal muscle biopsies at various stages of severe pediatric burn injury and to identify the cell types where this activation may occur. Another aim of the study was to test the effect of propranolol (an effective treatment of patients with burns) on the activation of PARP in skeletal muscle biopsies. Poly(ADP-ribose) polymerase activation was measured by Western blotting for its product, poly(ADP-ribose) (PAR). The localization of PARP activation was determined by PAR immunohistochemistry. The results showed that PARP becomes activated in the skeletal muscle tissue after burns, with the peak of the activation occurring in the middle stage of the disease (13-18 days after burns). Even at the late stage of the disease (69-369 days after burn), an elevated degree of PARP activation persisted in some of the patients. Immunohistochemical studies localized the staining of PAR primarily to vascular endothelial cells and occasionally to resident mononuclear cells. There was a marked suppression of PARP activation in the skeletal muscle biopsies of patients who received propranolol treatment. We conclude that human burn injury is associated with the activation of PARP. We hypothesize that this response may contribute to the inflammatory responses and cell dysfunction in burns. Some of the clinical benefit of propranolol in burns may be related to its inhibitory effect on PARP activation.

  19. Characterization of Pseudomonas aeruginosa in Burn Patients Using PCR- Restriction Fragment Length Polymorphism and Random Amplified Polymorphic DNA Analysis

    Directory of Open Access Journals (Sweden)

    Abdolaziz Rastegar Lari

    2010-09-01

    Full Text Available One of the major opportunistic pathogens in patients with burninjuries is Pseudomonas aeruginosa, which causes severe infectionsin burned patients. The objective of the study was to examinethe molecular epidemiology of P. aeruginosa colonization inthe burn unit of Shahid Motahari Hospital in Tehran, Iran. Restrictionfragment length polymorphism (RFLP and random amplifiedpolymorphic DNA (RAPD analysis were employed tostudy 127 clinical and two environmental P. aeruginosa isolatescollected from January to June 2008. In RFLP, the PCR productsof 16S rRNA gene were digested with restriction enzyme Alu I,Hae III, and Rsa I, and the fragments generated were analyzed byagarose electrophoresis. Molecular typing by RFLP did show nodiscriminatory power for P. aeruginosa isolates, but RAPD-PCRrevealed eight different genotypes; RAPD1to RAPD8 in clinicaland environmental isolates. RAPD1 was the major genotype inclinical (n=64, 50.4% and environmental isolates (n=1, 50%.The findings suggest that RAPD might have a superior typeabilityand discriminatory power over RFLP to study P. aeruginusa.Moreover, they highlight the need for further attention to the controlof infection sources in Burn Units to prevent the transmissionof the bacterium.

  20. Prestorage leukocyte filtration may reduce leukocyte-derived bioactive substance accumulation in patients operated for burn trauma

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen; Hammer, J H; Krarup, Annabel Lee;

    1999-01-01

    and burn surface area. Histamine, interleukin-6 (IL-6), plasminogen activator inhibitor-1 (PAI-1), eosinophil cationic protein (ECP) and myeloperoxidase (MPO) were analysed in plasma or serum collected from all patients 30 min before skin incision, at skin incision and 5, 10 and 30 min and thereafter every...... 30 min after skin incision until the grafts were secured by wrapping. Samples were also taken 8 h after skin incision and in the morning of postoperative days 1-5. The amount of blood products transfused from admission until day 5 postoperatively was recorded. All patients were followed until...

  1. Cryptococcal meningitis in systemic lupus erythematosus patients : pooled analysis and systematic review

    NARCIS (Netherlands)

    Fang, Wenjie; Chen, Min; Liu, Jia; Hagen, Ferry; Ms, Abdullah; Al-Hatmi, A M S; Zhang, Peilian; Guo, Yun; Boekhout, Teun; Deng, Danqi; Xu, Jianping; Pan, Weihua; Liao, Wanqing

    2016-01-01

    Cryptococcal meningitis is an important fungal infection among systemic lupus erythematosus patients. We conducted a pooled analysis and systematic review to describe the epidemiological and clinical profile of cryptococcal meningitis in systemic lupus erythematosus patients. From two hospitals in C

  2. Patient participation in medication reviews is desirable but not evidence-based: a systematic literature review.

    NARCIS (Netherlands)

    Willeboordse, F.; Hugtenburg, J.G.; Schellevis, F.G.; Elders, P.J.M.

    2014-01-01

    Aim: The aim of this systematic literature review is to investigate which types of patient participation in medication reviews have been practiced and what is known about the effects of patient participation within the medication review process. Methods: A systematic literature review was performed

  3. Emphasize the diagnosis and treatment of infective endocarditis in patients with severe burn%重视严重烧伤患者感染性心内膜炎的诊断和治疗

    Institute of Scientific and Technical Information of China (English)

    郇京宁

    2016-01-01

    The incidence and mortality of infective endocarditis (IE) in patients with severe burn remain high,which are attributed to invasive procedures,bacteremia,and wound infection after burns.Clinical clues for IE in burns are usually masked by burn-related manifestations,so the diagnosis of IE may be delayed or missed.For burned patients with persistent bacteremia of unknown source,especially Staphylococcus aureus -induced bacteremia,the diagnosis of IE should be considered according to the Duke criteria,and early echocardiography performance is particularly important.Antibiotic therapy is the mainstay initial management,and early surgical intervention is strongly recommended once IE is clearly diagnosed in patients with burns.In order to lower the incidence and mortality of IE in burns,it is very important to take prophylactic procedures along with the whole course of burn management.

  4. The epidemiology and characteristics of burn injuries in pediatric patients%小儿烧伤流行病学特点及预防

    Institute of Scientific and Technical Information of China (English)

    邹晓防; 宋卫平; 李斌; 何兰; 蔡景宁; 曹卫红

    2013-01-01

    目的分析小儿烧伤的原因及临床表现,以减少和预防小儿烧伤的发生。方法对空军总医院烧伤整形科自2009年9月~2012年9月收治的432例0~14岁烧伤患儿病例资料,包括发病率、患儿的年龄、性别、致伤原因、季节分布、烧伤程度、发生的地点进行回顾总结及分析。结果小儿烧伤患者占本院同期烧伤患者的60.2%,男性占56.3%,0~3岁小儿发病率最高,为68.9%,致伤原因主要是热液烫伤为81.7%,春季发病率最高为33.3%,烧伤程度以轻、中度为主占,两者合计为74.3%,农村患儿为76.6%。结论小儿烧伤的发生有其特点,应针对小儿烧伤发生特点采取有效的措施,降低小儿烧伤的发生。%Objective To investigate epidemiology and characteristics of burn injuries in pediatric patients, and reduce the incidence of pediatric burn. Method Retrospective statistical description of incidence of burn injuries, sexual ratio, children’s age, cause of burn, seasonal distribution, severity of burn, distribution of season, geographic location for 432 burn case of 0~14 years old in the hospital from Sep. 2009 to 2012 Sep. were performed with. Result Pediatric burn accounted for 60.2% among the patients with burns at the same period in hospital. Incidence rate 0f male children is 56.3%. The highest incidence of burn during 0~3 years children accounted for 68.9%. The incidence rate of burn is 33%in summer. Scald burn were the most frequent form of burn. The burn injuries were mostly minor and moderate. 76.6%of burn in children is occurred in rural area.

  5. Fatty infiltration of the liver in severely burned pediatric patients : Autopsy findings and clinical implications

    NARCIS (Netherlands)

    Barret, JP; Jeschke, MG; Herndon, DN

    2001-01-01

    Background. Trauma induces hypermetabolic responses that are characterized by the mobilization of all available substrates. The marked increase of peripheral lipolysis after a burn can lead to the development of fatty liver, which has been associated with immunodepression and increased mortality. Me

  6. Control of Thermoregulatory Sweating during Exercise in Patients with Severe Burns

    OpenAIRE

    秦, 祐子; 林, 隆宏; 宮本, 隆志; 辛島, 修二; 山口, 昌夫; 花山, 耕三; 永坂, 鉄夫; 桜田, 惣太郎; 田辺, 実

    1995-01-01

    全身の広範囲な皮膚汗腺破壊をともなう重症熱傷患者の, 運動時の発汗能に着目し, 体温調節能力と運動耐久性について検討した。Burn Index 70以上で日常生活動作の自立した2症例を対象に, 自転車エルゴメーターによる運動負荷試験をおこない, 呼気ガス分析・発汗量・深部体温・皮膚温・皮膚血流量・心拍数を経時的に測定した。その結果, 両者とも予想最大酸素摂取量に対する実測の酸素摂取量のピーク値の割合は低く, 運動耐久性は低下していると推察された。一方, III度熱傷値皮部からの発汗は認められなかったが, 運動中の体温の恒常性はかなり保たれたものであった。したがって, 熱傷により広範囲に皮膚汗腺破壊が生じても, 運動中の体温調節能力は比較的維持されると言え, この汗腺破壊が, 運動遂行能力の制限因子となるとは考え難いことが示唆された。 Thermoregulatory capacity and exercise endurance during exercise were studied in patients with impaired sweating capacity ...

  7. Comparison of measures of physiologic stress during treadmill exercise in a patient with 20% lower extremity burn injuries and healthy matched and nonmatched individuals.

    Science.gov (United States)

    Wetzel, J L; Giuffrida, C; Petrazzi, A; Schlanser, J; McDowell-Montini, C; Pietrzyk, C; Landry, V L

    2000-01-01

    Patients with burn injuries are referred for rehabilitation within days after the injuries to encourage early ambulation and functional training. Many of these patients are hypermetabolic at rest. Metabolic demands of activity are added to the already hypermetabolic state and elevate total energy requirements and some physiologic measures. Reports on the physiologic stress imposed by therapeutic activities for patients with burn injuries are limited to low levels of metabolic demand (burn injuries. The purpose of this study was to report the clinical measures of myocardial and physiologic stress in a patient with 20% lower extremity total body surface area burns during an exercise challenge equivalent to stair climbing. Physiologic measures were assessed before and during a treadmill activity (5 METS) for a 40-year-old obese man 3 weeks after he had lower extremity burn injuries. These measures were compared with mean values for 62 healthy counterparts and 6 healthy subjects matched for age, gender, and fitness level. Heart rate, systolic blood pressure, rate pressure product, and the rating of perceived exertion for the patient with burn injuries were higher at baseline and during exercise than the mean values for the 62 healthy individuals and the 6 matched subjects. The steady state exercise values for heart rate, systolic blood pressure, rate pressure product, and rating of perceived exertion at 6 minutes were 189 beats per minute, 190 mm Hg, 3591, and 17, respectively, for the patient with burn injuries and were 111.3 beats per minute, 149 mm Hg, 1680, and 11.7, respectively, for the 6 matched subjects. Ventilation during exercise also increased for the patient with burn injuries more than for the matched subjects (3/4 vs 1/4). Pain experienced by the patient with burn injuries decreased with activity (9.8 vs 7.3 on a 15-cm scale). Treadmill walking produced near maximal responses for most physiologic measures for this patient who was hypermetabolic at rest

  8. Stroke warning campaigns: delivering better patient outcomes? A systematic review

    Directory of Open Access Journals (Sweden)

    Mellon L

    2015-02-01

    Full Text Available Lisa Mellon,1 Frank Doyle,1 Daniela Rohde,1 David Williams,2 Anne Hickey1 1Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland; 2Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland Background: Patient delay in presenting to hospital with stroke symptoms remains one of the major barriers to thrombolysis treatment, leading to its suboptimal use internationally. Educational interventions such as mass media campaigns and community initiatives aim to reduce patient delays by promoting the signs and symptoms of a stroke, but no consistent evidence exists to show that such interventions result in appropriate behavioral responses to stroke symptoms. Methods: A systematic literature search and narrative synthesis were conducted to examine whether public educational interventions were successful in the reduction of patient delay to hospital presentation with stroke symptoms. Three databases, MEDLINE, CINAHL, and PsycINFO, were searched to identify quantitative studies with measurable behavioral end points, including time to hospital presentation, thrombolysis rates, ambulance use, and emergency department (ED presentations with stroke. Results: Fifteen studies met the inclusion criteria: one randomized controlled trial, two time series analyses, three controlled before and after studies, five uncontrolled before and after studies, two retrospective observational studies, and two prospective observational studies. Studies were heterogeneous in quality; thus, meta-analysis was not feasible. Thirteen studies examined prehospital delay, with ten studies reporting a significant reduction in delay times, with a varied magnitude of effect. Eight studies examined thrombolysis rates, with only three studies reporting a statistically significant increase in thrombolysis administration. Five studies examined ambulance usage, and four reported a statistically significant increase in ambulance

  9. Is Real-Time Feedback of Burn-Specific Patient-Reported Outcome Measures in Clinical Settings Practical and Useful? A Pilot Study Implementing the Young Adult Burn Outcome Questionnaire.

    Science.gov (United States)

    Ryan, Colleen M; Lee, Austin F; Kazis, Lewis E; Shapiro, Gabriel D; Schneider, Jeffrey C; Goverman, Jeremy; Fagan, Shawn P; Wang, Chao; Kim, Julia; Sheridan, Robert L; Tompkins, Ronald G

    2016-01-01

    Long-term follow-up care of survivors after burn injuries can potentially be improved by the application of patient-reported outcome measures (PROMs). PROMs can inform clinical decision-making and foster communication between the patient and provider. There are no previous reports using real-time, burn-specific PROMs in clinical practice to track and benchmark burn recovery over time. This study examines the feasibility of a computerized, burn-specific PROM, the Young Adult Burn Outcome Questionnaire (YABOQ), with real-time benchmarking feedback in a burn outpatient practice. The YABOQ was redesigned for formatting and presentation purposes using images and transcribed to a computerized format. The redesigned questionnaire was administered to young adult burn survivors (ages 19-30 years, 1-24 months from injury) via an ipad platform in the office before outpatient visits. A report including recovery curves benchmarked to a nonburned relatively healthy age-matched population and to patients with similar injuries was produced for the domains of physical function and social function limited by appearance. A copy of the domain reports as well as a complete copy of the patient's responses to all domain questions was provided for use during the clinical visit. Patients and clinicians completed satisfaction surveys at the conclusion of the visit. Free-text responses, included in the satisfaction surveys, were treated as qualitative data adding contextual information about the assessment of feasibility. Eleven patients and their providers completed the study for 12 clinical visits. All patients found the ipad survey and report "easy" or "very easy" to use. In nine instances, patients "agreed" or "strongly agreed" that it helped them communicate their situation to their doctor/nurse practitioner. Patients "agreed" or "strongly agreed" that the report helped them understand their course of recovery in 10 visits. In 11 visits, the patients "agreed" or "strongly agreed" that

  10. Comparing ambient, air-convection, and fluid-convection heating techniques in treating hypothermic burn patients, a clinical RCT

    Directory of Open Access Journals (Sweden)

    Sjöberg Folke

    2011-07-01

    Full Text Available Abstract Background Hypothermia in burns is common and increases morbidity and mortality. Several methods are available to reach and maintain normal core body temperature, but have not yet been evaluated in critical care for burned patients. Our unit's ordinary technique for controlling body temperature (Bair Hugger®+ radiator ceiling + bed warmer + Hotline® has many drawbacks e.g.; slow and the working environment is hampered. The aim of this study was to compare our ordinary heating technique with newly-developed methods: the Allon™2001 Thermowrap (a temperature regulating water-mattress, and Warmcloud (a temperature regulating air-mattress. Methods Ten consecutive burned patients (> 20% total burned surface area and a core temperature t-tests were used to assess the significance of differences between the treatments within the patients. ANOVA was used to assess the differences in temperature from the first to the last measurement among all treatments. Three-way ANOVA with the Tukey HSD post hoc test and a repeated measures ANOVA was used in the same manner, but included information about patients and treatment/measuring-cycles to control for potential confounding. Data are presented as mean (SD and (range. Probabilities of less than 0.05 were accepted as significant. Results The mean increase, 1.4 (SD 0.6°C; range 0.6-2.6°C in core temperature/treatment/measuring-cycle highly significantly favoured the Allon™2001 Thermowrap in contrast to the conventional method 0.2 (0.6°C (range -1.2 to 1.5°C and the Warmcloud 0.3 (0.4°C (range -0.4 to 0.9°C. The procedures for using the Allon™2001 Thermowrap were experienced to be more comfortable and straightforward than the conventional method or the Warmcloud. Conclusions The Allon™2001 Thermowrap was more effective than the Warmcloud or the conventional method in controlling patients' temperatures.

  11. Systematic review and assessment of systematic reviews examining the effect of periodontal treatment on glycemic control in patients with diabetes

    Science.gov (United States)

    Iguchi, Shinya; Suzuki, Daigo; Kawano, Eisuke; Sato, Shuichi

    2017-01-01

    Objetives There have been several systematic reviews(SRs) on whether periodontal treatment for an individual with both periodontal disease and diabetes can improve diabetes outcomes. The purpose of this investigation was to conduct a systematic review (SR) of previous meta-analyses, and to assess the methodological quality of the SRs examining the effects of periodontal treatment and diabetes. (PROSPERO Registration # CRD 42015023470). Study Design We searched five electronic databases and identified previous meta-analyses of randomized controlled trials published through July 2015. In cases where the meta-analysis did not meet our criteria, the meta-analyses were recalculated. General characteristics of each included trial were abstracted, analyzed, and compared. The mean difference, 95% confidence intervals (CIs) and the I2 statistic were abstracted or recalculated. The Assessment of Multiple Systematic Reviews Instrument (AMSTAR) was used to assess methodological quality. Results Of the 475 citations screened, nine systematic reviews were included. In total, 13 meta-analyses included in nine SRs were examined. In comparability analyses, meta-analyses in four SRs did not meet our criteria, and were recalcuated. Of these 13 meta-analyses, 10 suggested significant effects of periodontal treatment on HbA1c improvement. Mean differences found in the 13 meta-analyses ranged from -0.93 to 0.13. AMSTAR assessment revealed six SRs with moderate and three with high overall quality. Conclusions We can conclude that there is a significant effect of periodontal treatment on improvement of HbA1c in diabetes patients, although the effect size is extremely small. In addition to the small effect size, not all SRs could be considered of high quality. Key words:Periodontal treatment, diabetes, HbA1c, systematic review, systematic review of systematic reviews, evidence-based medicine, AMSTAR. PMID:28160589

  12. Advances in the technology in modern rehabilitation of patients after burns%现代烧伤康复应用技术进展

    Institute of Scientific and Technical Information of China (English)

    龙艺; 贾赤宇

    2012-01-01

    With the rapid development of modern science and technology,various kinds of new therapy and technology have widely been used in rehabilitation medicine.This review summarizes those new therapies and principles in rehabilitation and their application during treatment of burn injury,in order to provide more ways and methods to imimprove the rehabilitation of mentation,motor function,and the quality of life of burn patients.

  13. Maggot therapy for repairing serious infective wound in a severely burned patient

    Directory of Open Access Journals (Sweden)

    WU Jun-cheng

    2012-04-01

    Full Text Available 【Abstract】The larvae of musca domestica were put in use to discard the dead tissue of a case of severe burn. A total of 50 000 aseptic maggots were put onto the infective wound surface, and aseptic dressings overlaid the surface. Three days later, another 20 000 maggots were put onto the wound for the second therapy. After twice maggot debridement, most necrotic muscle tissues of the wound were cleaned up, and eventually fresh granulation tissue grew and later the wound was covered and healed by 3 times of skin grafting. The result demonstrates that maggot therapy is safe and effective with no adverse complications except pain. Key words: Biological therapy; Wound infection; Burns; Wound healing; Debridement

  14. Scald Burns

    Science.gov (United States)

    Safety Tips & Info Scald Burns Thousands of scald burns occur annually, and ALL are preventable! The two high-risk populations are children under the age ... the single most important factor in preventing scald burns. Increased awareness is the key to scald prevention! ...

  15. Effects of short term aquatic exercise on physical parameters in burn patients

    OpenAIRE

    Anthonissen, Mieke; Van den Kerckhove, Eric; Daly, Daniel

    2011-01-01

    Introduction: The most frequent complications after burn injuries are deconditioning, muscle weakness, contractures, hypertrophic scarring, pain, itching, psychological and social impairments. Exercising is a well-known intervention for these complications and it is evidence-based practice in children. In adults however few RCTs are available. Aquatic exercise provides several therapeutic benefits. Buoyancy and hydrostatic pressure counteract gravity and create an environment with low...

  16. [Treatment of burns in infants].

    Science.gov (United States)

    Foyatier, J L; Latarjet, J; Comparin, J P; Zaragori, M; Robert, A; Braye, F; Weill, E; Masson, C L

    1995-10-01

    Because of the potential severity of their residual deformities, burn injuries in infants justify an early management in specialized centres when they cover more than 5% of body surface and in every case when hands, face, or external genitalia are concerned. Cooling with cold water is the first aid treatment to be performed as early as possible after the injury. The treatment in specialized centres must be both general and surgical. General treatment includes fluid and electrolyte therapy, temperature control, appropriate nutrition and pain suppression. Pain suppression is a major part of the treatment and morphine must be largely used. Surgical treatment starts as soon as the patient arrives in the centre and is eventually performed under general anesthesia: all the burned areas are covered with occlusive dressings. Infections are prevented by systematic cultures and adjusted antibiotic therapy. A vigorous rehabilitation program must be instituted as soon as possible: massages, compressive clothes, splints, physical therapy, plastic surgery. Primary prevention by sustained parental education is important in order to reduce the frequency of burn injuries in infants.

  17. How important is hydrotherapy? Effects of dynamic action of hot spring water as a rehabilitative treatment for burn patients in Switzerland.

    Science.gov (United States)

    Moufarrij, S; Deghayli, L; Raffoul, W; Hirt-Burri, N; Michetti, M; de Buys Roessingh, A; Norberg, M; Applegate, L A

    2014-12-31

    Burn rehabilitation using hydrotherapy can have multiple benefits for the burn patient. The therapy uses specific mineral enriched hot spring water and water jets with varied hydro-pressure to combat hypertrophy, inflammatory reaction signs, abnormal pigmentation, and, more specifically, redness and scarring. Standard operating procedures for burn rehabilitation have been developed and integrated into the Standard of Care at the CHUV hospital using localized hydro-mechanical stimulation of burn sites (20 minutes of alternating anatomical sites) followed by constant pressure large-bore and filiform showers targeting specific scarred areas. These therapeutic regimens are repeated daily for 2 to 3 weeks. Patients showed lasting effects from this regimen (up to 3-6 months), the results becoming permanent with more uniform skin structure, color and visco-elasticity in addition to a decrease in pruritus. The specifications of clinical protocols are described herein along with the virtues of hot spring hydro-pressure therapy for burn rehabilitation. The use of hydrotherapy, which has been a controversial topic among burn units across the world, is also discussed. In North America, hydrotherapy is defined only within the scope of in-patient wound cleansing and is thought to lead to microbial auto-contamination and bacterial resistance. In Switzerland and France the emphasis of hydrotherapy is on rehabilitation after the wound has closed.

  18. Reanimación del paciente quemado Resuscitation of burned patients

    Directory of Open Access Journals (Sweden)

    Marco Antonio Hoyos Franco

    2008-06-01

    -pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;}

    Extensive burns can cause significant morbidity and high mortality, determined by both the injuries themselves and the quality of the initial resuscitation measures applied to the patient. If adequate, such measures can prevent the worsening of the burn and, consequently, they can improve the prognosis for the patient. The objective of this review was to compile information that may help resuscitation teams to improve the care of burned patients, looking for lower mortality and less frequent sequels and complications. The Pubmed database was reviewed searching for studies made on the subject from 2000 to 2007, using the key words “Resuscitation” and “Burn”. Some articles published before 2000 were also included because they were considered relevant for understanding this subject.

  19. Hand chemical burns.

    Science.gov (United States)

    Robinson, Elliot P; Chhabra, A Bobby

    2015-03-01

    There is a vast and ever-expanding variety of potentially harmful chemicals in the military, industrial, and domestic landscape. Chemical burns make up a small proportion of all skin burns, yet they can cause substantial morbidity and mortality. Additionally, the hand and upper extremity are the most frequently involved parts of the body in chemical burns, and therefore these injuries may lead to severe temporary or permanent loss of function. Despite this fact, discussion of the care of these injuries is sparse in the hand surgery literature. Although most chemical burns require only first response and wound care, some require the attention of a specialist for surgical debridement and, occasionally, skin coverage and reconstruction. Exposure to certain chemicals carries the risk of substantial systemic toxicity and even mortality. Understanding the difference between thermal and chemical burns, as well as special considerations for specific compounds, will improve patient treatment outcomes.

  20. [Chickenpox, burns and grafts].

    Science.gov (United States)

    Rojas Zegers, J; Fidel Avendaño, L

    1979-01-01

    An outbreak of chickenpox that occurred at the Burns Repair Surgery Unit, Department of Children's Surgery, Hospital R. del Río, between June and November, 1975, is reported. 27 cases of burned children were studied, including analysis of correlations of the stages and outcome of the disease (varicela), the trauma (burns) and the graft (repair surgery). As a result, the authors emphasize the following findings: 1. Burns and their repair are not aggravating factors for varicella. In a small number of cases the exanthema looked more confluent in the graft surgical areas and in the first degree burns healing spontaneously. 2. Usually there was an uneventful outcome of graft repair surgery on a varicella patient, either during the incubation period, the acme or the convalescence. 3. The fact that the outmost intensity of secondary viremia of varicella occurs before the onset of exanthemia, that is, during the late incubation period, is confirmed.

  1. Effect of a combined continuous and intermittent transcutaneous electrical nerve stimulation on pain perception of burn patients evaluated by visual analog scale: a pilot study

    Science.gov (United States)

    Pérez-Ruvalcaba, Irma; Sánchez-Hernández, Viridiana; Mercado-Sesma, Arieh R

    2015-01-01

    Aim The aim of this study was to assess the effect of continuous and intermittent electrical transcutaneous nerve stimulation on the perception of pain in patients with burns of different types. Materials and methods A pilot study was conducted in 14 patients (age 30.9±7.5 years) with second- and third-degree burns of different types. The burn types included electrical, fire/flame, and chemical. All patients received continuous and intermittent electrical transcutaneous nerve stimulation sessions three times per week for 4 weeks. Each session had a duration of 30 minutes. A pair of electrodes were placed around the burn. The primary efficacy endpoint was the perception of pain assessed by a visual analog scale at baseline and at the 30th day. Results A significant reduction of pain perception was reported (8.0±1.7 vs 1.0±0.5; P=0.027) by all patients after electrical stimulation therapy. There were no reports of adverse events during the intervention period. Conclusion Electrical stimulation could be a potential nonpharmacological therapeutic option for pain management in burn patients. PMID:26719723

  2. S-C复合制剂在临床的应用和研究%Application and Study of the S-C Compound Agent in Burned Patients

    Institute of Scientific and Technical Information of China (English)

    严根荣; 陈国华

    2003-01-01

    173 patients with burn injury were admitted to Shanghai Power Hosptial from 2001 to 2002.These patients include 116 malesand 57 females with a mean age of 33 years. Ther bum injury involved 15% ± 2.3% per cent of TBSA(Total Body Surface Area). With fullthickness burn of 5.5 % ± 1.2% per cent of TBSA.These patients with burn injury were charged medicine by the S. C compound agent,57 casesof burned patients were changed medicine by silver sulfadiazin as a control. S. C compound agent is consisted of cerium nitrate,silver salt andsome additive agent etc. It is possessed of good anti - infection curative effects. Therefore many bacteriums that include Staphylococcus aureus,pseudomonas, aeruginosa, E. coli, E. cloacae, proteus, and some C. albicans etc have been killed by S. C compound agent in vitro, anantimicrobial susceptibility testing in vitro that includes a disk agar diffusion test and a dilution test namely minimal inhibitory concentration, MIChas approved it. Therefore, the wound healing time of partial thickness bum in an experimmt group was significant in statistics ( P < 0.05) ascompared with a control; group. No side - effects, no allergic reactions occurred in all course of applyning S. C compound agent for burned patients.

  3. Effect of a combined continuous and intermittent transcutaneous electrical nerve stimulation on pain perception of burn patients evaluated by visual analog scale: a pilot study

    Directory of Open Access Journals (Sweden)

    Pérez-Ruvalcaba I

    2015-12-01

    Full Text Available Irma Pérez-Ruvalcaba,1 Viridiana Sánchez-Hernández,1 Arieh R Mercado-Sesma2,3 1Burn Unit, Hospital de Especialidades, Centro Médico Nacional de Occidente, Mexican Institute of Social Security, 2Health Sciences Department, Centro Universitario de Tonalá, University of Guadalajara, Guadalajara, Mexico; 3Diabetes sin Complicaciones, Zapopan, Mexico Aim: The aim of this study was to assess the effect of continuous and intermittent electrical transcutaneous nerve stimulation on the perception of pain in patients with burns of different types. Materials and methods: A pilot study was conducted in 14 patients (age 30.9±7.5 years with second- and third-degree burns of different types. The burn types included electrical, fire/flame, and chemical. All patients received continuous and intermittent electrical transcutaneous nerve stimulation sessions three times per week for 4 weeks. Each session had a duration of 30 minutes. A pair of electrodes were placed around the burn. The primary efficacy endpoint was the perception of pain assessed by a visual analog scale at baseline and at the 30th day. Results: A significant reduction of pain perception was reported (8.0±1.7 vs 1.0±0.5; P=0.027 by all patients after electrical stimulation therapy. There were no reports of adverse events during the intervention period. Conclusion: Electrical stimulation could be a potential nonpharmacological therapeutic option for pain management in burn patients. Keywords: TENS, burn pain, pain management, electrotherapy

  4. Epidemiology and virulence of VIM-4 metallo-beta-lactamase-producing Pseudomonas aeruginosa isolated from burn patients in eastern Algeria.

    Science.gov (United States)

    Meradji, Samah; Barguigua, Abouddihaj; Bentakouk, Mohamed Cherif; Nayme, Kaotar; Zerouali, Khalid; Mazouz, Dekhil; Chettibi, Houria; Timinouni, Mohammed

    2016-06-01

    In this study, we investigated the prevalence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in burn patients from eastern Algeria, CRPA virulence factors and the molecular epidemiology of CRPA. The overall prevalence of CRPA was 48.38%. Seven (46.66%) isolates were metallo-β-lactamases (MBL) producers and contained the MBL genes blaVIM-4 (n=6) and blaVIM-2 (n=1). Risk factors for CRPA infection were urinary catheter use and intubation (p=0.008). A high percentage of virulence factors (86.6% of these isolates were able to produce protease; 73.3% of isolates has DNase; and 66.6% were haemolysin positive) was observed in CRPA isolates. Among the seven MBL-producing isolates, four had the same clonal profile. The class 1 integrons, which contained the aadA7 gene cassette, were detected in six isolates. The 16SrRNA methylase gene, rmtB, was detected in one strain. All CRPA isolates were biofilm formers. A study on the kinetics of biofilm production revealed that biofilm production increased when the concentration of imipenem or ciprofloxacin and the incubation time increased. This is the first study to report the presence of VIM-4-producing P. aeruginosa from North Africa and also of the high prevalence of CRPA isolates. Based on our study of burn unit patients, the high percentage of P. aeruginosa with virulence factors and multi-drug resistance is alarming.

  5. Exercise therapy and other types of physical therapy for patients with neuromuscular diseases: a systematic review.

    NARCIS (Netherlands)

    Cup, E.H.C.; Pieterse, A.J.; Broek-Pastoor, J.M. Ten; Munneke, M.; Engelen, B.G.M. van; Hendricks, H.T.; Wilt, G.J. van der; Oostendorp, R.A.B.

    2007-01-01

    OBJECTIVE: To summarize and critically appraise the available evidence on exercise therapy and other types of physical therapies for patients with neuromuscular diseases (NMD). DATA SOURCES: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Medline, CINAHL,

  6. Effectiveness of Sclerotherapy, Surgery, and Laser Therapy in Patients With Venous Malformations: A Systematic Review

    NARCIS (Netherlands)

    Vleuten, C.J.M. van der; Kater, A.; Wijnen, M.H.W.A.; Schultze Kool, L.J.; Rovers, M.M.

    2014-01-01

    Because the best possible treatment for venous malformations is unclear, this study systematically reviews the available literature regarding the effectiveness of different treatment options for the patient group. Venous malformations result from incorrect development of the veins during embryogenes

  7. Systematic care for caregivers of patients with dementia: a multicenter, cluster-randomized, controlled trial

    NARCIS (Netherlands)

    Spijker, A.; Wollersheim, H.C.H.; Teerenstra, S.; Graff, M.J.L.; Adang, E.M.M.; Verhey, F.; Vernooij-Dassen, M.J.F.J.

    2011-01-01

    OBJECTIVE: To evaluate the effectiveness of the Systematic Care Program for Dementia (SCPD) on patient institutionalization and to determine the predictors of institutionalization. DESIGN: Single-blind, multicenter, cluster-randomized, controlled trial. SETTING: Six community mental health services

  8. 烧伤治疗中的肠外营养支持策略%Review and prospect of parenteral nutrition support for burn patients in China

    Institute of Scientific and Technical Information of China (English)

    邓诗琳

    2008-01-01

    Parenteral nutrition support for burn injury in China began to develop in 1970s along with improvement in burn foundational research of burn injury and the marketing of parenteral nutrition solutions manufactured by Chinese amino acids pharmaceutical industry. Up to 1980s many kinds of parenteral nutrition products were used in clinical therapy, and they were proved to be effective and safe. Meanwhile the guide for parenteral nutrition support of China was drafted to ensure standard ized administration. Some problems should be called for attention in present practice of parenteral nutrition support. First, immunonutrients have been proved to possess synergistic effect on parenteral/enteral nutrition support. But for those critical patients in sepsis/MODS period, more attention should be paid to the use of immunonutrients in time of administration and optimal dosage because of the complicate physiopathologic reactions. Secondly,the use of growth hormone has been proved to be effective for promoting healing in patients with burn in many cases. However, the indications of growth hormone should be strictly observed and the regime of a low dose and short course should be adopted 7 days after burn for ensuring safety. Thirdly, we should pay attention to the best path of giving nutrition, whether enteral or parenteral. Parcnteral nutrition support should be adopted for critical burn patients in early period with intestinal dysfunction, and enteral nutrition support should be used when intestinal functions recover partially. For patients with burn hypermetabolism, the application of enteral and parenteral nutrition support is complimentary, and it is aptly called total nutrition.

  9. Comorbidity-polypharmacy score predicts in-hospital complications and the need for discharge to extended care facility in older burn patients.

    Science.gov (United States)

    Justiniano, Carla F; Coffey, Rebecca A; Evans, David C; Jones, Larry M; Jones, Christian D; Bailey, J Kevin; Miller, Sidney F; Stawicki, Stanislaw P

    2015-01-01

    Advancing age is associated with increased mortality despite smaller burn size. Chronic conditions are common in the elderly with resulting polypharmacy. The Comorbidity-Polypharmacy Score (CPS) facilitates quantitative assessment of the severity of comorbid conditions, or physiologic age. Burn injury in older patients is associated with increasing morbidity and mortality and the CPS may be predictive of outcomes such as mortality, ICU and hospital LOS, complications, and final hospital disposition. Our goal was to evaluate the predictive value of CPS for outcomes in the elderly burn population. A retrospective study was undertaken of 920 burn patients with age ≥45 admitted with acute burn injuries (January 1, 2006 to December 31, 2012). CPS was calculated by adding preinjury comorbidities and medications. Subjects were stratified into three groups according to CPS severity. Data collected included demographics, total body surface area burned (TBSA), presence of inhalation injury, ICU/hospital length of stay, complications, discharge disposition, and mortality. Univariate and multivariate analyses were performed. The mean age was 55.7; 72.9% were males; the mean initial TBSA was 6.93%; and mean CPS was 8.01. The risk of in-hospital complications is independently associated with CPS (OR 1.35). CPS (OR 1.81) was an independent predictor of discharge to a facility CPS but not of mortality. While increasing CPS was associated with lower TBSA, mortality remained unchanged. CPS is an independent predictor of in-hospital complications and need for transfer to extended care facilities in older burn patients, which can be determined at the stage of admission to help direct patient management.

  10. A randomized controlled trial to compare the effects of liquid versus powdered recombinant human growth hormone in treating patients with severe burns

    Science.gov (United States)

    CHEN, GUOXIAN; SHAO, HUAWEI; PAN, XUANLIANG

    2016-01-01

    Recombinant human growth hormone (rhGH) promotes protein utilization and synthesis, and is widely used as a therapy to treat severe burns. The present randomized controlled trial evaluated the effects of different forms of rhGH on patients with severe burns. A total of 29 adult severe burns patients were enrolled between February 2009 and November 2011, and randomly assigned to either treatment group (T, liquid rhGH) or control group (C, powder rhGH). From days 5 to 7 following the infliction of burns, both patient groups received rhGH at 0.067 mg/kg/d, once for 10 days. Median serum pre-albumin levels increased in both groups following treatment, the elevation from baseline was significantly higher in the T group on day 10 compared to the C group (88 mg/l vs. 65 mg/l, P=0.046). C-reactive protein, fasting plasma glucose and body weight decreased in both groups. Body weight was significantly lower in the T compared to the C group at baseline, Day 5 and Day 10 (P=0.046, P=0.018 and P=0.006, respectively), however the decrease from baseline levels were not significantly different. Wound healing time was similar between groups (P=0.270). In conclusion the early use of liquid rather than powder rhGH may be more beneficial for treating adult patients with severe burns. PMID:27123246

  11. Effect of oral olive oil on healing of 10-20% total body surface area burn wounds in hospitalized patients.

    Science.gov (United States)

    Najmi, Mahtab; Vahdat Shariatpanahi, Zahra; Tolouei, Mohammad; Amiri, Zohreh

    2015-05-01

    The purpose of this study was to evaluate the effect of consumption of oral olive oil on clinical outcomes and wound healing of thermally injured patients with hospital stays. One hundred patients (mean age; 33.34±7 years) with 10-20% total body surface area, deep second degree and more burn wounds were randomized to receive either oral olive oil or sunflower oil as the oil in their diet. Patients were evaluated daily for occurrence of wound infection, sepsis and healing of the grafted skin. Also the duration of hospitalization and admission to the intensive care unit were compared in two groups. Results showed that there was no significant difference between the olive oil group and the control group in percent of TBSA involvement (14.28±0.53 vs. 13.02±0.48, P=0.7), albumin concentration (3.25±0.5 vs. 3.13±0.5, P=0.5) and mean calorie intake (2034±216.9 kcal vs2118±192.1 kcal, P=0.2). We found a significant difference in the duration of wound healing (7.2±0.5 vs. 8.7±0.5, P=0.04) and duration of hospitalization (7.4±0.5 vs. 8.9±0.4, P=0.05) in the olive oil group versus the control group. We did not find any difference in ICU admission, wound infection and occurrence of sepsis between two groups. This study showed that an oral diet provided with olive oil in patients with burn may accelerate wound healing and decrease the duration of hospitalization.

  12. 康复科病人烧烫伤的因素分析及防范措施%Rehabilitation section burn patients with factor analysis and preventive measures

    Institute of Scientific and Technical Information of China (English)

    吕梅芬; 李菊华; 赵友兰; 李凤花

    2014-01-01

    皮肤是保护人体抵抗外来病原的首道防线,因此维护皮肤完整性是重要的医疗护理目标之一。尽管病人在医疗机构中接受密集的专业治疗护理,不预期的烧烫伤仍有可能发生。烧烫伤可导致病人病程延迟,甚至死亡,增加病人及医疗机构额外的医疗成本,若因为医疗护理过失造成皮肤受损,医院将承担相关责任或面临法律诉讼。预防烧烫伤是医务人员、病人及照顾者共同的责任。因此从制度方面要建立预防烫伤的护理指导标准,执行预防烫伤标准流程及护理指导,给予医务人员、病人及家属预防烧烫伤的观念,强化病人及照顾者认识烧烫伤倾向;及早评估病人发生烧烫伤的原因,制定预防烧烫伤的防范措施,可降低烧烫伤对病人的伤害与合并症。%The skin is the first line of defense to protect the body against foreign pathogens,thus maintain skin integrity is one of the important goal of medical care.AlG though patients in medical institutions receiving intensive professional care,don't expect burns could stil happen.To prevent burns is both the responsibility of the medical staff,patients and caregivers.Therefore from the aspects of system to establish guidelines for nursing to prevent burns,perform to prevent burns standard procedures and nursing instructions,giving medical staff,patients and their families to prevent burns the concept of strengthening patients and caregivers know burn tendency;As soon as possible causes of burn and assessment of the patient,make effective measures to prevent burns,can reduce burn injuries and complications of patients.

  13. Cerebral activation during thermal stimulation of patients who have burning mouth disorder: an fMRI study.

    Science.gov (United States)

    Albuquerque, Romulo J C; de Leeuw, Reny; Carlson, Charles R; Okeson, Jeffrey P; Miller, Craig S; Andersen, Anders H

    2006-06-01

    The pathophysiology of burning mouth disorder (BMD) is not clearly understood, but central neuropathic mechanisms are thought to be involved. The aim of this study was to gain insight into the pathophysiology associated with BMD by using functional magnetic resonance imaging (fMRI). Areas of brain activation following thermal stimulation of the trigeminal nerve of eight female patients with BMD (mean age 49.1+/-10.1) were mapped using fMRI and compared with those of eight matched pain-free volunteers (mean age 50.3+/-12.3). Qualitative and quantitative differences in brain activation patterns between the two study groups were demonstrated. BMD patients displayed greater fractional signal changes in the right anterior cingulate cortex (BA 32/24) and bilateral precuneus than did controls (p<0.005). The control group showed larger fractional signal changes in the bilateral thalamus, right middle frontal gyrus, right pre-central gyrus, left lingual gyrus, and cerebellum than did the BMD patients (p<0.005). In addition, BMD patients had less volumetric activation throughout the entire brain compared to the control group. Overall, BMD patients displayed brain activation patterns similar to those of patients with other neuropathic pain conditions and appear to process thermal painful stimulation to the trigeminal nerve qualitatively and quantitatively different than pain-free individuals. These findings suggest that brain hypoactivity may be an important feature in the pathophysiology of BMD.

  14. Management of burn wounds.

    Science.gov (United States)

    Schiestl, Clemens; Meuli, Martin; Trop, Marija; Neuhaus, Kathrin

    2013-10-01

    Small and moderate scalds in toddlers are still the most frequent thermal injuries the pediatric surgeons have to face today. Over the last years, surgical treatment of these patients has changed in many aspects. Due to new dressing materials and new surgical treatment strategies that are particularly suitable for children, today, far better functional and aesthetic long-term results are possible. While small and moderate thermal injuries can be treated in most European pediatric surgical departments, the severely burned child must be transferred to a specialized, ideally pediatric, burn center, where a well-trained multidisciplinary team under the leadership of a (ideally pediatric) burn surgeon cares for these highly demanding patients. In future, tissue engineered full thickness skin analogues will most likely play an important role, in pediatric burn as well as postburn reconstructive surgery.

  15. Analysis of Epidemiological Status of 1701 Burn Patients%1701例烧伤患者的流行病学现况分析

    Institute of Scientific and Technical Information of China (English)

    岳丽辉; 彭欢; 梁鹏飞

    2012-01-01

    [Objective] To analyze the epidemic characteristics of burn patients so as to provide the scientific evidence for working out the intervention strategy of burns. [Methods]A total of 1701 burn inpatients in the department of burns and reconstructive surgery of Xiangya hospital were collected. The age, sex, geographical distribution, season, burn part, burn area, the seriousness, hospitalized day and the situation of cure were analyzed. [Results] There were 784 pediatric patients(46. 1%), in which the age of 411 infants(52. 4%) was 0 - 3 years old. The age of 688 patients(40. 4%) were 25 - 60 years old. There were 1175 males(69. 1%) and 526 females (30. 9%) , and the ratio of male to female was 2. 23 to 1. The ratio of male to female in pediatric patients was 2. 4 to 1. There were 1444 burns(84. 9%) caused by heat, but there was no obvious difference in constituent ratio between rural and urban area. There was no obvious difference in epidemic seasons, but the prevalence in spring was the highest and that in autumn was the lowest. There were 930 patients(54. 7%) from rural area and 771 patients (45. 3%) from urban area. There were 1010 burns (59. 5%) of many parts of whole body (more than 3 parts), 215 burns(12. 6%) of head, face and neck, 182 burns(10. 7%) of lower limbs and 118 burns(6. 9%) of hands. The area of burn in 448 patients(26. 3%) was more than 30% , and different with various burn reasons. There were 653 patients(38. 4%) with severe burns, in which 395 patients(23. 2%) were major burns. The cure rate was 83%. The hospitalized time of 921 patients(54. 1%) was more than 14 days, and that of 260 patients (15%) was more than a month, and that of 105 patients(6. 2%) was more than 2 months. [Conclusion] The prevalence rate of burns in children is high, and the main cause of burn is heat, and the male patients are obviously more than female patients. Most of burns can be avoided. Three levels of prevention should be strengthened in different seasons and areas

  16. Initial impact of a systematic multidisciplinary approach on the management of patients with gastroenteropancreatic neuroendocrine tumor.

    LENUS (Irish Health Repository)

    Tamagno, Gianluca

    2013-10-01

    According to the international guidelines, a multidisciplinary approach is currently advised for the optimal care of patients with a gastroenteropancreatic neuroendocrine tumor (GEP NET). In our institution (tertiary care center), a systematic multidisciplinary approach was established in May 2007. In this study, we have aimed to assess the initial impact of establishing a systematic multidisciplinary approach to the management of GEP NET patients. We have collected and compared the biochemical, imaging, and pathological data and the therapeutic strategies in GEP NET patients diagnosed, treated, or followed-up from January 1993 to April 2007 versus GEP NET patients attending our institution after the multidisciplinary approach starting, from May 2007 to October 2008. Data of 91 patients before and 42 patients after the establishment of the multidisciplinary approach (total: 133 consecutive GEP NET patients) have been finally collected and analyzed. Before the establishment of the multidisciplinary approach, a lack of consistency in the biochemical, imaging, and pathological findings before treatment initiation as well as during follow-up of GEP NET patients was identified. These inconsistencies have been reduced by the systematic multidisciplinary approach. In addition, the therapeutic management of GEP NET patients has been altered by the multidisciplinary approach and became more consistent with recommended guidelines. We think that a systematic multidisciplinary approach significantly impacts on GEP NET patient care and should be established in all centers dealing with these tumors.

  17. The questions and nursing methods in the nursing of burn patients%烧伤护理中所遇到的问题及护理方法

    Institute of Scientific and Technical Information of China (English)

    王玉梅; 李雪

    2013-01-01

    目的:总结烧伤护理中所遇到的问题及护理方法。方法回顾性分析本院所收治97例各类型烧伤患者的临床资料和护理方法。结果收治的97例烧伤患者经过精心的护理,身体和心理的伤痛的治愈都得到良好的效果,出院后恢复了正常的生活状态。结论良好的护理是烧伤救治过程中的重要环节,也是烧伤救治成功的关键。%Objective To summarize questions and nursing methods in the nursing of burn patients. Methods The clinical data and nursing methods of 97 burn patients in our hospital were analyzed retrospectively. Results The 97 burn patients were nursed carefully. The physical and psychological wounds were heal goodly. The normal activities were resume after discharge. Conlusion Good post-operative care is the important link in the process of burn treatment, and also the key to succed in burn treatment.

  18. Effects of environmental conditions on the morphologic change of Pseudomonas aeruginosa and its association with antibiotic resistance in burn patients

    Directory of Open Access Journals (Sweden)

    Mohsen Moghoofei

    2015-12-01

    Full Text Available Introduction: Pseudomonas aeruginosa is an aerobic gram-negative bacteria, which causes hospital infections. Bacteria under stress, such as lack of food, pH and osmotic pressure change and antibiotic stress transforms its morphology to coccoid form. In the bacill form due to changes in the peptidoglycan cell wall, membrane lipids and decreased metabolic activity, bacteria resistant to antibiotics. Due to an increase in mortality in burn patients and important problem of antibiotic resistance in P.aeruginosa the researcher decided to study the factors affecting on morphologic change to coccoid form. Materials and methods: In this study P.aeruginosa strains obtained from clinical samples of burned patients (8 samples were taken from the wound by Infectious Disease Specialist and standard strain ATCC 27853 were used. Samples were confirmed by biochemical tests and PCR by 16srDNA primer. Then bacteria were put under lack of food and antibiotic stress invitro. After that bacterial morphology was examined on different days by digital DP 72-BX 51 microscope to 60 days. After induction coccoid forms, bacterial viability was confirmed by flow cytometry. Results: Bacteria begin to change morphology from 5 days for antibiotic stress and 10 days for other stress. Changing morphology was initially elongate bacilli, U shape and finally the coccoid form was seen. Discussion and conclusion: Changing morphology of bacilli to coccoid bacteria that are the result of stress on the bacteria which enter the body can lead to bacterial resistance to antibiotics and have grave consequences for the patient.

  19. Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients: An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates.

    Science.gov (United States)

    Friedman, Bruce C; Mian, Mohammad A H; Mullins, Robert F; Hassan, Zaheed; Shaver, Joseph R; Johnston, Krystal K

    2015-01-01

    The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ≤60% (16.2 vs 7.3, P = .01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.

  20. Maggot therapy for repairing serious infective wound in a severely burned patient

    Institute of Scientific and Technical Information of China (English)

    WU Jun-cheng; LU Ren-rong; HUO Ran; FU Hong-bin

    2012-01-01

    The larvae of musca domestica were put in use to discard the dead tissue of a case of severe burn.A total of 50 000 aseptic maggots were put onto the infective wound surface,and aseptic dressings overlaid the surface.Three days later,another 20 000 maggots were put onto the wound for the second therapy.After twice maggot debridement,most necrotic muscle tissues of the wound were cleaned up,and eventually fresh granulation tissue grew and later the wound was covered and healed by 3 times of skin grafting.The result demonstrates that maggot therapy is safe and effective with no adverse complications except pain.

  1. MRI findings of the brain in high-voltage electrical burn patient: case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Cheung Sook; Hong, Sung Hwan; Lee, Myung Joon; Cho, Seong Whi; Lee, Eil Seong; Kang, Ik Won [Hallym University College of Medicine, Seoul (Korea, Republic of)

    2003-05-01

    We report the delayed sequelae arising in a case of electrical injury, reviewing the literature on the subject and focusing on the MRI findings of the brain. A 23-year-old male suffered burns to the left parietal scalp, both feet, and the anterior chest wall. Neurological symptoms and MRI abnormalities appeared 14 days after the insult and continued for about three months. T1-weight MR images demonstrated homogeneous hypointensity, while T2-weighted images depicted hyperintense finger-like projections. Contrast-enhanced T1-weighted images demonstrated strong band-like enhancement, indicating meningeal hyperemia. Follow-up MR imaging showed that the lesion had disappeared, indicating that the cerebral edema and meaningeal hyperemia were reversible.

  2. The search for endocarditis in patients with candidemia: a systematic recommendation for echocardiography? A prospective cohort.

    Science.gov (United States)

    Fernández-Cruz, A; Cruz Menárguez, M; Muñoz, P; Pedromingo, M; Peláez, T; Solís, J; Rodríguez-Créixems, M; Bouza, E

    2015-08-01

    Most current guidelines do not recommend systematic screening with echocardiography in patients with candidemia, as Candida infective endocarditis (CIE) is considered an uncommon disease. During the study period, we recommended echocardiography systematically to all candidemic patients that did not have contraindications and accepted to participate in the study. We intended to assess the incidence of unrecognized CIE in adult patients with candidemia. Our institution is a tertiary teaching hospital in which we follow all patients with candidemia. From January 2007 to October 2012, echocardiography was systematically recommended to suitable candidates. We recorded 263 cases of candidemia in adult patients. Echocardiography was not performed in 76 of these patients for the following reasons: patients had died when blood cultures became positive (17), patients were critically or terminally ill (38), or the patient or physician refused the procedure (21). The remaining 187 patients constitute the basis of this report. CIE was diagnosed in 11 cases (4.2 % of the whole candidemic population and 5.9 % of the population with echocardiographic study). The results of transthoracic echocardiography (TTE) suggested infective endocarditis (IE) in 5/172 patients (2.9 %), and the result of transesophageal echocardiography (TEE) was positive in 10/87 (11.5 %). Among 11 confirmed cases of CIE, the disease was clinically unsuspected in three patients. At least 4.2 % of all candidemic patients have CIE. CIE is frequently clinically unsuspected and echocardiography is required to demonstrate a high proportion of cases.

  3. 烧伤患者真菌感染分析%A clinical study of fungal infection in burn patients

    Institute of Scientific and Technical Information of China (English)

    罗高兴; 吴军; 张家平; 罗奇志; 黄跃生; 彭毅志; 聂志宏; 张晓兵; 庄颖; 袁志强; 张立辉; 周秘; 程文广

    2009-01-01

    Objective To address the features of the fungal infection after burn injury in clinic.Methods Three thousand nine hundred and nine bum patients admitted to our institute from Jan. 2003 to Dec. 2006 were involved in this study. Two thousand two hundred and seventy-one samples were harvested for fungal detection by culture from 467 patients suspected to be infected by fungi based on their clinic mani-festations. The collected samples included wound tissue, blood, urine, stool, sputum, catheters and others.The antibiotic sensitivity of the identified fungi were determined by routine method. When same kind of fun-gus was found from different samples taken from one patient, it was recorded as one positive sample. The samples were ranked in an ascending order as wound secretion, stool, urine, sputum and bronchia alveolar lavage fluid, arteriovenous catheter or urinary catheter, blood. Only the positive sample of the highest rank source was recorded as the positive strain of fungus from this particular patient. Results It was found 61 fungal positive samples from the 2271 samples collected. Out of 467 patients, 38 strains of fungi were detec-ted from 36 bum patients during the investigated period, the incidence was O. 92% (36/3909). The most three commonest types among the identified 38 strains of fungi were Candida tropicalis (42.1%), Candida albicans (31.6%) and Candida famata (T. Famata, 10.5% ). The drug sensitivity tests demonstrated that most of the strains detected in this investigation, with the exception of candida galbrata, were sensitive to most of the routine antimyeotics agents such as Amphotericin B, Fluconazol, and ltraconazole etc. Among the 36 fungus positive patients, in 18 patients the burn area exceeded 80% TBSA, 12 patients with 50%-79% TBSA, 4 patients with 30% -49% TBSA, and in 2 patients the burn area was smaller than 30% TBSA. It was found most of the fungal infections(77.78% ) occurred 2 weeks after burn injury, and 8 of the 36 fun

  4. Patient neglect in healthcare institutions: a systematic review and conceptual model

    OpenAIRE

    Reader, Tom W; Gillespie, Alex

    2013-01-01

    Background\\ud Patient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error.\\ud \\ud Method\\ud The Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion crit...

  5. 浅谈临床防治烧伤感染对策%A brief account of prevention and treatment of infection in burn patients

    Institute of Scientific and Technical Information of China (English)

    柴家科; 盛志勇

    2008-01-01

    Prevention and treatment of infection in burn patients involve a wide range of issues.This present article is to introduce only briefly clinical experience focusing on this problem.Among them,satisfactory timely prevention and treatment of burn shock is imperative because it exerts tremendous impact on homeostasis,including especially deterioration of immune functions.Early gastro-intestinal feeding is known to help restore gastro-intestinal circulation after shock,and it is an important avenue to give important nutritional elements like glutamine.It is also very important to excise devitalized tissue,followed by total coverage of all open wounds as early as possible,so that nidus of infection is removed.Rational ase of antibiotic,immunological modulation and other measured were also important contributory factors in successfully preventing and treating infection in patients with major burns.

  6. Patient-reported outcome measures for asthma : a systematic review

    NARCIS (Netherlands)

    Worth, Allison; Hammersley, Victoria; Knibb, Rebecca; Flokstra-de-Blok, Bertine; DunnGalvin, Audrey; Walker, Samantha; Dubois, Anthony EJ; Sheikh, Aziz

    2014-01-01

    BACKGROUND: Patient-reported outcome measures (PROMs) are measures of the outcome of treatment(s) reported directly by the patient or carer. There is increasing international policy interest in using these to assess the impact of clinical care. AIMS: To identify suitably validated PROMs for asthma a

  7. Improving Patient Safety Culture in Primary Care: A Systematic Review

    NARCIS (Netherlands)

    Verbakel, Natasha J.; Langelaan, Maaike; Verheij, Theo J. M.; Wagner, Cordula; Zwart, Dorien L. M.

    2016-01-01

    Background: Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is believed to be related to the impact of patient safety improvements. However, in primary care, it is yet unknown, which effec

  8. Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery.

    Science.gov (United States)

    Rejeh, Nahid; Heravi-Karimooi, Majideh; Vaismoradi, Mojtaba; Jasper, Melanie

    2013-10-01

    Inadequate pain control in older patients who have undergone abdominal surgery can lead to many complications. This study investigates the effect of systematic relaxation techniques on pain and anxiety in older patients undergoing abdominal surgery. One hundred twenty-four patients were randomly assigned into the experimental and control groups. The systematic relaxation techniques consisted of older patients in the experimental group slowly reading relaxing sentences during recovery in ambulation after the surgery. Patients' satisfaction with pain and anxiety relief was recorded, as was their use of opioid analgesia. Statistically significant differences in pain and anxiety, and in analgesic use, were reported between the patients in experimental and control groups after the intervention. These relaxation techniques can be incorporated into the care plan to reduce pain and anxiety after surgery as well as offering a measure for increasing the patients' independence in pain management control.

  9. Self-efficacy strategies to improve exercise in patients with heart failure: A systematic review

    OpenAIRE

    Rajati, Fatemeh; Sadeghi, Masoumeh; Feizi, Awat; Sharifirad, Gholamreza; Hasandokht, Tolu; Mostafavi, Firoozeh

    2014-01-01

    BACKGROUND Despite exercise is recommended as an adjunct to medication therapy in patients with heart failure (HF), non-adherence to exercise is a major problem. While improving self-efficacy is an effective way to increase physical activity, the evidence concerning the relationship between strategies to enhance self-efficacy and exercise among HF has not been systematically reviewed. The objective of this systematic review is to assess the effect of interventions to change the self-efficacy ...

  10. Dental implant survival rate in well-controlled diabetic patients. A systematic review.

    OpenAIRE

    Heber Arbildo; César Lamas; Dora Camara; Hernán Vásquez

    2015-01-01

    Background: Dental implants have now become one of the most popular options for replacing a missing tooth. On the other hand, diabetes mellitus is a systemic disease that affects a large part of the population and is generally considered an absolute or relative contraindication to implant therapy. Aim: To determine the survival rate of dental implants in controlled diabetic patients through a systematic review. Material and methods: A systematic search in Pubmed, SciELO and RedALyC databases...

  11. 重度烧伤患者烧伤初期内环境改变及输血治疗的探讨%Investigation of internal environment changes and transfusion therapy at early burn stage of severe burn patients

    Institute of Scientific and Technical Information of China (English)

    陈妙婵; 蔡葵

    2015-01-01

    Objective To explore the clinical significance of internal environment changes and transfusion therapy at early burn stage of severe burn patients.Methods From January 2010 to May 2014,forty-three early extensive severe burn patients who hospitalized in Foshan First People's Hospital of Guangdong Province were enrolled into this study,as study group.Detect the internal environment changes at different time during treatment,such as routine blood test,blood coagulation function,blood gas analysis,blood biochemical indicators and so on.Except of conventional burn treatment,appropriate component transfusion therapy was conducted on patients at the same time,according to its burn surface area and burn degree,volume of surgical hemorrhage,blood oozing from the wound surface and the progression of disease.Analyze the blood transfusion and internal environment changes of early severe burn patients.Forty-three cases of healthy who took health examination in the same hospital during the same period were chose as control group.Statistical analysis was performed on two groups of routine blood test,blood coagulation function,arterial blood gas analysis,blood biochemical indicator and so on.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Foshan First People's Hospital of Guangdong Province.Informed consent was obtained from all participants.There were no significant differences about age and gender between two groups (P>0.05).Results ① At the early stage of burn,sever burn patients had different degree of coagulation dysfunction.Within one day after burning,the prothrombin time (PT),international normalized ratio (INR) and activated partial thromboplastin time (APTT) of study group were higher than t.hose of control group,and the differences were statistically significant (P<0.05) ; At the time of admission,thrombin time (TT) of study group was higher than that of control group,and the difference was statistically significant

  12. One-week acid suppression trial in uninvestigated dyspepsia patients with epigastric pain or burning to predict response to 8 weeks' treatment with esomeprazole

    DEFF Research Database (Denmark)

    van Zanten, S V; Flook, N; Talley, N J;

    2007-01-01

    BACKGROUND: While empiric acid-suppressive therapy for uninvestigated dyspepsia patients with symptoms of epigastric pain or burning is standard practice, it is unknown whether an early response to therapy predicts outcome. AIM: To evaluate whether a 1-w acid suppression trial is effective for pr...

  13. A Pilot Review of Gradual Versus Goal Re-initiation of Enteral Nutrition after Burn Surgery in the Hemodynamically Stable Patient

    Science.gov (United States)

    2014-01-01

    slowly initiate and advance EN while monitoring for signs of feeding intolerance such as vomiting, diarrhea, abdominal distension, and gastric residual ...achieved previously), has not been thoroughly studied. Our facility has closely examined caloric deficits and over time has decreased these deficits. One...surgical burn patients on caloric provision, incidence of gastrointestinal (GI) complications, GRVs, and outcomes. We hypothesized that subjects in the

  14. Increased B-type natriuretic peptide and decreased proteinuria might reflect decreased capillary leakage and is associated with a better outcome in patients with severe burns

    NARCIS (Netherlands)

    de Leeuw, Karina; Nieuwenhuis, Marianne K; Niemeijer, Anuschka S; Eshuis, Hans; Beerthuizen, Gerard I J M; Janssen, Wilbert M

    2011-01-01

    INTRODUCTION: It is difficult to adjust fluid balance adequately in patients with severe burns due to various physical changes. B-type natriuretic peptide (BNP) is emerging as a potential marker of hydration state. Proteinuria is used as a predictor of outcome in severe illness and might correlate t

  15. 高效辐射烧伤治疗仪对烧伤患者体温的影响及护理%Effect of efficient radiation burning therapeutic instrument on body temperature of burn patients

    Institute of Scientific and Technical Information of China (English)

    黄丽芝; 杨素敏; 陈凯燕; 杨翠玲

    2012-01-01

    Objective To investigate the effect of efficient radiation burning therapeutic instrument on the body temperature of bum patients. Methods 60 burn patients hospitalized during October 2010 and July 2011 were randomly divided into experiment group (n = 33) and control group (n s 27). The burn wounds of the control group was treated with external application of silver sulfadiazine and dressed after debridement, followed by intravenous transfusion of antibiotics. The wounds in the experimental group received treatment by efficient radiation burning therapeutic instrument for 10 days, 2-4 times/d. The two groups were compared concerning the body temperature. Results 10 days after treatment, the incidence of fever was lower than that of the control group and the fever was less serious and the duration of fever was shorter than that of the control group (P < 0.05 for all). Conclusions The auxiliary therapy byefficient radiation burning therapeutic instrument is effective for the decrease of fever incidence, alleviate fever degree and shorter the fever duration. So it may lower the possibility of infection and promote the recovery of patients.%目的 观察高效辐射烧伤治疗仪对烧伤患者体温的影响及护理要点.方法 选择2010年10月~2011年7月本科室收治的60例烧伤患者,随机分为实验组33例和对照组27例.对照组采用对烧伤创面进行清创,磺胺嘧啶银粉外涂并包扎,常规静脉滴注抗生素消炎治疗,实验组在此基础上加用高效辐射烧伤治疗仪照射烧伤创面,比较两组患者体温变化的差异.结果 实验组患者入院后10 d出现发热的发生率低于对照组,发热程度轻于对照组,发热时间短于对照组(均P<0.05).结论 烧伤患者采用高效辐射烧伤治疗仪进行辅助治疗,能有效降低患者发热的发生率,减轻发热程度,缩短患者的发热持续时间,从而有效控制感染,促进患者早日康复.

  16. 老年烧伤患者流行病学分析及护理%Nursing care and epidemiological analyse of elderly burn patients

    Institute of Scientific and Technical Information of China (English)

    吕月; 凌峭; 廖青玲; 张庆庆

    2012-01-01

    目的 探讨531例老年烧伤患者的流行病学特点并提出防治经验.方法 选取2002-2010年收治于某两家医院烧伤科的531例年龄在60岁以上老年烧伤患者为对象,对其一般资料、致伤原因、占同期入院人数比例和疾病转归等进行回顾性分析,总结流行病学特点并提出防治措施.结果 在531例患者中,患者的平均年龄为72.86岁;家庭烧伤患者占72.50%,意外事故伤占16.70%;老年烧伤的临床治愈率为82.11%,死亡率为2.33%;老年烧伤入院患者占同期总住院人数比例从2002年的5.13%上升至2010年的5.64%;患者的平均年龄从2002年的72.53岁上升到2010年的73.58岁.结论 2002-2010年老年烧伤住院患者人数占同期总住院人数比例和平均住院年龄整体呈上升趋势,家庭生活烧伤是老年患者烧伤的主要原因,需要加强对家庭生活烧伤的预防和宣传教育.%Objective To explore the epidemiological character of elderly burn patients and to provide the experience of prevention and treatment.Methods The retrospective study method was used,and totals of 531 elderly patients with burn from January 2002 to December 2010 in two hospitals were selected.Cases information such as demographics,clinical diagnosis,treatments,causes of injury,mortality rate and causes of death since admission and so on was recorded and analysed,then,the epidemiological character was summarized and the prevention and treatment were proposed.Results Among 531 patients with burn,the average age was 72.86,the rate of burn in home was 72.5% and in accident was 16.70%.The clinical cure rate was 82.11%and the mortality rate was 2.33%.The proportion of the elderly burn patients account for the total admitted patients in the same period was 5.13% in 2002 and 5.64% in 2010,and the average age of elderly burn patients was higher from 72.53 years old in 2002 to 73.58 years old in 2010.Conclusions The proportion of the elderly

  17. [The organization of burn care].

    Science.gov (United States)

    Latarjet, Jacques

    2002-12-15

    In 2002, the organisation of burn care is confronted to a great deficiency in burn epidemiological datas. The main mechanisms of hospitalized burns are somehow wellknown in industrialized countries: about 60% scalds and 30% flame burns; as well as the place of occurrence (60% at home, and 20% at work), and the risk groups (3 times more important for the age group 0-4 years old). The incidence of burns needing medical care (all levels) (250/100,000 inh/yr) or hospitalization (15-20/100,000 inh/yr) is much more uncertain. The statistics of Diagnosis Related Groups (DRG), for hospitalized patients will allow in France very shortly to know more about the most rational ways of dispatching and treating them. They already show that only 30% of hospitalized burned patients are treated in specialized facilities.

  18. Effects of Whole-Body Vibration Therapy in Patients with Fibromyalgia: A Systematic Literature Review

    OpenAIRE

    Daniel Collado-Mateo; Jose C. Adsuar; Olivares, Pedro R.; Borja del Pozo-Cruz; Parraca, Jose A; Jesus del Pozo-Cruz; Narcis Gusi

    2015-01-01

    Objective. To review the literature on the effects of whole-body vibration therapy in patients with fibromyalgia. Design. Systematic literature review. Patients. Patients with fibromyalgia. Methods. An electronic search of the literature in four medical databases was performed to identify studies on whole-body vibration therapy that were published up to the 15th of January 2015. Results. Eight articles satisfied the inclusion and exclusion criteria and were analysed. According to the Dutch CB...

  19. Reality Therapy as an Antidote to Burn-Out.

    Science.gov (United States)

    Wubbolding, Robert E.; Kessler-Bolotin, Else

    1979-01-01

    Counselor burn-out is characterized by feelings of frustration, rigidity, omnipotence, and the like. Reality therapy uses systematic plans to increase love, worth, fun, and self-discipline to deal effectively with burn-out. (Author)

  20. Use of previously burned skin as random cutaneous local flaps in pediatric burn reconstruction

    NARCIS (Netherlands)

    Barret, JP; Herndon, DN; McCauley, RL

    2002-01-01

    Reconstruction after post-burn scarring remains a challenge. It is especially true in the severely burned patient, who normally presents with a paucity of donor sites Healed skin from areas that had been burned and skin from grafted areas (termed as previously burned skin) have been occasionally use

  1. Burn, freeze, or photo-ablate?: comparative symptom profile in Barrett's dysplasia patients undergoing endoscopic ablation

    Science.gov (United States)

    Gill, Kanwar Rupinder S.; Gross, Seth A.; Greenwald, Bruce D.; Hemminger, Lois L.; Wolfsen, Herbert C.

    2009-06-01

    Background: There are few data available comparing endoscopic ablation methods for Barrett's esophagus with high-grade dysplasia (BE-HGD). Objective: To determine differences in symptoms and complications associated with endoscopic ablation. Design: Prospective observational study. Setting: Two tertiary care centers in USA. Patients: Consecutive patients with BE-HGD Interventions: In this pilot study, symptoms profile data were collected for BE-HGD patients among 3 endoscopic ablation methods: porfimer sodium photodynamic therapy, radiofrequency ablation and low-pressure liquid nitrogen spray cryotherapy. Main Outcome Measurements: Symptom profiles and complications from the procedures were assessed 1-8 weeks after treatment. Results: Ten BE-HGD patients were treated with each ablation modality (30 patients total; 25 men, median age: 69 years (range 53-81). All procedures were performed in the clinic setting and none required subsequent hospitalization. The most common symptoms among all therapies were chest pain, dysphagia and odynophagia. More patients (n=8) in the porfimer sodium photodynamic therapy group reported weight loss compared to radio-frequency ablactation (n=2) and cryotherapy (n=0). Four patients in the porfimer sodium photodynamic therapy group developed phototoxicity requiring medical treatment. Strictures, each requiring a single dilation, were found in radiofrequency ablactation (n=1) and porfimer sodium photodynamic therapy (n=2) patients. Limitations: Small sample size, non-randomized study. Conclusions: These three endoscopic therapies are associated with different types and severity of post-ablation symptoms and complications.

  2. [Epidemiology of burns in France].

    Science.gov (United States)

    Latarjet, Jacques; Ravat, François

    2012-01-01

    As with most traumas, the epidemiology of the "burn" health-event has long been neglected by public health doctors and rarely considered by burns specialists. There were therefore few verified data and many approximations and preconceived ideas. The gathering of information recently undertaken in France enables the reliability of the data to be improved and the diagnostic and demographic elements relating to hospitalised patients with burns to be established.

  3. Increasing the utility of the Functional Assessment for Burns Score: Not just for major burns.

    Science.gov (United States)

    Smailes, Sarah T; Engelsman, Kayleen; Rodgers, Louise; Upson, Clara

    2016-02-01

    The Functional Assessment for Burns (FAB) score is established as an objective measure of physical function that predicts discharge outcome in adult patients with major burn. However, its validity in patients with minor and moderate burn is unknown. This is a multi-centre evaluation of the predictive validity of the FAB score for discharge outcome in adult inpatients with minor and moderate burns. FAB assessments were undertaken within 48 h of admission to (FAB 1), and within 48 h of discharge (FAB 2) from burn wards in 115 patients. Median age was 45 years and median burn size 4%. There were significant improvements in the patients' FAB scores (pburns.

  4. [Nursing care systematization for outpatient treatment care of patients with multiple sclerosis].

    Science.gov (United States)

    Corso, Nair Assunta Antônia; Gondim, Ana Paula Soares; Dalmeida, Patrícia Chagas Rocha; Albuquerque, Maria Girlene de Freitas

    2013-06-01

    An experience report of nurses in the implementation of care systematization in ambulatory care in an interdisciplinary care center for patients with multiple sclerosis of a public hospital in Fortaleza, Ceará, Brazil. This implementation is based on the NANDA International, Inc., Nursing Interventions Classification, and Nursing Outcomes Classifications. One of the results concerns systemized nursing care, which has enabled the identification and understanding of the responses of MS patients to potential and current health problems. Systematization entails expanding knowledge through a practice based on approach and encourage further research scientific evidence, in addition to promoting the role of the nurse in acomprehensive approachand encourage further research.

  5. Analysis of predictor factors of limb amputation in patients with high-voltage electrical burns

    OpenAIRE

    2015-01-01

    Background: Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients. Methods: Eighty-two high-voltage electrically injured patients were admitted to the Department of Plastic and Reconstructive Surg...

  6. Effect of enteral feeding ELENTAL on nutritional status of burned patients%要素营养制剂ELENTAL对烧伤患者营养状况的维护效应

    Institute of Scientific and Technical Information of China (English)

    颜洪; 汪仕良; 彭朝阳; 李江

    2003-01-01

    AIM:To investigate the maitainance effect of enteral feeding ELENTAL on intestine,liver and nutritional status of burned patients.METHODS:30 cases of burned patients were randomly devided into ELENTAL feeding group(E group) and intravenous nutrition group(control, D).The whole calorie in group E were supplied by feeding elemental diet ELENTAL and those in group D were supplied by intravenous nutrition from the third day after burning.the supplemented calorie and nitrogen were equal in two groups. Before the experiment and on the 5th day and 10th day,blood were drawn to examine the levels of and serum transferring.RESULTS:There were no significant difference of serum lipid and serum transferring levels on the 7th day and 10th day in burned patients.CONCLUSION:ELENTAL diet can protect intestine effectively and improve nutritious status of the burned patients.

  7. Familiar question and related nursing cares for patients with accident burning%意外烧伤患者的常见问题及护理

    Institute of Scientific and Technical Information of China (English)

    胡素勤

    2009-01-01

    Objective To analyze the familiar question during nursing for patients with accident burning. Methods Retrospective analyzed the clinical data of 668 patients with accident burning. Nursing cares inclued injury processing, restiratory tract nursing, prevention shock and certain key spot nursing. Re-sults All the patients with accident burning had recovered with 7~62 days. Conclusions Nursing for pa-tients with accident burning should combined burning reasons, concreted nursing cares include preveting shock, infection and psychological nursing, nutrition nursing.%目的 分析意外烧伤的护理过程中的问题.方法 回顾性分析668例意外烧伤患者的临床护理资料.对668例患者实施创面的处理、呼吸道的护理、防治休克、重要部位(面部、口鼻、眼睛、四肢、会阴)护理、心理护理等方面综合护理.结果 668例患者创面全部愈合,创面愈合时间7~62d,平均20 d,均达到生理性愈合. 结论护理意外烧伤时应实施结合烧伤原因的抗休克、抗感染、心理和营养支持全方位的综合护理.

  8. Use of information sources by cancer patients: results of a systematic review of the research literature

    Directory of Open Access Journals (Sweden)

    Kalyani Ankem

    2006-01-01

    Full Text Available Objectives. Existing findings on cancer patients' use of information sources were synthesized to 1 rank the most and least used information sources and the most helpful information sources and to 2 find the impact of patient demographics and situations on use of information sources. Method. . To synthesize results found across studies, a systematic review was conducted. Medline and CINAHL were searched to retrieve literature on cancer patients' information source use. The retrieved articles were carefully selected according to predetermined criteria, and several articles were eliminated in a systematic approach. Analysis. The twelve articles that met the criteria were systematically analysed by extracting data from articles and summarizing data for the purpose of synthesis to determine the meaning of findings on most used information sources, least used information sources, most helpful information sources, effect of patient characteristics on preference for an information source, and effect of patient situations on preference for an information source. Results. In descending order of use, health care professionals, medical pamphlets, and family and friends were most used information sources. Internet and support groups were least used. In descending order of helpfulness, books, health care professionals and medical pamphlets were found to be most helpful information sources. Younger patients used health care professionals and certain forms of written information sources more than older patients. Conclusion. . The systematic review shows that many areas of cancer patients' information source use have been either neglected or barely analysed. An in-depth understanding of cancer patients' use of information sources and the characteristics in information sources they consider to be helpful is important for developing successful interventions to better inform patients.

  9. Development and Validation of the Satisfaction with Appearance Scale: Assessing Body Image among Burn-Injured Patients.

    Science.gov (United States)

    Lawrence, John W.; Heinberg, Leslie J.; Roca, Robert; Munster, Andrew; Spence, Robert; Fauerbach, James A.

    1998-01-01

    The Satisfaction with Appearance Scale (SWAP) was administered to 165 burn victims. SWAP showed a high level of internal consistency (Cronbach's alpha, r(a)=0.87); an 84-subject retest measured reliability (r(tt)=0.59). SWAP is both a reliable and valid measure of body image for a burn-injured population. (Author/MAK)

  10. American Burn Association consensus conference to define sepsis and infection in burns.

    Science.gov (United States)

    Greenhalgh, David G; Saffle, Jeffrey R; Holmes, James H; Gamelli, Richard L; Palmieri, Tina L; Horton, Jureta W; Tompkins, Ronald G; Traber, Daniel L; Mozingo, David W; Deitch, Edwin A; Goodwin, Cleon W; Herndon, David N; Gallagher, James J; Sanford, Art P; Jeng, James C; Ahrenholz, David H; Neely, Alice N; O'Mara, Michael S; Wolf, Steven E; Purdue, Gary F; Garner, Warren L; Yowler, Charles J; Latenser, Barbara A

    2007-01-01

    Because of their extensive wounds, burn patients are chronically exposed to inflammatory mediators. Thus, burn patients, by definition, already have "systemic inflammatory response syndrome." Current definitions for sepsis and infection have many criteria (fever, tachycardia, tachypnea, leukocytosis) that are routinely found in patients with extensive burns, making these current definitions less applicable to the burn population. Experts in burn care and research, all members of the American Burn Association, were asked to review the literature and prepare a potential definition on one topic related to sepsis or infection in burn patients. On January 20, 2007, the participants met in Tucson, Arizona to develop consensus for these definitions. After review of the definitions, a summary of the proceedings was prepared. The goal of the consensus conference was to develop and publish standardized definitions for sepsis and infection-related diagnoses in the burn population. Standardized definitions will improve the capability of performing more meaningful multicenter trials among burn centers.

  11. 音乐治疗对烧伤患者疼痛和焦虑干预的研究进展%Advances in the research of effects of music therapy on pain and anxiety in burn patients

    Institute of Scientific and Technical Information of China (English)

    李瑾怡; 王云贵

    2015-01-01

    Pain and anxiety engender major psychic problems during all phases of treatment for burn patients.Analgesic alone does not allay these problems satisfactorily in these patients.Music therapy,as an important complementary and alternative therapy,has been widely used in multiple medical fields.However,its positive effect on alleviation of pain and anxiety in burn patients is undefined.The objective of this review is to summarize the feasibility,application fields,methods,and the effectiveness of music therapy in allaying pain and anxiety of burn patients during the whole course of treatment.

  12. 1082: Prevalence of Kidney Injury in Burn Patients Requiring Fluid Resuscitation

    Science.gov (United States)

    2014-12-01

    to kind of acidosis in the immediately postoperative period. The clas- sification evaluated metabolic acidosis by base excess <-4 mmol/L and albumin ...high and normal albumin -corrected anion gap) and to the non-acidosis. Results:The study involved 618 patients. Overall, the acidosis incidence was

  13. Dissociation of Blood Volume and Flow in Regulation of Salt and Water Balance in Burn Patients,

    Science.gov (United States)

    1991-09-01

    arterial capacity, which is underfilled at sites of lower than in the patients in the present study (276 versus hormone control. 286 mosm/kg). The serum...well as looking at given ability to concentrate their urine and lower their voiding volume 02 consumption measured by indirect calorimetry. at night, I

  14. Bioactive substance accumulation and septic complications in a burn trauma patient: effect of perioperative blood transfusion?

    DEFF Research Database (Denmark)

    Nielsen, H J; Reimert, C M; Dybkjaer, E;

    1997-01-01

    cationic protein (ECP), eosinophil protein X (EPX), neutrophil myeloperoxidase (MPO) and interleukin 6 (IL-6) were drawn frequently from the patient before, during and after the operations, and from all transfused red cell, platelet and fresh frozen plasma units. Urine was sampled every hour during...

  15. Early ICU Standardized Rehabilitation Therapy for the Critically Injured Burn Patient

    Science.gov (United States)

    2014-10-01

    Objective: ultrasound to evaluate skeletal muscles in patients with There is currently 25 considerable methodological variability in the...Denehy L The Role Of Neuromuscular Ultrasound Imaging And Relationship To Muscle Strength And Physical Function In The Critically Ill Population...Nothing to Appendices: 7 MUSCLE ULTRASOUND & SHORT PHYSICAL PERFORMANCE BATTERY (SPPB) TO PREDICT ICU FUNCTIONAL OUTCOMES Sanjay Dhar, Aarti

  16. Early Rehabilitation Nursing Care of Patients with Hand Burns%手烧伤患者的早期康复护理

    Institute of Scientific and Technical Information of China (English)

    丁庆华; 马秀峰

    2012-01-01

    Objective In order to explore the nursing of early rehabilitation after hand burns method and clinical effect. Methods The paper used a retrospective analysis of 2010 January to 2011 December,56 cases of hand deep burn patients with early rehabilitation nursing methods and clinical effect was summarized. Results 56 cases of hand burn patients after treatment and early rehabilitation nursing, arm telescopic function recovered completely in 48 cases,5 cases recovered, 3 cases of hand burn scar contracture.the cure rate is 85.71%,the effective rate was 94.64%. Conlcusion Practice has proved that early rehabilitation nursing care of patients with hand burns, can effectively prevent hand scar formation, promote the recovery of hand function.%目的:探讨手部烧伤后早期康复护理的方法及临床效果.方法:回顾性分析2010年1月~ 2011年12月56例手部深度烧伤患者的早期康复护理方法和临床效果进行总结.结果:本组56例手烧伤患者经治疗和早期康复护理,手伸缩功能完全恢复48例,基本恢复5例,3例手部瘢痕挛缩,治愈率为85.71%,有效率为94.64%.结论:手烧伤患者的早期康复护理,可有效预防手部瘢痕形成,促进手功能恢复.

  17. Trigeminal neuralgia--a prospective systematic study of clinical characteristics in 158 patients

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Gozalov, Aydin; Olesen, Jes

    2014-01-01

    OBJECTIVE: To prospectively describe the clinical characteristics of classical trigeminal neuralgia (TN) in a standardized manner. BACKGROUND: TN is a rare disease and most clinicians only see a few patients. There is a lack of prospective systematic studies of the clinical characteristics of TN...

  18. A systematic review of oral fungal infections in patients receiving cancer therapy

    NARCIS (Netherlands)

    Lalla, Rajesh V.; Latortue, Marie C.; Hong, Catherine H.; Ariyawardana, Anura; D'Amato-Palumbo, Sandra; Fischer, Dena J.; Martof, Andrew; Nicolatou-Galitis, Ourania; Patton, Lauren L.; Elting, Linda S.; Spijkervet, Fred K. L.; Brennan, Michael T.

    2010-01-01

    The aims of this systematic review were to determine, in patients receiving cancer therapy, the prevalence of clinical oral fungal infection and fungal colonization, to determine the impact on quality of life and cost of care, and to review current management strategies for oral fungal infections. T

  19. Voice-Related Patient-Reported Outcome Measures: A Systematic Review of Instrument Development and Validation

    Science.gov (United States)

    Francis, David O.; Daniero, James J.; Hovis, Kristen L.; Sathe, Nila; Jacobson, Barbara; Penson, David F.; Feurer, Irene D.; McPheeters, Melissa L.

    2017-01-01

    Purpose: The purpose of this study was to perform a comprehensive systematic review of the literature on voice-related patient-reported outcome (PRO) measures in adults and to evaluate each instrument for the presence of important measurement properties. Method: MEDLINE, the Cumulative Index of Nursing and Allied Health Literature, and the Health…

  20. A systematic review of the effects of bronchodilators on exercise capacity in patients with COPD

    NARCIS (Netherlands)

    Liesker, JJW; Wijkstra, PJ; Ten Hacken, NHT; Koeter, GH; Postma, DS; Kerstjens, HAM

    2002-01-01

    One of the major goals of bronchodilator therapy in patients with COPD is to decrease airflow limitation in the airways and, as a consequence, improve dyspnea and exercise tolerance. The focus of this systematic review is to assess the effects of treatment with beta-agonists, anticholinergics, and t

  1. Improving patient handovers from hospital to primary care: a systematic review

    NARCIS (Netherlands)

    Hesselink, G.; Schoonhoven, L.; Barach, P.; Spijker, A.; Gademan, P.; Kalkman, C.; Liefers, J.; Vernooij-Dassen, M.J.F.J.; Wollersheim, H.

    2012-01-01

    BACKGROUND: Evidence shows that suboptimum handovers at hospital discharge lead to increased rehospitalizations and decreased quality of health care. PURPOSE: To systematically review interventions that aim to improve patient discharge from hospital to primary care. DATA SOURCES: PubMed, CINAHL, Psy

  2. Eccentric overload training in patients with a chronic Achilles tendinopathy: a systematic review.

    NARCIS (Netherlands)

    Kingma, J.J.; Knikker, R. de; Wittink, H.M.; Takken, T.

    2007-01-01

    Background: Eccentric overload training seems to be a promising conservative intervention in patients with chronic Achilles tendinopathy. The efficacy of eccentric overload training on the outcome measures of pain and physical functioning are not exactly clear. Study design: Systematic review of the

  3. Online health information tool effectiveness for older patients: A systematic review of the literature

    NARCIS (Netherlands)

    Bolle, S.; van Weert, J.C.M.; Daams, J.G.; Loos, E.F.; de Haes, J.C.J.M.; Smets, E.M.A.

    2015-01-01

    Online health information tools (OHITs) have been found to be effective in improving health outcomes. However, the effectiveness of these tools for older patients has been far from clear. This systematic literature review therefore provides an overview of online health information tool effectiveness

  4. Online Health Information Tool Effectiveness for Older Patients : A Systematic Review of the Literature

    NARCIS (Netherlands)

    Bolle, Sifra; Van Weert, Julia C M; Daams, Joost G.; Loos, Eugène F.; De Haes, Hanneke C J M; Smets, Ellen M A

    2015-01-01

    Online health information tools (OHITs) have been found to be effective in improving health outcomes. However, the effectiveness of these tools for older patients has been far from clear. This systematic literature review therefore provides an overview of online health information tool effectiveness

  5. Educational needs of patients with a stroke and their caregivers : A systematic review of the literature

    NARCIS (Netherlands)

    Hafsteinsdottir, Thora B.; Vergunst, Martine; Lindeman, Eline; Schuurmans, Marieke

    2011-01-01

    Objective: To systematically review the research on stroke patients' and caregivers' educational needs. Methods: A search of the literature prior to and including the year January 2009 was conducted using Medline, CINAHL, EMBASE, PsychINFO and the Cochrane Library, yielding 959 articles. Of these, 2

  6. Daily physical activities of patients with chronic pain or fatigue versus asymptomatic controls : a systematic review

    NARCIS (Netherlands)

    Weering, van Marit; Vollenbroek-Hutten, M.M.R.; Kotte, E.M.; Hermens, H.J.

    2007-01-01

    Objective: To gain an insight into the daily physical activity levels of patients with chronic pain or fatigue compared with asymptomatic controls. Data sources: MEDLINE, EMBASE, PsycINFO, Picarta, Cochrane Database of Systematic Reviews, reference tracking and a manual search of relevant journals.

  7. Anemia and mortality in heart failure patients - A systematic review and meta-analysis

    NARCIS (Netherlands)

    Groenveld, Hessel F.; Januzzi, James L.; Damman, Kevin; van Wijngaarden, Jan; Hillege, Hans L.; van Veldhuisen, Dirk J.; van der Meer, Peter

    2008-01-01

    Objectives The aim of this study was to assess the effect of anemia on mortality in chronic heart failure (CHF). Background Anemia is frequently observed in patients with CHF, and evidence suggests that anemia might be associated with an increased mortality. Methods A systematic literature search in

  8. Patient autonomy problems in palliative care: systematic development and evaluation of a questionnaire.

    NARCIS (Netherlands)

    Vernooy-Dassen, M.J.F.J.; Osse, B.H.P.; Schade, E.; Grol, R.P.T.M.

    2005-01-01

    No instrument to assess autonomy problems in palliative care is currently available. The purpose of this study was to develop a comprehensive and concise questionnaire to measure autonomy problems in palliative cancer patients and to study its validity and reliability. We systematically developed a

  9. Evaluating the psychological effects of genetic testing in symptomatic patients: a systematic review.

    Science.gov (United States)

    Vansenne, Fleur; Bossuyt, Patrick M M; de Borgie, Corianne A J M

    2009-10-01

    Most research on the effects of genetic testing is performed in individuals at increased risk for a specific disease (presymptomatic subjects) but not in patients already affected by disease. If results of these studies in presymptomatic subjects can be applied to patients is unclear. We performed a systematic review to evaluate the effects of genetic testing in patients and describe the methodological instruments used. About 2611 articles were retrieved and 16 studies included. Studies reported great variety in designs, methods, and patient outcomes. In total, 2868 participants enrolled of which 62% were patients. Patients appeared to have a lower perceived general health and higher levels of anxiety and depression than presymptomatic subjects before genetic testing. In the long term no psychological impairment was shown. We conclude that patients differ from presymptomatic subjects and may be more vulnerable to negative effects of genetic testing. Conclusions from earlier research on presymptomatic genetic testing cannot be generalized to patients, and more standardized research is needed.

  10. 76例头面部烧伤的护理体会%Nursing Experience of 76 Cases of Patients with Facial Burns

    Institute of Scientific and Technical Information of China (English)

    易蔓

    2015-01-01

    Objective To study the rehabilitation nursing plan to stimulate the head facial burn patients as soon as possible. Methods From May 2013 to May 2014, treated 76 cases of facial burn patients head to give cor esponding nursing plan according to the dif erent period and giving psychological nursing and rehabilitation nursing. Results In 76 cases of facial burn patients, 71 cases of patients with primary healing, the second phase of healing after skin graft, 5 patients without complications, patients with rehabilitation hospital discharge. Conclusion The cor ect nursing plan, can promote the healing of head facial burns, and reduce the occur ence of sequelae.%目的:探讨促进头面部烧伤患者尽快康复的护理方案。方法对我院2013年5月~2014年5月收治的76例头面部烧伤患者根据不同的时期给予针对性的护理方案并给予心理护理与康复护理。结果在76例头面部烧伤的患者中,有71例患者一期愈合,5例患者植皮后二期愈合,无患者出现并发症,均康复出院。结论正确的护理方案,能够促进头面部烧伤的愈合,并减少后遗症的发生。

  11. Epidemiology and resistance features of Acinetobacter baumannii isolates from the ward environment and patients in the burn ICU of a Chinese hospital.

    Science.gov (United States)

    Gong, Yali; Shen, Xiaodong; Huang, Guangtao; Zhang, Cheng; Luo, Xiaoqiang; Yin, Supeng; Wang, Jing; Hu, Fuquan; Peng, Yizhi; Li, Ming

    2016-08-01

    Acinetobacter baumannii is an important opportunistic pathogen that causes severe nosocomial infections, especially in intensive care units (ICUs). Over the past decades, an everincreasing number of hospital outbreaks caused by A. baumannii have been reported worldwide. However, little attention has been directed toward the relationship between A. baumannii isolates from the ward environment and patients in the burn ICU. In this study, 88 A. baumannii isolates (26 from the ward environment and 62 from patients) were collected from the burn ICU of the Southwest Hospital in Chongqing, China, from July through December 2013. Antimicrobial susceptibility testing results showed that drug resistance was more severe in isolates from patients than from the ward environment, with all of the patient isolates being fully resistant to 10 out of 19 antimicrobials tested. Isolations from both the ward environment and patients possessed the β-lactamase genes bla OXA-51, bla OXA-23, bla AmpC, bla VIM, and bla PER. Using pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST), these isolates could be clustered into 4 major PFGE types and 4 main sequence types (ST368, ST369, ST195, and ST191) among which, ST368 was the dominant genotype. Epidemiologic and molecular typing data also revealed that a small-scale outbreak of A. baumannii infection was underway in the burn ICU of our hospital during the sampling period. These results suggest that dissemination of β-lactamase genes in the burn ICU might be closely associated with the high-level resistance of A. baumannii, and the ICU environment places these patients at a high risk for nosocomial infection. Cross-contamination should be an important concern in clinical activities to reduce hospitalacquired infections caused by A. baumannii.

  12. A systematic review on pharmacokinetic changes in critically ill patients: role of extracorporeal membrane oxygenation

    OpenAIRE

    Mousavi, S.; Levcovich, B; M Mojtahedzadeh

    2011-01-01

    Objective Several factors including disease condition and different procedures could alter pharmacokinetic profile of drugs in critically ill patients. For optimizing patient's outcome, changing in dosing regimen is necessary. Extracorporeal Membrane Oxygenation (ECMO) is one of the procedures which could change pharmacokinetic parameters.The aim of this review was to evaluate the effect of ECMO support on pharmacokinetic parameters and subsequently pharmacotherapy. Method A systematic review...

  13. Factors Influencing Cognitive Functioning Following Mild Traumatic Brain Injury in OIF/OEF Burn Patients

    Science.gov (United States)

    2010-01-01

    Archives of Clinical Neuropsychology 19 (2004), 825–834. [5] H.G. Belanger, T. Kretzmer, R. Yoash-Gantz, T. Pickett and L.A. Tupler...Poppe, N. Davis, B. Schmaus and S.E. Hobbs, Cognitive functioning and postconcussive symptoms in trau- ma patients with and without mild TBI, Archives of Clinical Neuropsychology 21...Koffler, C.R. Reynolds and C.H. Silver, Neuropsychological evalua- tion in the diagnosis and management of sports-related con- cussion, Archives of

  14. Outcomes with the Use of Recombinant Human Erythropoietin in Critically Ill Burn Patients

    Science.gov (United States)

    2010-09-01

    complications, and mortality. Thromboembolic complication rate to include myo- cardial infarction , deep venous thrombo is, and pul- monary embolism...groups. There wa no difference in Hb value at di charge. om pared with the contemporane u. c ntrols, rhEPO- treated patients received significantly...DVT/PE • MI Historical Epogen Non-Epo FIG. I. omphcations. DYT, deep venous thrombosis; PE. pulmonary embolisms: MI. myocardial infar tion

  15. Prevention of multiple organ dysfunction syndrome in patients with extensive deep burns

    Institute of Scientific and Technical Information of China (English)

    盛志勇

    2002-01-01

    @@ Multiple organ dysfunction (or failure) syndrone (MODS or MOFS) remains a hurdle for us to overcome before further improvement in the survival rate can be achieved in the patients with extensive deep bums. It is, however, generally recognized that MODS is the final result of the liberation and interplay of multiple inflammatory mediators or cytokines, and there is a two-hit phenomenon in its pathogenesis.

  16. Trimethoprim-induced hyperkalemia in burn patients treated with intravenous or oral trimethoprim sulfamethoxazole for methicillin-resistant Staphylococcus aureus and other infections: nature or nurture?

    Science.gov (United States)

    Ackerman, Bruce H; Patton, Mary L; Guilday, Robert E; Haith, Linwood R; Stair-Buchmann, Megan; Reigart, Cynthia L

    2013-01-01

    Trimethoprim is well known to cause rashes; however, what is not commonly known is that it causes sudden and profound hyperkalemia in 10 to 20% of treated patients. The uniqueness of burn patients begs the question whether changes known to occur in these patients might also increase this trimethoprim effect. After institutional review board approval, a retrospective study evaluated 224 patients with thermal injury who had been treated with trimethoprim sulfamethoxazole (TMP-SMX), 24 of whom had underlying renal impairment (creatinine clearances drug-induced hyperkalemia were used: 1) a ≥ 1 mEq/L rise, 2) a >0.8 mEq rise in potassium in hyperkalemia defined as serum potassium of ≥ 5.5 mEq/L within 48 hours. A potassium level before trimethoprim exposure (TxK) and after TxK were collected retrospectively. Demographic data were analyzed with Student's t-test and trimethoprim dose alone, demonstrating a significant difference. Analysis of 200 patients exposed to trimethoprim demonstrated an elevation of potassium (first definition) in 31 patients (15.5%), a rapid change in serum potassium in two patients (second definition), and marked hyperkalemia (>5.5 mEq/L) in 13 patients (6.5%). Hyperkalemia never occurred in 166 of 200 patients (82%; before TxK, 3.9 ± 0.4; after TxK, 4.3 ± 0.5 mEq/L). Change in serum potassium among patients with hyperkalemia was 4.0 ± 0.5 mEq/L before TxK and 5.3 ± 0.7 mEq/L after TxK. Twelve published hyperkalemia risk factors were reviewed in these 200 patients and only history of hypertension and need for intubation was more common in those with hyperkalemia. A nearly 20% incidence of hyperkalemia and 6% serious hyperkalemia in burn patients is consistent with reports in patients without burn injury. These data also suggest that the metabolic and hormonal changes associated with burn injury do not increase further the genetically predisposed hyperkalemia resulting from exposure to trimethoprim. These data suggest patients treated with

  17. Evaluation of patient involvement in a systematic review and meta-analysis of individual patient data in cervical cancer treatment

    Directory of Open Access Journals (Sweden)

    Vale Claire L

    2012-05-01

    Full Text Available Abstract Background In April 2005, researchers based at the Medical Research Council Clinical Trials Unit, set out to involve women affected by cervical cancer in a systematic review and meta-analysis of individual patient data to evaluate treatments for this disease. Each of the women had previously been treated for cervical cancer. Following completion of the meta-analysis, we aimed to evaluate the process of involvement from the researcher and research partner perspective. Methods An advisory group was first established to give advice on recruiting, supporting and involving women and led to efforts to recruit women to take part in the systematic review using different approaches. Evaluation of the process and outcomes of the partnership between the systematic reviewers and the patients, in respect to what the partnership achieved; what worked well and what were the difficulties; what was learned and the resource requirements, took place during the conduct of the meta-analysis and again after completion of the project. Results Six women, each of whom had received treatments for cervical cancer, were recruited as Patient Research Partners and five of these women subsequently took part in a variety of activities around the systematic review. They attended progress meetings and all but one attended a meeting at which the first results of the review were presented to all collaborators and gave feedback. Three of the women also became involved in a further related research project which led to an editorial publication from the patient perspective and also participated, along with two lead researchers, in the evaluation of the process and outcomes. While they were generally positive about the experience, one Patient Research Partner questioned the extent of the impact patients could make to the systematic review process. Conclusions In general, researchers and patient research partners felt that they had learned a lot from the process and considered

  18. Creating a Patient-Centered Health Care Delivery System: A Systematic Review of Health Care Quality From the Patient Perspective.

    Science.gov (United States)

    Mohammed, Khaled; Nolan, Margaret B; Rajjo, Tamim; Shah, Nilay D; Prokop, Larry J; Varkey, Prathibha; Murad, Mohammad H

    2016-01-01

    Patient experience is one of key domains of value-based purchasing that can serve as a measure of quality and be used to improve the delivery of health services. The aims of this study are to explore patient perceptions of quality of health care and to understand how perceptions may differ by settings and condition. A systematic review of multiple databases was conducted for studies targeting patient perceptions of quality of care. Two reviewers screened and extracted data independently. Data synthesis was performed following a meta-narrative approach. A total of 36 studies were included that identified 10 quality dimensions perceived by patients: communication, access, shared decision making, provider knowledge and skills, physical environment, patient education, electronic medical record, pain control, discharge process, and preventive services. These dimensions can be used in planning and evaluating health care delivery. Future research should evaluate the effect of interventions targeting patient experience on patient outcomes.

  19. Cografts of artificial dermis matrix and autogenetic split-thickness of repaired skin in severe hand wounds in patients with deep burns

    Directory of Open Access Journals (Sweden)

    Liu Hongqi

    2014-01-01

    Full Text Available The aim of this paper was to evaluate the effect of using artificial dermis matrix plus autologous split-thickness skin (ADM and ASTS in the treatment of deep-burns in hands of severely burned patients.We recruited a total of 58 patients with large area burns greater than 80% that were eschar-excised. Twenty-eight of them were treated with ADM and ASTS (test group; 30 were treated with autologous medium-thickness skin (AMTS (control group. The healing time of the hand wound was noted, clinical and photographic evaluations were performed, and a Jebsen-Taylor hand function test was compared and analyzed in the two groups. The wound healing time in the test group (24.22±3.34 days were longer than that of the control group (13.42±3.36 days and statistically significant. The healing time of skin graft donor sites was shorter than that of the control group (7.14±1.63 vs. 14.28±2.37 days and statistically significant (P<0.05. The 3rd and 6th month follow-up with clinical and functional evaluations revealed no differences between the two groups. In addition, there was no obvious scar formation and less pigmentation in either group. The repair of deeply burned hands with artificial dermis matrix was beneficial to both wound healing and the donor site, and was beneficial to the whole body rehabilitation of severely burned patients.

  20. High frequency of multidrug-resistant Staphylococcus aureus with SCCmec type III and Spa types t037 and t631 isolated from burn patients in southwest of Iran.

    Science.gov (United States)

    Parhizgari, Najmeh; Khoramrooz, Seyed Sajjad; Malek Hosseini, Seyed Ali Asghar; Marashifard, Masoud; Yazdanpanah, Mahboobeh; Emaneini, Mohammad; Gharibpour, Farzaneh; Mirzaii, Mehdi; Darban-Sarokhalil, Davood; Moein, Masoud; Naraki, Mahmood

    2016-03-01

    Methicilin resistance Staphylococcus aureus (MRSA) infections are the major challenges in hospitals, especially in the burn units. The use of molecular typing methods is essential for tracking the spread of S. aureus infection and epidemiological investigations. The aim of this study was to find the profile of the spa types and also the prevalence of each SCCmec type of S. aureus strains in a central burn hospital in southwest of Iran. A total of 81 non-duplicate S. aureus were isolated from burn patients between April 2011 and February 2012. The susceptibility of the isolates against 13 different antibiotics was tested by disk agar diffusion (DAD) method. MRSA strains were identified by amplification of mecA gene. Multiplex-polymerase chain reaction (PCR) technique was used to determine the SCCmec types of MRSA strains and all the S. aureus isolates were typed by spa typing method. Detection of mecA gene showed that 70 (86.4%) of the isolates were MRSA. The highest rate of resistance was observed for penicillin (97.5%) and erythromycin (77.8%). None of the isolates were resistant to vancomycin. Sixty-seven of the 70 MRSA isolates harbored only SCCmec type III and three untypeable isolates. Five different spa types were detected. The most common spa types were t037 (42.5%) and t631 (34.5%) and were only found in MRSA isolates. Only SCCmec type III was found in burn patients which emphasizes the HA-MRSA origin of these strains. Only five different spa types identified in this study are in accordance with one SCCmec type which indicates that a limited number of bacterial colons are circulated in the burn unit in this hospital.

  1. Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: a systematic literature review.

    NARCIS (Netherlands)

    Hopman, P.; Bruijn, S.R. de; Forjaz, M.J.; Rodriguez-Blazquez, C.; Tonnara, G.; Lemmens, L.C.; Onder, G.; Baan, C.A.; Rijken, M.

    2016-01-01

    Objective: To describe comprehensive care programs targeting multimorbid and/or frail patients and to estimate their effectiveness regarding improvement of patient and caregiver related outcomes, healthcare utilization and costs. Methods: Systematic search in six electronic databases for scientific

  2. X-ray analysis of 80 patients with severe endemic fluorosis caused by coal burning

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Z.P.; Yuan, M.B.; Liu, G.F. [Luzhou Medical College, Luzhou (China)

    1996-05-01

    Radiographs of 80 patients with severe endemic fluorosis of coalburning type (CBFF) - 49 males and 31 females aged 30 to 70 years - were analysed to examine the changes to the bone substance, peripheral structure of bone, and joints. The changes to bone substance were: (1) osteosclerosis type, 62 cases (77.5%); (2) mixed type, 16 cases (21.25%); (3) osteoporosis type, one case (1.25%); (4) osteomalacia type, one case (1.25%). The changes to the joints were found in the hips and elbows in 79 cases (98.75%), and in the knees in 75 cases (93.75%). When combinations of the above three changes occur, the classification of the disease is according to the most severe one of the three. Our findings can increase the accuracy of X-ray diagnosis, making it more consistent with clinical diagnosis, thus improving prevention and treatment of CBEF.

  3. Effect of lumbar stabilization exercises on the balance ability of patients with stroke: a systematic review.

    Science.gov (United States)

    Ko, Dae-Sik; Jung, Dae-In; Bae, Sang-Yeol

    2014-12-01

    [Purpose] This study performed a systematic literature review of the ability of lumbar stabilization exercises (LSE) to improve the balance ability of stroke patients. [Subjects and Methods] A systematic review was conducted of four databases. The papers retrieved were evaluated based on the following inclusion criteria: 1) design, a controlled clinical trial; 2) intervention, LSE; 3) outcome, change in balance ability; and 4) year of publication, 2000 to 2013. [Results] The findings of 6 papers were compared to determine the effects of lumbar stabilization exercises on stroke patients' balance abilities. The papers had methodological quality scores of 5-8 on the PEDro scale. [Conclusion] Lumbar stabilization exercises have a positive influence on stroke patients' balance abilities.

  4. 烧伤外科病人再手术原因分析与预防%Reason Analysis and Precautions of Reoperation in Burns Surgical Patients

    Institute of Scientific and Technical Information of China (English)

    倪俊; 顾海峰; 许献荣; 陈瑞彩; 张杏梅

    2012-01-01

    Objective To analyze the causes of reoperation in burns surgical patients and to explore the effective preventive measures so as to make an improvement in operation quality of burns surgery. Method 202 patients undergoing operation in burns ward from January 2006 to December 2011 were analyzed retrospectively. Results There were 91 reoperations done in 60 patients in this group, included 54 times of planned reoperation and 37 times of non-planned reoperation. The causes of non-planned reoperation were postoperative complications (21 times) and operation did not achieve the desired effects (16 times) . The highest rate of non-planned reoperation was in non-burn refractory wound patients, and the lowest was in burns deformed plastic patients. It was significantly higher of the non-planned reoperation rate in the non-burn plastic patients, comparing with the burned plastic deformity patients ( P 0. 05 ) . Conclusions Active prevention and treatment of complications, emphasis on the treatment of trauma and refractory wound, improving the level of diagnosis and treatment of surgeons and reducing surgical mistakes are effective measures to decrease the incidence of non-planned reoperations in burns surgical patients.%目的 分析烧伤外科病人再手术的原因,探讨有效预防措施,以提高烧伤外科手术治疗水平.方法 对我科2006年1月至2011年12月间收治的202例烧伤外科手术病人再手术情况进行回顾性分析.结果 60例行再手术91次,包括计划再手术54次和非计划再手术37次.非计划再手术中,术后出现并发症21次,手术未达到预期疗效16次.非计划再手术率在非烧伤难愈性创面病人中最高,达22.73%,在烧伤后畸形整形病人中最低,为0.非烧伤整形病人的非计划再手术率为20.90%,明显高于烧伤整形病人的10.18% (P <0.05),难愈性创面病人的非计划再手术率为18.52%,虽高于非难愈性创面病人的10.38%,但无统计学差异(P>0.05).

  5. Sedation and Analgesia in Burn

    Directory of Open Access Journals (Sweden)

    Özkan Akıncı

    2011-07-01

    Full Text Available Burn injury is one of the most serious injuries that mankind may face. In addition to serious inflammation, excessive fluid loss, presence of hemodynamic instability due to intercurrent factors such as debridements, infections and organ failure, very different levels and intensities of pain, psychological problems such as traumatic stress disorder, depression, delirium at different levels that occur in patient with severe burn are the factors which make it difficult to provide the patient comfort. In addition to a mild to moderate level of baseline permanent pain in burn patients, which is due to tissue damage, there is procedural pain as well, which occurs by treatments such as grafting and dressings, that are severe, short-term burst style 'breakthrough' pain. Movement and tactile stimuli are also seen in burn injury as an effect to sensitize the peripheral and central nervous system. Even though many burn centers have established protocols to struggle with the pain, studies show that pain relief still inadequate in burn patients. Therefore, the treatment of burn pain and the prevention of possible emergence of future psychiatric problems suc as post-traumatic stress disorder, the sedative and anxiolytic agents should be used as a recommendation according to the needs and hemodynamic status of individual patient. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 26-30

  6. Burn treatment in the elderly.

    Science.gov (United States)

    Keck, M; Lumenta, D B; Andel, H; Kamolz, L P; Frey, M

    2009-12-01

    The population of elderly patients is expected to rise continuously over the next decades due to global demographic changes. The elderly seem to be most vulnerable to burns and their management remains undoubtedly a challenge. A clear age margin for elderly patients is not yet defined, but most studies adhere to the inclusion of patients 65 years and above, but the general condition and social situation must be taken into account. The understanding of the physiological basis of aging and its related pathophysiological changes has only marginally influenced treatment and decision making in elderly burn patients. When looking at treatment regimens currently applied in elderly burn patients, the discussion of standards in intensive care as well as surgical strategies is ongoing. However, trends towards a moderate, non-aggressive resuscitation approach and careful inclusion of key parameters like physiological age, pre-burn functional status and premorbid conditions, seem to be useful guidelines for interdisciplinary treatment decisions. Once ordered for surgical treatment, the amount of body surface area operated in one session should be adapted to the general status of the patient. Even if older burn victims have a reported higher mortality rate than younger patients, improved therapeutic options have contributed to a reduced mortality rate even in the elderly over the last decades. As a result of improved outcome, more attention has to be given to a comprehensive rehabilitation program. This review will give an overview of the current literature and will draw attention to specific topics related to this important subpopulation of burn patients.

  7. A review of hydrofluoric acid burn management.

    Science.gov (United States)

    McKee, Daniel; Thoma, Achilleas; Bailey, Kristy; Fish, Joel

    2014-01-01

    Hydrofluoric acid (HF) causes a unique chemical burn. Much of the current treatment knowledge of HF burns is derived from case reports, small case series, animal studies and anecdotal evidence. The management can be challenging because clinical presentation and severity of these burns vary widely. Plastic surgeons managing burn patients must have a basic understanding of the pathophysiology, the range of severity in presentation and the current treatment options available for HF burns. The present article reviews the current understanding of the pathophysiology and systemic effects associated with severe HF burns. Furthermore, it distinguishes between minor and life-threatening HF burns and describes several of the basic techniques that are available to treat patients with HF burns.

  8. Serum Vancomycin Levels Resulting from Continuous or Intermittent Infusion in Critically Ill Burn Patients With or Without Continuous Renal Replacement Therapy

    Science.gov (United States)

    2012-12-01

    casualty care , CI vancomycin dosing was used as a means to reduce the burden and complexity of care for the nursing staff to maximize patient care ...acquired, ventilator-associated, and healthcare-associated pneumonia . Am J Respir Crit Care Med 2005;171:388–416. 8. Wysocki M, Delatour F, Faurisson F...Antonio, Texas; §Burn Intensive Care Unit, United States Army Institute of Surgical Research, Fort Sam Houston, Texas; and ||Infectious Disease Clinical

  9. Burns (For Parents)

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old Burns KidsHealth > For Parents > Burns A A A What's ... outlets, etc.) overexposure to the sun Types of Burns Burns are often categorized as first-, second-, or ...

  10. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis

    Science.gov (United States)

    Fonseca, Nina Teixeira; Urbano, Jessica Julioti; Nacif, Sergio Roberto; Silva, Anderson Soares; Peixoto, Roger Andre Oliveira; Urbano, Giovanni Julioti; Oliveira, Ezequiel Fernandes; Santos, Israel Reis; Oliveira, Claudia Santos; Insalaco, Giuseppe; Oliveira, Luis Vicente Franco

    2016-01-01

    The purpose of this study was to conduct a systematic review of the available evidence on sleep disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD). [Subjects and Methods] Two independent reviewers performed a computer-assisted search of the MEDLINE, SciELO, LILACS, and BIREME Virtual Health Library medical databases from their inception to November 2015. [Results] One thousand one hundred twenty-six articles were found that met the inclusion criteria. Articles were excluded if they were not in English, the patients did not undergo HD, or the studies were not cross-sectional or clinical trials. After reading the full text, a further 300 studies were excluded because they did not use polysomnography. The remaining 18 studies with ESRD patients undergoing HD comprised 8 clinical trials and 10 cross-sectional studies. This systematic review followed the criteria outlined by the PRISMA declaration. [Conclusion] In this systematic review, a high prevalence of sleep disorders was observed in ESRD, including sleep-disordered breathing. This knowledge may enable health professionals to devise new strategies for the diagnosis and treatment of these patients, in order to reduce morbidity and mortality and improve their quality of life. PMID:27512289

  11. Effectiveness of mHealth interventions for patients with diabetes: An overview of systematic reviews

    Science.gov (United States)

    Paré, Guy; Jaana, Mirou; Gerber, Ben

    2017-01-01

    Background Diabetes is a common chronic disease that places an unprecedented strain on health care systems worldwide. Mobile health technologies such as smartphones, mobile applications, and wearable devices, known as mHealth, offer significant and innovative opportunities for improving patient to provider communication and self-management of diabetes. Objective The purpose of this overview is to critically appraise and consolidate evidence from multiple systematic reviews on the effectiveness of mHealth interventions for patients with diabetes to inform policy makers, practitioners, and researchers. Methods A comprehensive search on multiple databases was performed to identify relevant systematic reviews published between January 1996 and December 2015. Two authors independently selected reviews, extracted data, and assessed the methodological quality of included reviews using AMSTAR. Results Fifteen systematic reviews published between 2008 and 2014 were eligible for inclusion. The quality of the reviews varied considerably and most of them had important methodological limitations. Focusing on systematic reviews that offered the most direct evidence, this overview demonstrates that on average, mHealth interventions improve glycemic control (HbA1c) compared to standard care or other non-mHealth approaches by as much as 0.8% for patients with type 2 diabetes and 0.3% for patients with type 1 diabetes, at least in the short-term (≤12 months). However, limitations in the overall quality of evidence suggest that further research will likely have an important impact in these estimates of effect. Conclusions Findings are consistent with clinically relevant improvements, particularly with respect to patients with type 2 diabetes. Similar to home telemonitoring, mHealth interventions represent a promising approach for self-management of diabetes. PMID:28249025

  12. Personalized Patient Education and the Internet: Linking health information to the Electronic Patient Record (STEPPS in burn care)

    NARCIS (Netherlands)

    P.V. Doupi (Persephone)

    2005-01-01

    markdownabstract__Abstract__ For patients and their carers, information seeking and processing is an integral part of managing disease or coping with a health condition. The nature and content of that information may vary widely; from general medical knowledge, to practical details on diagnosis and

  13. Burden of different beta-lactamase classes among clinical isolates of AmpC-producing Pseudomonas aeruginosa in burn patients: A prospective study

    Directory of Open Access Journals (Sweden)

    V Kumar

    2012-01-01

    Full Text Available Background: Pseudomonas aeruginosa is one of the most common pathogens causing infections in burns, and shows increasing resistance to β-lactam antibiotics by producing different classes of beta-lactamases. It is also not unusual to find a single isolate that expresses multiple β-lactamase enzymes, further complicating the treatment options. Thus, in this study, we aimed to determine the coexistence of different beta-lactamase enzymes in clinical isolates of P. aeruginosa in the burn ward. Materials and Methods: A total of 101 clinical isolates of P. aeruginosa from the burn ward were identified and tested for the presence of different beta-lactamase enzymes (extended spectrum beta lactamase (ESBL, Amp C and metallo β-lactamases (MBL from October 2006 to May 2009. In vitro susceptibility pattern of antipseudomonal antibiotics was done by the Kirby Bauer disc diffusion method. Results: A total of 33 (32.7% isolates were confirmed to be positive for AmpC beta-lactamase. Co-production of AmpC along with ESBL and MBL was reported in 24.5% and 45.5% isolates, respectively. A total of 12 (11.9% isolates were resistant to three or more antibiotic classes (multidrug resistance. Imipenem and piperacillin/tazobactum showed high sensitivity, with 86.1% and 82.2%, respectively. Conclusion: This study reveals the high prevalence of multidrug- resistant P. aeruginosa producing beta-lactamase enzymes of different mechanisms in this region from burn patients. The emerging antimicrobial resistance in burn wound pathogens poses serious therapeutic challenge. Thus proper antibiotic policy and measures to restrict the indiscriminate use of cephalosporins and carbapenems should be taken to minimize the emergence of this multiple beta -lactamase producing pathogen.

  14. An integrative model of patient-centeredness - a systematic review and concept analysis.

    Directory of Open Access Journals (Sweden)

    Isabelle Scholl

    Full Text Available Existing models of patient-centeredness reveal a lack of conceptual clarity. This results in a heterogeneous use of the term, unclear measurement dimensions, inconsistent results regarding the effectiveness of patient-centered interventions, and finally in difficulties in implementing patient-centered care. The aim of this systematic review was to identify the different dimensions of patient-centeredness described in the literature and to propose an integrative model of patient-centeredness based on these results.Protocol driven search in five databases, combined with a comprehensive secondary search strategy. All articles that include a definition of patient-centeredness were eligible for inclusion in the review and subject to subsequent content analysis. Two researchers independently first screened titles and abstracts, then assessed full texts for eligibility. In each article the given definition of patient-centeredness was coded independently by two researchers. We discussed codes within the research team and condensed them into an integrative model of patient-centeredness.4707 records were identified through primary and secondary search, of which 706 were retained after screening of titles and abstracts. 417 articles (59% contained a definition of patient-centeredness and were coded. 15 dimensions of patient-centeredness were identified: essential characteristics of clinician, clinician-patient relationship, clinician-patient communication, patient as unique person, biopsychosocial perspective, patient information, patient involvement in care, involvement of family and friends, patient empowerment, physical support, emotional support, integration of medical and non-medical care, teamwork and teambuilding, access to care, coordination and continuity of care. In the resulting integrative model the dimensions were mapped onto different levels of care.The proposed integrative model of patient-centeredness allows different stakeholders to speak

  15. An Integrative Model of Patient-Centeredness – A Systematic Review and Concept Analysis

    Science.gov (United States)

    Scholl, Isabelle; Zill, Jördis M.; Härter, Martin; Dirmaier, Jörg

    2014-01-01

    Background Existing models of patient-centeredness reveal a lack of conceptual clarity. This results in a heterogeneous use of the term, unclear measurement dimensions, inconsistent results regarding the effectiveness of patient-centered interventions, and finally in difficulties in implementing patient-centered care. The aim of this systematic review was to identify the different dimensions of patient-centeredness described in the literature and to propose an integrative model of patient-centeredness based on these results. Methods Protocol driven search in five databases, combined with a comprehensive secondary search strategy. All articles that include a definition of patient-centeredness were eligible for inclusion in the review and subject to subsequent content analysis. Two researchers independently first screened titles and abstracts, then assessed full texts for eligibility. In each article the given definition of patient-centeredness was coded independently by two researchers. We discussed codes within the research team and condensed them into an integrative model of patient-centeredness. Results 4707 records were identified through primary and secondary search, of which 706 were retained after screening of titles and abstracts. 417 articles (59%) contained a definition of patient-centeredness and were coded. 15 dimensions of patient-centeredness were identified: essential characteristics of clinician, clinician-patient relationship, clinician-patient communication, patient as unique person, biopsychosocial perspective, patient information, patient involvement in care, involvement of family and friends, patient empowerment, physical support, emotional support, integration of medical and non-medical care, teamwork and teambuilding, access to care, coordination and continuity of care. In the resulting integrative model the dimensions were mapped onto different levels of care. Conclusions The proposed integrative model of patient-centeredness allows different

  16. The validity of using analogue patients in practitioner-patient communication research: systematic review and meta-analysis.

    Science.gov (United States)

    van Vliet, Liesbeth M; van der Wall, Elsken; Albada, Akke; Spreeuwenberg, Peter M M; Verheul, William; Bensing, Jozien M

    2012-11-01

    When studying the patient perspective on communication, some studies rely on analogue patients (patients and healthy subjects) who rate videotaped medical consultations while putting themselves in the shoes of the video-patient. To describe the rationales, methodology, and outcomes of studies using video-vignette designs in which videotaped medical consultations are watched and judged by analogue patients. Pubmed, Embase, Psychinfo and CINAHL databases were systematically searched up to February 2012. Data was extracted on: study characteristics and quality, design, rationales, internal and external validity, limitations and analogue patients' perceptions of studied communication. A meta-analysis was conducted on the distribution of analogue patients' evaluations of communication. Thirty-four studies were included, comprising both scripted and clinical studies, of average-to-superior quality. Studies provided unspecific, ethical as well as methodological rationales for conducting video-vignette studies with analogue patients. Scripted studies provided the most specific methodological rationales and tried the most to increase and test internal validity (e.g. by performing manipulation checks) and external validity (e.g. by determining identification with video-patient). Analogue patients' perceptions of communication largely overlap with clinical patients' perceptions. The meta-analysis revealed that analogue patients' evaluations of practitioners' communication are not subject to ceiling effects. Analogue patients' evaluations of communication equaled clinical patients' perceptions, while overcoming ceiling effects. This implies that analogue patients can be included as proxies for clinical patients in studies on communication, taken some described precautions into account. Insights from this review may ease decisions about including analogue patients in video-vignette studies, improve the quality of these studies and increase knowledge on communication from the

  17. Effects of systematic rehabilitation training and mental intervention on the prevention of scar deformities of deep hand burn%系统性康复训练及心理干预预防手部深度烧伤后瘢痕畸形的效果

    Institute of Scientific and Technical Information of China (English)

    何柳; 朱文君

    2016-01-01

    Objective To apply and evaluate the effects systematic rehabilitation training on patients with scar deformity after the deep hand burn and carry out mental intervention. Methods A total of 66 patients with scar deformity after the deep hand burn were randomly admitted to either observation group ( n=33 ) or control group (n=33). Statistical software was used for random number method. The patients of control group adopted routine treatment nursing measures and the patients of observation group received early prevention and treatment measures, and psychological intervention. We compared and analyzed the two groups of patients with rehabilitation, psychological status and satisfaction and so on. Results The patients in the observation group were better in hand function rehabilitation, excellent in 17 cases, good in 12 cases and poor in 4 cases comparing with control group, in 33 cases of the control group, it was excellent in 7 cases, good in 10 cases and poor in 16 cases(P<0. 01). The average SF-36 score of the observation group was (81. 37 ± 4. 71), and that of the control group was (69.46 ±4.53), and the patient satisfaction of the observation group was higher(P<0. 05). Conclusions Systematic training can benefit the recovery of hand deep burn while mental intervention can promote patients′ psychological health, so this kind of patients should be taken positive treatment interventions combined with mental intervention in clinic.%目的:对手部深度烧伤后瘢痕畸形的患者采取系统性的康复训练,并加以心理干预,评价其效果。方法随机选取解放军总医院第一附属医院手部深度烧伤且瘢痕畸形患者66例,应用统计软件取随机数法将其均分为两组,其中33例患者作为观察组,采取早期预防和治疗措施,并加以心理干预;另外33例患者作为对照组,对其仅采取常规诊疗和护理措施。对比分析两组患者的康复情况、心理状态及满意度等。结果

  18. Randomized crossover comparison of the laryngeal mask airway classic with i-gel laryngeal mask airway in the management of difficult airway in post burn neck contracture patients

    Directory of Open Access Journals (Sweden)

    Jeevan Singh

    2012-01-01

    Full Text Available Purpose: The objective of the study was to compare the performance of i-gel supraglottic airway with cLMA in difficult airway management in post burn neck contracture patients and assess the feasibility of i-gel use for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening. Methods: Prospective, crossover, randomized controlled trial was performed amongst forty eight post burn neck contracture patients with limited mouth opening and neck movement. i-gel and cLMA were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, visualization of square wave pattern. Results: Success rate for the i-gel was 91.7% versus 79.2% for the cLMA. i-gel required shorter insertion time (19.3 seconds vs. 23.5 seconds, P=0.000. Airway leak pressure difference was statistically significant (i-gel 21.2 cm H20; cLMA 16.9 cm H 2 0; P=0.00. Fiberoptic view through the i-gel showed there were less epiglottic downfolding and better fiberoptic view of the glottis than cLMA. Overall agreement in insertion outcome for i-gel was 22/24 (91.7% successes and 2/24(8.3% failure and for cLMA, 19/24 (79.16% successes and 5/24 (16.7% failure in the first attempt. Conclusion: The i-gel is cheap, effective airway device which is easier to insert and has better clinical performance in the difficult airway management of the airway in the post burn contracture of the neck. Our study shows that i-gel is feasible for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening in post burn neck.

  19. Bad advice; bad burn: a new problem in burn prevention.

    Science.gov (United States)

    Deans, L; Slater, H; Goldfarb, I W

    1990-01-01

    Deep partial-thickness burns had been inflicted on the perineal area of an infant who was recently treated in our Burn Center. The burns were a result of advice to the patient's mother by a pediatrician. The doctor told her to use a hair dryer to prevent diaper rash. We surveyed pediatricians, well-baby clinics, and pediatric nurse practitioners in our area and found that approximately half of them advised the use of hair dryers to treat or prevent diaper rash. We tested four widely available hand-held hair dryers to determine potential for inflicting burn injury. All of the dryers are capable of delivering air heated to at least 53 degrees C after 2 minutes of use. We believe that warnings against the use of hair dryers for perineal hygiene should be included in burn prevention programs.

  20. Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review

    Science.gov (United States)

    2017-01-01

    Background With online health information becoming increasingly popular among patients, concerns have been raised about the impact of patients’ Internet health information-seeking behavior on their relationship with physicians. Therefore, it is pertinent to understand the influence of online health information on the patient-physician relationship. Objective Our objective was to systematically review existing research on patients’ Internet health information seeking and its influence on the patient-physician relationship. Methods We systematically searched PubMed and key medical informatics, information systems, and communication science journals covering the period of 2000 to 2015. Empirical articles that were in English were included. We analyzed the content covering themes in 2 broad categories: factors affecting patients’ discussion of online findings during consultations and implications for the patient-physician relationship. Results We identified 18 articles that met the inclusion criteria and the quality requirement for the review. The articles revealed barriers, facilitators, and demographic factors that influence patients’ disclosure of online health information during consultations and the different mechanisms patients use to reveal these findings. Our review also showed the mechanisms in which online information could influence patients’ relationship with their physicians. Conclusions Results of this review contribute to the understanding of the patient-physician relationship of Internet-informed patients. Our main findings show that Internet health information seeking can improve the patient-physician relationship depending on whether the patient discusses the information with the physician and on their prior relationship. As patients have better access to health information through the Internet and expect to be more engaged in health decision making, traditional models of the patient-provider relationship and communication strategies must be

  1. Ingesta de antioxidantes y poliaminas en pacientes con quemaduras graves Ingestion of antioxidants and polyamines in patients with severe burns

    Directory of Open Access Journals (Sweden)

    M. Farriol

    2004-10-01

    Full Text Available El objetivo del estudio fue valorar el aporte energético, de antioxidantes y de poliaminas de la ingesta, iniciándose desde las primeras 24 horas inmediatas a la quemadura. La valoración nutricional se realizó a los 7, 15 y 21 días y se comparó con el grupo control (n = 30. La edad de los pacientes (n = 25; 20 hombres y 5 mujeres fue de 45,6 ± 20,4 años. Veintiún pacientes presentaron una superficie corporal quemada (SQC entre el 20-50% y en 4 casos fue superior al 50%. Se observó un descenso del aporte energético medio de ~40% vs el teórico calculado en los 3 períodos: 1.186 ± 32, 1.117 ± 589 y 1.331 ± 578 kcal. En los primeros 15 días la ingesta de antioxidantes fue ligeramente inferior a las RDA para la vitamina C: 60 mg vs 57 ± 32, 57 ± 53 y 75 ± 53 mg, e inferior durante todo el período para la vitamina E: 10 mg vs 5,0 ± 2,9; 4,5 ± 3,0 y 5,3 ± 3,4 mg, selenio: 40 µg vs 22,8 ± 13,7, 22,5 ± 9,8 y 25,7 ± 11,2 µg y zinc: 12 mg vs 7.3 ± 3.0; 6,8 ± 4,8 y 8.4 ± 5,3 mg. La ingesta de taurina descendió en el día 15 y se incrementó significativamente en el día 21: 65,7 ± 30 mg, 50,9 ± 25 y 72,0 ± 29 mg (p Starting the first 24 hours after burn injury, energy supply, antioxidants and polyamines were assessed in 25 severe burn patients (20 men and 5 women with a mean age of 45.6 ± 20.4 years. Nutritional assessment was performed at 7, 15 and 21 days and was compared with a control group (n = 30. In 21 patients the burned body surface area was 20%-50% and in four patients it was greater than 50%. A mean decrease in energy supply of ~40% versus the calculated theoretical value was found in the three periods: 1,186 ± 32; 1,117 ± 589 and 1,331 ± 578 kcal. In the first 15 days antioxidant ingestion was slightly lower than the recommended daily allowance for vitamin C: 60 mg versus 57 ± 32, 57 ± 53 and 75 ± 53 mg, and was lower during the entire period for vita-min E: 10 mg versus 5.0 ± 2.9; 4.5 ± 3.0 and 5.3

  2. Oral health status in patients with brain injury: a systematic review

    DEFF Research Database (Denmark)

    Kothari, Mohit; Pillai, Rajath; Futarmal Kothari, Simple

    2017-01-01

    publications focusing on other form of brain injury diseases. Overall, oral health has been noted to be poor in patients with ABI, but oral hygiene, and OHrQoL, has been found to be improved when oral hygiene interventions are provided to the patients.......Objective: To undertake a systematic review on the current knowledge and future perspectives regarding the status of various oral health factors, including social and behavioral aspects in patients with acquired brain injury (ABI). Study design: A structured search strategy was applied to Pub......Med, Embase, and Scopus electronic databases until January 2016 to identify studies presenting the assessment of the oral health status of patients afflicted with any kind of ABI. The search strategy was restricted to English-language publications, enrolling patients above 18 years. Studies on the association...

  3. Health-related quality of life in Guillain-Barré syndrome patients: a systematic review.

    Science.gov (United States)

    Darweesh, Sirwan K L; Polinder, Suzanne; Mulder, Maxim J H L; Baena, Cristina P; van Leeuwen, Nikki; Franco, Oscar H; Jacobs, Bart C; van Doorn, Pieter A

    2014-03-01

    Guillain-Barré syndrome (GBS) encompasses a broad spectrum of health-related quality of life (HRQL) determinants, including mobility, fatigue, pain, and depression. We systematically reviewed the literature on functional outcome domains in which GBS patients experience limitations in the short and long terms and evaluated determinants of HRQL in GBS patients. MEDLINE and EMBASE were systematically searched by two independent reviewers for articles covering HRQL data of GBS patients. Of 730 abstracts screened, 17 articles covering data of 14 studies matched the selection criteria. The included articles showed that many GBS patients experienced physical limitations, even years after the acute phase of the disease, while results were inconsistent for perceived levels of pain, fatigue, and general mental well-being. Only three papers covered HRQL assessments at more than one time point, generally showing large improvements in HRQL in the first year after GBS onset, but not thereafter. We appraised the methodological quality of included studies using a 13-item checklist; none of the articles fulfilled all items and only seven articles presented data on correlations between HRQL and determinants. In conclusion, the majority of studies on HRQL in GBS patients are cross-sectional and of low methodological quality. This paper provides guidance for much needed high-quality studies on patterns of patient-perceived recovery after GBS onset.

  4. Acknowledging the patient with back pain: A systematic review based on thematic synthesis

    DEFF Research Database (Denmark)

    Damsgaard, Janne Brammer; Bastrup, Lene; Norlyk, Annelise

    Abstract NOF 2014 Acknowledging the back patient. A thematic synthesis of qualitative research. A systematic literature review. Introduction: Back conditions and back pain rank among the most common causes of reduced working capacity and lengthy, challenging and costly illness trajectories and ar...... a question of adopting certain norms as binding; to be bound by obligation or loyalty. Thus, the literature review argues for a more process-oriented patient approach that incorporates patients' narratives as an integral and ethical part of the care and treatment.......Abstract NOF 2014 Acknowledging the back patient. A thematic synthesis of qualitative research. A systematic literature review. Introduction: Back conditions and back pain rank among the most common causes of reduced working capacity and lengthy, challenging and costly illness trajectories...... and are associated with heavy personal costs and hospitalisations. Thus, it has been the aim of this qualitative literature review to investigate what it feels like to be a back patient and what back patients consider important when dealing with the healthcare system. Methods: The thematic synthesis aims...

  5. Antibiotic efficacy in patients with a moderate probability of acute rhinosinusitis: a systematic review.

    Science.gov (United States)

    Burgstaller, Jakob M; Steurer, Johann; Holzmann, David; Geiges, Gabriel; Soyka, Michael B

    2016-05-01

    The aim of this systematic review was to synthesize the results of original studies assessing antibiotic efficacy at different time points after initiating treatment in patients with a moderate probability of acute bacterial rhinosinusitis. We searched the Cochrane library for systematic reviews on the efficacy of antibiotic treatment in patients with acute rhinosinusitis (ARS). Only randomized controlled trials (RCTs) that compared treatment of any antibiotic with placebo were included. The synthesis of the results of six RCTs showed a benefit of antibiotic treatment compared to placebo for the rate of improvement after 3 [pooled odds ratio (OR) 2.78 (95 % confidence interval (CI) 1.39-5.58)] and 7 [OR 2.29 (95 % CI 1.19-4.41)] days after initiation in patients with symptoms and signs of ARS lasting for 7 or more days. After 10 days [pooled OR 1.36 (95 % CI 0.66-2.90)], improvement rates did not differ significantly between patients treated with or without antibiotics. Compared to placebo, antibiotic treatment relieves symptoms in a significantly higher proportion of patients within the first days of treatment. Reporting an overall average treatment efficacy may underestimate treatment benefits in patients with a self-limiting illness.

  6. Dental implant survival rate in well-controlled diabetic patients. A systematic review.

    Directory of Open Access Journals (Sweden)

    Heber Arbildo

    2015-12-01

    Full Text Available Background: Dental implants have now become one of the most popular options for replacing a missing tooth. On the other hand, diabetes mellitus is a systemic disease that affects a large part of the population and is generally considered an absolute or relative contraindication to implant therapy. Aim: To determine the survival rate of dental implants in controlled diabetic patients through a systematic review. Material and methods: A systematic search in Pubmed, SciELO and RedALyC databases was performed. The selection criteria were: studies published in the last 10 years, with at least 20 controlled diabetic patients, reporting survival rate and number of implants placed, with follow-up periods equal to or longer than 1 year, including a control group of healthy patients. Methodological quality was analyzed with the follwing scales: Jadad and Downs & Black’s CMQ. Results: Three articles with a follow-up period between 1 and 12 years were analyzed. The overall survival rate of dental implants in diabetic controlled patients was 97.43%. Conclusion: The reviewed literature suggests that survival rate of dental implants in well-controlled diabetic patients is similar to non-diabetic patients.

  7. Serum infliximab concentrations in psoriatic patients treated with infliximab: a systematic review

    OpenAIRE

    Dannepond, Carole; Maruani, Annabel; Machet, Laurent; Ternant, David; Paintaud, Gilles

    2015-01-01

    The efficacy of infliximab is influenced by individual variability in its pharmacokinetics and pharmacodynamics. Serum infliximab concentrations could therefore be related to the efficacy and tolerance of infliximab, and assist adjustment of treatment. The aim of this systematic review was to assess the value of measuring serum infliximab concentrations in psoriatic patients. A bibliographic search was performed on MEDLINE, CENTRAL, EMBASE, LILACS for original studies on serum infliximab conc...

  8. [Hydrofluoric acid burns].

    Science.gov (United States)

    Holla, Robin; Gorter, Ramon R; Tenhagen, Mark; Vloemans, A F P M Jos; Breederveld, Roelf S

    2016-01-01

    Hydrofluoric acid is increasingly used as a rust remover and detergent. Dermal contact with hydrofluoric acid results in a chemical burn characterized by severe pain and deep tissue necrosis. It may cause electrolyte imbalances with lethal consequences. It is important to identify high-risk patients. 'High risk' is defined as a total affected body area > 3% or exposure to hydrofluoric acid in a concentration > 50%. We present the cases of three male patients (26, 31, and 39 years old) with hydrofluoric acid burns of varying severity and describe the subsequent treatments. The application of calcium gluconate 2.5% gel to the skin is the cornerstone of the treatment, reducing pain as well as improving wound healing. Nails should be thoroughly inspected and possibly removed if the nail is involved, to ensure proper healing. In high-risk patients, plasma calcium levels should be evaluated and cardiac monitoring is indicated.

  9. 生长激素治疗儿童烧伤的研究进展%Advancement in the research of growth hormone in treating pediatric burn patients

    Institute of Scientific and Technical Information of China (English)

    王飞; 邱林

    2013-01-01

    The serious and persistent hypercatabolic state caused by severe burn injury leads to weight loss,weakening of muscles,immunity decline,and delayed wound healing in injured patients.Pediatric burn patients also suffer growth retardation.How to ameliorate the persistent hypercatabolic response is what the medical professionals should concern.Recombinant human growth hormone (rhGH) can attenuate the hypercatabolic response and alleviate the growth retardation.This article reviews the researches on the use of rhGH in the treatment of burn injury in children.%儿童处于生长发育的重要时期,严重烧伤对其身心都有重大影响,及时纠正和改善这些影响对烧伤患儿的预后及生活质量至关重要.生长激素(growth hormone,GH)用于烧伤儿童,可有效改善烧伤后的高分解代谢状态和生长发育落后现象,本文就目前国内外对GH在治疗儿童烧伤方面的研究作一系统介绍.

  10. The biology of burn injury.

    Science.gov (United States)

    Evers, Lars H; Bhavsar, Dhaval; Mailänder, Peter

    2010-09-01

    Burn injury is a complex traumatic event with various local and systemic effects, affecting several organ systems beyond the skin. The pathophysiology of the burn patient shows the full spectrum of the complexity of inflammatory response reactions. In the acute phase, inflammation mechanism may have negative effects because of capillary leak, the propagation of inhalation injury and the development of multiple organ failure. Attempts to mediate these processes remain a central subject of burn care research. Conversely, inflammation is a necessary prologue and component in the later-stage processes of wound healing. In this review, we are attempting to present the current science of burn wound pathophysiology and wound healing. We also describe the evolution of innovative strategies for burn management.

  11. The Antimicrobial Activity o f Honey o n Bacterial Isolates From Burns/Wound o f Patients Attending General Hospital, Ankpa, Kogi State. Nigeria

    Directory of Open Access Journals (Sweden)

    Aliyu Aminu Ibrahim

    2016-05-01

    Full Text Available The antimicrobial activity of honey samples from Ankpa, Enjema and Ojoku districts of Ankpa Local Government Area of Kogi State, Nigeria against coagulase negative Staphylococcus species, Pseudomonas aeruginosa, coagulase positive Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli and Proteus speciesobtained from 200 burns/wound patients attending General Hospital, Ankpa were determined. The sensitivity of honey to the test organisms ranges from 16mm to 19mm in diameter. The minimum inhibitory concentration (MIC of the honey samples on the bacterial isolates from Ankpa and Ojoku were 0.16 v/v and 0.32 v/v for honey from Enjema. The results of the study revealed that honey from the area understudy has high antimicrobial activity and it is recommended that pure natural honey should be stocked in hospitals/clinics so as to encourage its application in the treatment of burns/wound infections

  12. Toxoplasmosis in immunocompromised patients in Iran: a systematic review and meta-analysis.

    Science.gov (United States)

    Ahmadpour, Ehsan; Daryani, Ahmad; Sharif, Mahdi; Sarvi, Shahabeddin; Aarabi, Mohsen; Mizani, Azadeh; Rahimi, Mohammad Taghi; Shokri, Azar

    2014-12-15

    Although toxoplasmosis in immunocompetent individuals is generally asymptomatic, in immunocompromised patients (HIV/AIDS, cancer, and transplant patients), it can lead to serious pathological effects. This study included a systematic review and meta-analysis to comprehensively assess the seroprevalence rate of Toxoplasma infection in immunocompromised patients in Iran. Electronic English and Persian databases (PubMed, Google Scholar, ScienceDirect, Scopus, Magiran, Scientific Information Database [SID], IranMedex, and IranDoc), parasitology congresses, and projects and theses of Iranian medical universities, were systematically searched from 1997 to 2013 (published or unpublished data). In this paper, several studies that used serological methods for diagnosis of toxoplasmosis were selected. Analysis of seroprevalence estimates was pooled using a random-effects meta-analysis. Twenty-two studies, comprising 2,805 individuals, were included in the meta-analysis. Overall seroprevalence rate of Toxoplasma infection in Iranian immunocompromised patients was 50.01% (95% confidence interval, 43.85 to 56.17); however, there was significant heterogeneity among study groups. The results showed that seroprevalence rate of toxoplasmosis among transplant recipients, HIV/AIDS, and cancer patients in Iran was 55.1%, 50.05%, and 45.06%, respectively. In addition, IgM seroprevalence rate was estimated to be 4.85% (95% confidence interval, 2.22 to 8.41). This systematic review and meta-analysis identified a high seroprevalence rate of Toxoplasma infection among immunocompromised patients (50%). Consideration of management, design and provision of appropriate control measures of toxoplasmosis is highly recommended.

  13. A Statistical Analysis of 2537 Cases of Burn Injuried Patients%2537例烧伤患者统计分析

    Institute of Scientific and Technical Information of China (English)

    韩利坤; 肖三麦

    2013-01-01

      目的了解烧伤的发病规律、特点,以减少或者预防烧伤的发生.方法根据我院2009年10月-2011年10月收治的2537例烧伤患者的性别、年龄、职业、烧伤面积、烧伤原因等特征,揭示烧伤的特点.结果2537例烧伤患者中,男性1698人,女性839人,男女性别比为2.02∶1;年龄段0~6岁的儿童发病构成比最高,达到40.01%,其中1~3岁儿童的发病构成比占到该组68.37%;职业分布上在岗工人的发病构成比最高,达到43.52%;烧伤面积以1%~10%的烧伤患者最多;烧伤原因中所占比例最高的为热液烧伤,为50.93%.结论烧伤重在预防,加强对儿童的监护和看管,加强对在岗工人的安全生产意识和预防措施.%Objective To understand the occurrence rule ,characteristics of burn injury ,so as to reduce or prevent the occurrence of it .Methods By investigating the sex ,age ,occupation ,burn area ,burn reason ,et al of the 2537 cases of burn injuried patients in our hospital from October ,2009 to October ,2011 ,this paper reveals the characteristics of burn injury .Results There were 1698 males whereas 839 females in the 2537 cases of burn injuried patients ,which shows sex ratio is 2 .02 :1 .Aged from 0 to 6 years old children got the highest incidence - up to 40 .01% ,in which 1 to 3 years old children got 68 .37% incidence .On the distribution of vocation ,workers on duty got the highest incidence ,which is 43 .52% .Most of patients’ burned area is 1% to 10% .The most fre-quent reason is hydrothermal burn injury ,which is 50 .93% .Conclusion The most important of reducing the occurrance of burn in -jury is prevention .We should pay more attention to children’s care and custody as well as strengthen the safe production consciousness and take preventive measures to workers on the job .

  14. Construction of pain management program during rehabilitation period for adult burn patients%成年烧伤病人康复期疼痛管理方案的构建

    Institute of Scientific and Technical Information of China (English)

    孙颖; 王光毅; 冯苹; 纪世召; 张玲娟

    2016-01-01

    [目的]构建成年烧伤病人康复期疼痛管理方案,促进临床烧伤疼痛管理护理实践科学、统一和规范。[方法]检索 OVID JBI,Cochrane Library,BEST PRACTICE,RNAO,EBSCO 循证护理学数据库,PubMed 以及中国生物医学文献数据库(CBM),检索从创建到2014年12月31日公开发表的关于烧伤病人康复期疼痛管理方法的临床实践指南、证据总结、系统评价、集束化措施,由3位评价者单独进行文献的筛除、质量评价、数据提取并交叉核对形成方案初稿,通过专家会议法和专家咨询对方案进行调整,最终构建成年烧伤病人康复期疼痛管理方案。[结果]本研究共纳入9篇文献,其中6篇指南、3篇系统评价,构建的疼痛管理方案包括疼痛评估流程和疼痛护理干预方案。[结论]以循证护理为研究方法,构建的疼痛管理方案对我国烧伤疼痛护理的实践具有一定的指导作用。%Objective:In order to construct the management plan of pain management for burn patients in rehabil-itation period,and to promote the scientific,unified and standardized clinical burn pain management nursing practice.Methods:It retrieved Cochrane,Library OVID JBI,PRACTICE BEST,RNAO,EBSCO evidence based nursing database,PubMed,and the Chinese biomedical literature database (CBM).It searched clinical practice guidelines,evidence summary,system evaluation,and cluster based measures for pain management in burn patients from search database creation to December 31,2014.3 reviewers separately screened literature, quality evaluation,data extraction and cross check the formation of the first draft.Through the expert meeting method and expert consultation to adj ust the program,and constructed the pain management plan for burn pa-tients in rehabilitation period.Results:The study included 9 papers,6 guide and 3 systematic review.The pain management programs included pain assessment procedures and pain nursing intervention program

  15. Exercise interventions to improve sleep in cancer patients: A systematic review and meta-analysis.

    Science.gov (United States)

    Mercier, Joanie; Savard, Josée; Bernard, Paquito

    2016-11-10

    Exercise leads to several positive outcomes in oncology. However, the question as to whether exercise is a valuable option for improving patients' sleep, which is frequently disturbed in cancer patients, remains unanswered. The aims of this study were to conduct a systematic review and meta-analysis of randomized and non-randomized clinical trials that have investigated the effect of exercise on sleep outcomes, assessed subjectively and objectively. Relevant studies, published before May 2016, were traced through a systematic search of PubMed, Embase, PsycINFO, SportDiscus and Cochrane library databases. The review looked at twenty one trials, including 17 randomized controlled trials. Most interventions were home-based aerobic walking programs and breast cancer patients were the subgroup most represented. Sleep variables were most commonly used as secondary outcomes in the reviewed studies. Studies were highly heterogeneous in terms of methodology. The qualitative review of available evidence suggested a beneficial effect of exercise interventions on sleep in several studies (48%). However, the meta-analysis conducted on RCTs revealed no significant effect either on subjective or on objective sleep measures. This lack of significant effect could be due, at least in part, to a floor effect. More rigorous studies are needed to assess the effect of exercise interventions in cancer patients, in particular randomized controlled trials conducted in patients with clinically significant sleep disturbances at baseline.

  16. Systematic Review of Peri-Operative Nutritional Supplementation in Patients Undergoing Pancreaticoduodenectomy

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    Kolitha Sanjaya Goonetilleke

    2006-01-01

    Full Text Available Background: Although nutritional supplementation is established in surgicalpractice, studies on feeding patients undergoing pancreaticoduodenectomy utilize widely disparate protocols, include small numbers of patients and have disparate endpoints. The aim of this study is to carry out a systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy in order to identify consistent themes. Methods :Searches of the MEDLINE and EMBASE databases yielded 10 studies examining nutritional support in 571 patients undergoing pancreaticoduodenectomy. Data were retrieved on: proportion of pre-operative weight loss, biochemical parameters (preoperative albumin and the presence of jaundice, type and duration of nutritional support and clinical outcome (morbidity, mortality and hospital stay. Results: Pre-operative percentage weight loss was similar in all studies evaluated. Routine post-operative total parenteral nutrition (TPN was associated with a higher incidence of complications. Enteral nutrition reduced infective complications. Cyclical nutrition was associated with a lower incidence of postoperative gastric stasis. Conclusion :Clear themes emerge from this systematic review. Patients undergoing pancreaticoduodenectomy are nutritionally depleted at the time of surgery and the preoperative period may present a window for intervention. Routine TPN is not beneficial. Routine post-operative enteral nutritional support, delivered on a cyclical basis appears to be the optimal mode of delivery.

  17. 大面积烧伤延迟复苏效果探讨%Study on the Effect of Delayed Resuscitation in Extensive Burn Patients

    Institute of Scientific and Technical Information of China (English)

    张宏; 林国安

    2014-01-01

    Objective To explore the means and efficacy of delayed resuscitation in patients with extensive burns. Method The fluid resuscitation plan for shock stage of burns provided by the 107th Hospital of PLA (hereinafter referred to as 107 Resuscitation Plan) was adopted as the resuscitation treatment in 25 patients with extensive burns and at delayed admission, and the efficacy was observed. Result Twenty three patients were all healed and discharged, two patients died from multi-organ failure 6 days and 34 days after injury respectively. Conclusion The 107 Resuscitation Plan can help es-timate the accumulated loss of fluid and transfusion speed. It can be used in patients who were at shock stage and delayed to be hospitalized.%目的:探讨大面积烧伤患者延迟复苏的方法及其疗效。方法采用中国人民解放军第107医院提出的烧伤休克期液体复苏方案(下称“107复苏方案”)对25例延迟入院的大面积烧伤患者进行复苏治疗,观察治疗效果。结果23例患者痊愈出院,2例患者分别于伤后第6天和第34天死于多器官功能衰竭。结论107复苏方案能够预估累积丢失量和输液速度,可用于延迟入院治疗的烧伤休克期患者。

  18. Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews

    Science.gov (United States)

    Karunanithi, Mohanraj; Fatehi, Farhad; Ding, Hang; Walters, Darren

    2017-01-01

    Background Many systematic reviews exist on the use of remote patient monitoring (RPM) interventions to improve clinical outcomes and psychological well-being of patients with heart failure. However, research is broadly distributed from simple telephone-based to complex technology-based interventions. The scope and focus of such evidence also vary widely, creating challenges for clinicians who seek information on the effect of RPM interventions. Objective The aim of this study was to investigate the effects of RPM interventions on the health outcomes of patients with heart failure by synthesizing review-level evidence. Methods We searched PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from 2005 to 2015. We screened reviews based on relevance to RPM interventions using criteria developed for this overview. Independent authors screened, selected, and extracted information from systematic reviews. AMSTAR (Assessment of Multiple Systematic Reviews) was used to assess the methodological quality of individual reviews. We used standardized language to summarize results across reviews and to provide final statements about intervention effectiveness. Results A total of 19 systematic reviews met our inclusion criteria. Reviews consisted of RPM with diverse interventions such as telemonitoring, home telehealth, mobile phone–based monitoring, and videoconferencing. All-cause mortality and heart failure mortality were the most frequently reported outcomes, but others such as quality of life, rehospitalization, emergency department visits, and length of stay were also reported. Self-care and knowledge were less commonly identified. Conclusions Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone–based monitoring and videoconferencing, require further investigation. PMID:28108430

  19. The Correlation Between the Burning Features, the Burning Agent and Motivation in Burn Victims Attending Shahid Motahari Hospital in Tehran During 2009: letter to Editor

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    Kamran Aghakhani M.D.

    2011-06-01

    Full Text Available Burning is one of the commonest causes of death. Due to the high rate of death among burn victims epidemiological investigation of burning, burning agents and the relevant motivations can be of great preventive value.1 In this cross-sectional study all the hospitalized patients in Shahid Motahari Burn Hospital at Tehran city in the year 2009 were included in the study. The collected data were analyzed by SPSS (ver. 17 software. Out of the 1548 hospitalized patients for burn, 1134 (73.3% left hospital in good conditions, 47 (3% left in relatively good conditions, 289 (18.7% died and 78 (5% persons left the Hospital satisfactorily on their own volition. About two-thirds of the patients were men. The mean age of the burn victims was 27.9±18.3 years, 16% of them being 5 years old or younger. The highest percentage of burn area was 30% of the total body surface which was seen in 20 to 30-year old patients. 58.7% of burns had been caused by fire. 94% of the burns had happened accidentally, 5% by suicidal and 1% by homicidal acts. The highest percentage of burn was observed in patients in whom the burn agent was fire. Six (4% persons had first degree, 820 (53% persons had second degree and 722 (46.6% had third degree burns. In patients who had committed suicide third degree burns were higher than second degree burns (7.7% vs. 2%. 24.4% of women and 16.6% of men died due to the burns. The rate of death in patients less than 50 years of age was 18% but the figure increased to 24% in those above 50. A burn area less than or more than 10% was, respectively correlated with 2.1% and 22.1% of deaths. 34.8% of the patients with third degree burns and 4.6% of those with second and first degree burns died. 58.3% of the suicidal patient died due to the severity of the burns relative to 16.7% due to other causes. 89 (5.7% patients had respiratory tract burns and the death rate was 58.4% among these patients while the death rate was 16.2% in patients without

  20. A systematic review of psychosocial interventions for family carers of palliative care patients

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    Thomas Kristina

    2010-08-01

    Full Text Available Abstract Background Being a family carer to a patient nearing the end of their life is a challenging and confronting experience. Studies show that caregiving can have negative consequences on the health of family carers including fatigue, sleep problems, depression, anxiety and burnout. One of the goals of palliative care is to provide psychosocial support to patients and families facing terminal illness. A systematic review of interventions for family carers of cancer and palliative care patients conducted at the start of this millennium demonstrated that there was a dearth of rigorous inquiry on this topic and consequently limited knowledge regarding the types of interventions likely to be effective in meeting the complex needs of family carers. We wanted to discern whether or not the evidence base to support family carers has improved. Furthermore, undertaking this review was acknowledged as one of the priorities for the International Palliative Care Family Carer Research Collaboration http://www.centreforpallcare.org. Methods A systematic review was undertaken in order to identify developments in family carer support that have occurred over the last decade. The focus of the review was on interventions that targeted improvements in the psychosocial support of family carers of palliative care patients. Studies were graded to assess their quality. Results A total of fourteen studies met the inclusion criteria. The focus of interventions included psycho-education, psychosocial support, carer coping, symptom management, sleep promotion and family meetings. Five studies were randomised controlled trials, three of which met the criteria for the highest quality evidence. There were two prospective studies, five pre-test/post-test projects and two qualitative studies. Conclusions The systematic review identified a slight increase in the quality and quantity of psychosocial interventions conducted for family carers in the last decade. More rigorous

  1. Reduced patient anxiety as a result of radiation therapist-led psychosocial support: a systematic review.

    Science.gov (United States)

    Elsner, Kelly; Naehrig, Diana; Halkett, Georgia K B; Dhillon, Haryana M

    2017-02-03

    Up to 49% of patients attending radiation therapy appointments may experience anxiety and distress. Anxiety is heightened during the first few visits to radiation oncology. Radiation therapists (RT) are the only health professionals in direct daily contact with patients during treatment, placing them in a unique position to explore patients' psychosocial needs. This review aims to synthesise literature regarding the effect of RT-led psychosocial support on patient anxiety. In May 2015, we searched the following electronic databases: Medline, PsycINFO, Embase, CINAHL, PubMed and Cochrane library. Radiation therapy-specific journals were hand-searched, and reference lists of identified studies searched. This review complies with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search identified 263 articles, of which 251 were excluded based on non-English language, duplicate article or relevance. A total of 12 articles involving 1363 patients were included and categorised into three broad themes: 'Patient Perspectives' 3 articles, 'Patient Information and Education' 5 articles and 'Screening and Needs Assessment' 4 articles. Two publications referred to the same sample and data. Quality ratings were mixed, with one study rated 'high' quality, seven 'moderate' and four 'low'. Methodological weaknesses were identified in relation to workflow, sample size and responder bias. RTs have a role in psychosocial support through increased communication and information sharing, which can benefit both patients and staff. RT-led practices such as relationship building, patient education sessions and screening and needs assessments are feasible and can reduce anxiety.

  2. The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: A systematic review

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    Asman Sara

    2007-01-01

    Full Text Available Abstract Background The assessment of outcomes from the patient's perspective becomes more recognized in health care. Also in patients with chronic ankle instability, the degree of present impairments, disabilities and participation problems should be documented from the perspective of the patient. The decision about which patient-assessed instrument is most appropriate for clinical practice should be based upon systematic reviews. Only rating scales constructed for patients with acute ligament injuries were systematically reviewed in the past. The aim of this study was to review systematically the clinimetric qualities of patient-assessed instruments designed for patients with chronic ankle instability. Methods A computerized literature search of Medline, Embase, Cinahl, Web of Science, Sport Discus and the Cochrane Controlled Trial Register was performed to identify eligible instruments. Two reviewers independently evaluated the clinimetric qualities of the selected instruments using a criteria list. The inter-observer reliability of both the selection procedure and the clinimetric evaluation was calculated using modified kappa coefficients. Results The inter-observer reliability of the selection procedure was excellent (k = .86. Four instruments met the eligibility criteria: the Ankle Joint Functional Assessment Tool (AJFAT, the Functional Ankle Outcome Score (FAOS, the Foot and Ankle Disability Index (FADI and the Functional Ankle Ability Measure (FAAM. The inter-observer reliability of the quality assessment was substantial to excellent (k between .64 and .88. Test-retest reliability was demonstrated for the FAOS, the FADI and the FAAM but not for the AJFAT. The FAOS and the FAAM met the criteria for content validity and construct validity. For none of the studied instruments, the internal consistency was sufficiently demonstrated. The presence of floor- and ceiling effects was assessed for the FAOS but ceiling effects were present for all

  3. 烧伤患者医院感染相关因素分析%Analysis of related factors for nosocomial infections among burn patients

    Institute of Scientific and Technical Information of China (English)

    谢金; 沈光裕; 林欣; 林明南

    2012-01-01

    OBJECTIVE To investigate the related factors of nosocomial infections among burn patients so as to take effective measures for prevention and control of nosocomial infections. METHODS We carried out a retrospective survey of 3220 burn patients from Jan 2007 to Dec 2009. RESULTS The incidence of nosocomial infections was 12. 7% in the patients aged less than 3 years old and 32. 4% in the patients aged more than 60 years old ,which was significantly higher than 8. 2% in the patients aged from 3 to 59 years of age. the difference in the incidence of nosocomial infections among the three groups was statistically significant (χ2 =69. 328, P<0. 01); the incidence of nosocomial infections during 3 time periods were 1.4% (5-20d) ,4. 4% (21-40d) , and 46. 5% (more than 40d), the difference was statistically significant (χ2 =981. 248, P<0.01); the incidence of nosocomial infections of the light burn was 1. 5% , the moderate burn 7. 1%, the severe burn 78. 4%, the difference was statistically significant (χ2 = 1606. 598. P<0.01). The infection rate in tracheotomy group was significantly higher than that in non-tracheotomy group ( 68.1% vs 3. 4%),the difference was statistically significant (χ2 = 59.077, P<0. 01) i the top 3 infection sites were in order as follows: burn wound, respiratory tract, and gastrointestinal tract. CONCLUSION Nosocomial infections are related to the age, hospital stay, severity of the burn, and tracheotomy. It is necessary to take active, targeted prevention measures.%目的 了解烧伤患者发生医院感染的相关因素,以采取有效的预防和控制措施.方法 对2007年1月-2009年12月3220例烧伤患者进行回顾性调查分析.结果 医院感染的发生率<3岁者为12.7%、>60岁患者为32.4%,明显高于3~59岁组(8.2%),3组年龄段患者医院感染率差异有统计学意义(x2=69.328,P<0.01);住院3个时间段5~20、21~40 d和>40 d发生的医院感染率分别为1.4%、4.4%和46.5

  4. Reconstructive surgery for hypospadias: A systematic review of long-term patient satisfaction with cosmetic outcomes

    Science.gov (United States)

    Adams, Julie; Bracka, Aivar

    2016-01-01

    Introduction: Research on long-term results of hypospadias has focused on surgical techniques and functional outcomes, and it is only recently that patient satisfaction with appearance and psychosocial outcomes have been considered. The aim of this study was to provide an evidence-based systematic review of adolescent and adult patient perceptions of cosmetic outcomes following childhood surgery for hypospadias. Methods: A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery. Results: A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity. Conclusions: Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery. PMID:27127350

  5. A systematic review of triage-related interventions to improve patient flow in emergency departments

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    Asplund Kjell

    2011-07-01

    Full Text Available Abstract Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department, and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency

  6. Medication review and reconciliation with cooperation between pharmacist and general practitioner and the benefit for the patient : a systematic review

    NARCIS (Netherlands)

    Geurts, Marlies M. E.; Talsma, Jaap; Brouwers, Jacobus R. B. J.; de Gier, Johan J.

    2012-01-01

    This article systematically reviews the literature on the impact of collaboration between pharmacists and general practitioners and describes its effect on patients' health. A systematic literature search provided 1041 articles. After first review of title and abstract, 152 articles remained. After

  7. Interventions for wound healing among diabetic patients infected with Staphylococcus aureus: a systematic review

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    Anacássia Fonseca Lima

    Full Text Available CONTEXT AND OBJECTIVE: Staphylococcus aureus is the most frequent agent isolated in diabetic foot infections and may be associated with changes to wound healing times. The aim of this study was to perform a systematic review of the literature, including studies that assessed the efficacy of any clinical or surgical intervention, as well as oral or topical therapy for diabetic ulcers infected with S. aureus. DESIGN AND SETTING: Systematic review with a search conducted in databases. METHODS: We conducted a systematic review with a comprehensive search in the Lilacs, SciELO, PubMed/Medline, Old Medline, Embase and Cochrane Library databases, for articles published from 1966 to 2010. The articles selected were limited to studies on diabetic patients with wounds infected with S. aureus for whom their healing was followed up, with the use of either antibiotics or experimental treatments. Animal studies and those that did not report the wound healing, as well as review articles, were excluded. RESULTS: Five studies that met the inclusion and exclusion criteria were analyzed. CONCLUSIONS: There are few studies reporting the healing of wounds infected with S. aureus in diabetic patients, although this is the most commonly found pathogen in this type of wound and it frequently consists of methicillin-resistant S. aureus (MRSA. There is insufficient evidence to support early use of broad-spectrum antibiotics against MRSA to promote healing of diabetic ulcers, since antibiotic resistance may develop from such treatment. This highlights the need for further studies on the subject.

  8. Erosive burning of solid propellants

    Science.gov (United States)

    King, Merrill K.

    1993-01-01

    Presented here is a review of the experimental and modeling work concerning erosive burning of solid propellants (augmentation of burning rate by flow of product gases across a burning surface). A brief introduction describes the motor design problems caused by this phenomenon, particularly for low port/throat area ratio motors and nozzleless motors. Various experimental techniques for measuring crossflow sensitivity of solid propellant burning rates are described, with the conclusion that accurate simulation of the flow, including upstream flow development, in actual motors is important since the degree of erosive burning depends not only on local mean crossflow velocity and propellant nature, but also upon this upstream development. In the modeling area, a brief review of simplified models and correlating equations is presented, followed by a description of more complex numerical analysis models. Both composite and double-base propellant models are reviewed. A second generation composite model is shown to give good agreement with data obtained in a series of tests in which composite propellant composition and heterogeneity (particle size distribution) were systematically varied. Finally, the use of numerical models for the development of erosive burning correlations is described, and a brief discussion of scaling is presented.

  9. Topical agents in burn care

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    Momčilović Dragan

    2002-01-01

    Full Text Available Introduction Understanding of fluid shifts and recognition of the importance of early and appropriate fluid replacement therapy have significantly reduced mortality in the early post burn period. After the bum patient successfully passes the resuscitation period, the burn wound represents the greatest threat to survival. History Since the dawn of civilization, man has been trying to find an agent which would help burn wounds heal, and at the same time, not harm general condition of the injured. It was not until the XX century, after the discovery of antibiotics, when this condition was fulfilled. In 1968, combining silver and sulfadiazine, fox made silver-sulfadiazine, which is a 1% hydro-soluble cream and a superior agent in topical treatment of burns today. Current topical agents None of the topical antimicrobial agents available today, alone or combined, have the characteristics of ideal prophylactic agents, but they eliminate colonization of burn wound, and invasive infections are infrequent. With an excellent spectrum of activity, low toxicity, and ease of application with minimal pain, silver-sulfadiazine is still the most frequently used topical agent. Conclusion The incidence of invasive infections and overall mortality have been significantly reduced after introduction of topical burn wound antimicrobial agents into practice. In most burn patients the drug of choice for prophylaxis is silver sulfadiazine. Other agents may be useful in certain clinical situations.

  10. American Burn Association Consensus Statements

    Science.gov (United States)

    2013-08-01

    Veterans Affairs, 1996. 20. Davidson JRT, Book SW, Colket JT, Tupler LA, Roth S, Hertzberg M, Mellman T, Beckham JC, Smith RD, David- son RM, Katz R...episodes in severely burned children. J Trauma 2007;62:676–81. 3. Kelemen JJ 3rd, Cioffi WG Jr, Mason AD Jr, Mozingo DW, McManus WF, Pruitt BA Jr...versus late enteral nu- tritional support in adults with burn injury: a systematic re- view. J Hum Nutr Diet 2007;20:75–3. 12. Wilmore DW, Mason AD Jr

  11. Strategies for prevention and cure of burn infection%烧伤感染防治对策

    Institute of Scientific and Technical Information of China (English)

    郇京宁; 高成金

    2009-01-01

    Infection is still the major cause of death in severe burn patients, thus the optimization of antibiotic therapy is an important approach to the annihilation of pathogenic bacte-ria and the decrease of drug-resistance bacteria. It is urgent for burn surgeons to face the selection pressure of antibiotics and the fungous infections following the incorrect use of antibiotics. Re-gardless of its complexity, the treatment of sepsis associated with post-burn bacterial infections should be systematical. Besides the effective anti-shock therapy, early enteral feeding, excision of necrotic tissues, and effective anti-infection treatment, the immunological regulation and the prevention and cure of coagula-tion disorders are necessary in the treatment of severely burned patients.

  12. Evaluation of the Role of Enteral Nutrition in Managing Patients with Diabetes: A Systematic Review

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    Omorogieva Ojo

    2014-11-01

    Full Text Available The aim of this systematic review is to evaluate the role of enteral nutrition in managing patients with diabetes on enteral feed. The prevalence of diabetes is on the increase in the UK and globally partly due to lack of physical activities, poor dietary regimes and genetic susceptibility. The development of diabetes often leads to complications such as stroke, which may require enteral nutritional support. The provision of enteral feeds comes with its complications including hyperglycaemia which if not managed can have profound consequences for the patients in terms of clinical outcomes. Therefore, it is essential to develop strategies for managing patients with diabetes on enteral feed with respect to the type and composition of the feed. This is a systematic review of published peer reviewed articles. EBSCOhost Research, PubMed and SwetsWise databases were searched. Reference lists of identified articles were reviewed. Randomised controlled trials comparing enteral nutrition diabetes specific formulas with standard formulas were included. The studies which compared diabetes specific formulas (DSF with standard formulas showed that DSF was more effective in controlling glucose profiles including postprandial glucose, HbA1c and insulinemic response. The use of DSF appears to be effective in managing patients with diabetes on enteral feed compared with standard feed.

  13. Evaluation of the role of enteral nutrition in managing patients with diabetes: a systematic review.

    Science.gov (United States)

    Ojo, Omorogieva; Brooke, Joanne

    2014-11-18

    The aim of this systematic review is to evaluate the role of enteral nutrition in managing patients with diabetes on enteral feed. The prevalence of diabetes is on the increase in the UK and globally partly due to lack of physical activities, poor dietary regimes and genetic susceptibility. The development of diabetes often leads to complications such as stroke, which may require enteral nutritional support. The provision of enteral feeds comes with its complications including hyperglycaemia which if not managed can have profound consequences for the patients in terms of clinical outcomes. Therefore, it is essential to develop strategies for managing patients with diabetes on enteral feed with respect to the type and composition of the feed. This is a systematic review of published peer reviewed articles. EBSCOhost Research, PubMed and SwetsWise databases were searched. Reference lists of identified articles were reviewed. Randomised controlled trials comparing enteral nutrition diabetes specific formulas with standard formulas were included. The studies which compared diabetes specific formulas (DSF) with standard formulas showed that DSF was more effective in controlling glucose profiles including postprandial glucose, HbA1c and insulinemic response. The use of DSF appears to be effective in managing patients with diabetes on enteral feed compared with standard feed.

  14. Analysis of scapular muscle EMG activity in patients with idiopathic neck pain: a systematic review.

    Science.gov (United States)

    Castelein, Birgit; Cools, Ann; Bostyn, Emma; Delemarre, Jolien; Lemahieu, Trees; Cagnie, Barbara

    2015-04-01

    It is proposed that altered scapular muscle function can contribute to abnormal loading of the cervical spine. However, it is not clear if patients with idiopathic neck pain show altered activity of the scapular muscles. The aim of this paper was to systematically review the literature regarding the differences or similarities in scapular muscle activity, measured by electromyography ( = EMG), between patients with chronic idiopathic neck pain compared to pain-free controls. Case-control (neck pain/healthy) studies investigating scapular muscle EMG activity (amplitude, timing and fatigue parameters) were searched in Pubmed and Web of Science. 25 articles were included in the systematic review. During rest and activities below shoulder height, no clear differences in mean Upper Trapezius ( = UT) EMG activity exist between patients with idiopathic neck pain and a healthy control group. During overhead activities, no conclusion for scapular EMG amplitude can be drawn as a large variation of results were reported. Adaptation strategies during overhead tasks are not the same between studies. Only one study investigated timing of the scapular muscles and found a delayed onset and shorter duration of the SA during elevation in patients with idiopathic neck pain. For scapular muscle fatigue, no definite conclusions can be made as a wide variation and conflicting results are reported. Further high quality EMG research on scapular muscles (broader than the UT) is necessary to understand/draw conclusions on how scapular muscles react in the presence of idiopathic neck pain.

  15. Preparing prelicensure and graduate nursing students to systematically communicate bad news to patients and families.

    Science.gov (United States)

    Little, Jeanne; Bolick, Beth Nachtsheim

    2014-01-01

    Communicating bad news, otherwise known as difficult conversations, is a complex communication skill that requires didactic learning and practical application. Students learn that what may be interpreted as bad news is determined by the recipient and not by the person who is delivering the news. Learning a systematic approach, such as the SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary) mnemonic, prepares prelicensure and graduate nursing students for difficult conversations with patients and families in the clinical setting. Role-playing commonly includes clinical scenarios, and using video recording and playback of the encounters in such scenarios is one method of learning the systematic approach to communicating bad news. Follow-up practice after application in the clinical setting and feedback from faculty and mentors are essential for nursing students to achieve competence in this complex set of communication skills.

  16. Effects of dignity therapy on terminally ill patients: a systematic review

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    Suzana Cristina Teixeira Donato

    Full Text Available Abstract OBJECTIVE Analyzing the evidence of the effects of dignity therapy onterminally ill patients. METHOD A Systematic review of the literature conducted using the search strategy in six databases. Inclusion criteria were primary studies, excluding literature reviews (systematic or not and conceptual articles. RESULTS Ten articles were analyzed regarding method, results and evidence level. Dignity therapy improved the sense of meaning andpurpose, will to live, utility, quality of life, dignity and family appreciationin studies with a higher level of evidence. The effects are not well established in relation to depression, anxiety, spirituality and physical symptoms. CONCLUSION Studies with a moderate to high level of evidence have shown increased sense of dignity, will to live and sense of purpose. Further studies should be developed to increase knowledge about dignity therapy.

  17. Upper and lower urinary tract outcomes in adult myelomeningocele patients: a systematic review.

    Directory of Open Access Journals (Sweden)

    Paul W Veenboer

    Full Text Available BACKGROUND: The introduction of sophisticated treatment of bladder dysfunction and hydrocephalus allows the majority of SB patients to survive into adulthood. However, no systematic review on urological outcome in adult SB patients is available and no follow-up schemes exist. OBJECTIVES: To systematically summarize the evidence on outcome of urinary tract functioning in adult SB patients. METHODS: A literature search in PubMed and Embase databases was done. Only papers published in the last 25 years describing patients with open SB with a mean age >18 years were included. We focused on finding differences in the treatment strategies, e.g., clean intermittent catheterization and antimuscarinic drugs versus early urinary diversion, with regard to long-term renal and bladder outcomes. RESULTS: A total of 13 articles and 5 meeting abstracts on urinary tract status of adult SB patients were found describing a total of 1564 patients with a mean age of 26.1 years (range 3-74 years, with a few patients <18 years. All were retrospective cohort studies with relatively small and heterogeneous samples with inconsistent reporting of outcome; this precluded the pooling of data and meta-analysis. Total continence was achieved in 449/1192 (37.7%; range 8-85% patients. Neurological level of the lesion and hydrocephalus were associated with incontinence. Renal function was studied in 1128 adult patients. In 290/1128 (25.7%; range 3-81.8% patients some degree of renal damage was found and end-stage renal disease was seen in 12/958 (1.3% patients. Detrusor-sphincter dyssynergy and detrusor-overactivity acted as adverse prognostic factors for the development of renal damage. CONCLUSIONS: These findings should outline follow-up schedules for SB patients, which do not yet exist. Since renal and bladder deterioration continues beyond adolescence, follow-up of these individuals is needed. We recommend standardization in reporting the outcome of urinary tract function in

  18. Interventions to improve patient hand hygiene: a systematic review.

    Science.gov (United States)

    Srigley, J A; Furness, C D; Gardam, M

    2016-09-01

    Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HCAIs). The aim of this systematic review was to determine the efficacy of patient hand hygiene interventions in reducing HCAIs and improving patient hand hygiene rates compared to usual care. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HCAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Ten studies were included, most of which were uncontrolled before-after studies (N=8). The majority of interventions (N=7) were multi-modal, with components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HCAI outcomes and four studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. In conclusion, interventions to improve patient hand hygiene may reduce the incidence of HCAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes.

  19. Left atrial size and risk of stroke in patients in sinus rhythm. A systematic review.

    Science.gov (United States)

    Overvad, Thure Filskov; Nielsen, Peter Brønnum; Larsen, Torben Bjerregaard; Søgaard, Peter

    2016-08-01

    Little is known about the risk of stroke associated with left atrial enlargement in patients in sinus rhythm, and whether such patients may have an unmet need for thromboprophylaxis. In this systematic review we summarise the existing evidence concerning left atrial size and risk of stroke in patients in sinus rhythm. Nine cohort studies were identified, analysing a total of 67,875 participants and 3,093 stroke outcomes. Rates of stroke per 100 person-years in patients with left atrial enlargement and in sinus rhythm ranged from 0.59 in a population-based cohort to 2.06 in patients referred for echocardiography. All studies reported a higher risk of stroke with larger/enlarged left atrium compared to smaller/normal sized left atrium. Two studies found indications of modification by sex, with only positive associations observed in women. Left atrial enlargement may represent an important predictor of stroke across a variety of patient populations in sinus rhythm. The underlying aetiology explaining this observed higher risk is likely to be multifactorial and not confined to a potential direct effect of left atrial enlargement on thromboembolic risk. Formal stroke risk stratification among patients with left atrial enlargement may further help identify patients who stand to gain from preventive antithrombotic therapy.

  20. Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis

    Science.gov (United States)

    2017-01-01

    Background Nipple-areola complex (NAC) reconstruction transforms a mound of soft tissue into a breast and often marks the final stage of breast reconstruction after mastectomy. Methods A systematic review and meta-analysis were conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Articles were classified based on the nipple reconstructive technique—either composite nipple sharing or local flap with nipple-sparing mastectomy (NSM) used as a control. A standardized “Satisfaction Score” (SS) for “nipple appearance” and “nipple sensation” was calculated for each technique. A Fisher’s exact test was used to compare the SS with local flap reconstruction with NSM. Results Twenty-three studies met the systematic review inclusion criteria. Nine NSM articles were identified with patient satisfaction data from 473 patients. The weighted average SS for NSM was 80.5%. Fourteen local flap technique articles were identified with satisfaction data from 984 patients and a weighted average SS of 73.9%. This was a statistically significant difference (P=0.0079). C-V and badge local flap techniques were associated with the highest SS, 92.6% and 90.5%, respectively. C-V and modified C-V flap technique was associated with a higher SS when compared to those using one or more other flap techniques (P=0.0001). Conclusions While patient satisfaction with nipple reconstruction is high regardless of technique, it is higher with NSM. When NSM is not an option, local flap reconstruction with a C-V or modified C-V flap may be associated with higher satisfaction than alternative local flap techniques. PMID:28210547

  1. Survey of care and evaluation of East African burn unit feasibility: an academic burn center exchange.

    Science.gov (United States)

    Mitchell, Katrina B; Giiti, Geofrey; Gallagher, James J

    2013-01-01

    Weill Cornell Medical College in New York, partnered with Weill Bugando Medical College and Sekou Toure Regional Referral Hospital, in Mwanza, Tanzania, to consider the development of a burn unit there. This institutional partnership provided a unique opportunity to promote sustainable academic exchange and build burn care capacity in the East African region. A Weill Cornell burn surgeon and burn fellow collaborated with the Sekou Toure department of surgery to assess its current burn care capabilities and potential for burn unit development. All aspects of interdisciplinary burn care were reviewed and institutional infrastructure evaluated. Sekou Toure is a 375-bed regional referral center and teaching hospital of Weill Bugando Medical College. In 2010-2011, it admitted 5244 pediatric patients in total; 100 of these patients were burn-injured children (2% of admissions). There was no specific data kept on percentage of body surface burned, degree of burn, length of stay, or complications. No adult, operative, or outpatient burn data were available. There are two operating theaters. Patient's families perform wound care with nursing supervision. Rehabilitation therapists consult as needed. Meals are provided three times daily by a central kitchen. Public health outreach is possible through village-based communication networks. Infrastructure to support the development of a burn care unit exists at Sekou Toure, but needs increased clinical focus, human resource capacity building, and record-keeping to track accurate patient numbers. A multidisciplinary center could improve record-keeping and outcomes, encourage referrals, and facilitate outreach through villages.

  2. Pediatric burn rehabilitation: Philosophy and strategies

    Directory of Open Access Journals (Sweden)

    Shohei Ohgi

    2013-09-01

    Full Text Available Burn injuries are a huge public health issue for children throughout the world, with the majority occurring in developing countries. Burn injuries can leave a pediatric patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. Rehabilitation is an essential and integral part of pediatric burn treatment. The aim of this article was to review the literature on pediatric burn rehabilitation from the Medline, CINAHL, and Web of Science databases. An attempt has been made to present the basic aspects of burn rehabilitation, provide practical information, and discuss the goals and conceptualization of rehabilitation as well as the development of rehabilitation philosophy and strategies.

  3. Transcranial magnetic stimulation of visual cortex in migraine patients: a systematic review with meta-analysis.

    Science.gov (United States)

    Brigo, Francesco; Storti, Monica; Nardone, Raffaele; Fiaschi, Antonio; Bongiovanni, Luigi Giuseppe; Tezzon, Frediano; Manganotti, Paolo

    2012-07-01

    We systematically reviewed the literature to evaluate the prevalence of phosphenes and the phosphene threshold (PT) values obtained during single-pulse transcranial magnetic stimulation (TMS) in adults with migraine. Controlled studies measuring PT by single-pulse TMS in adults with migraine with or without aura (MA, MwA) were systematically searched. Prevalence of phosphenes and PT values were assessed calculating mean difference (MD) and odds ratio (OR) with 95 % confidence intervals (CI). Ten trials (277 migraine patients and 193 controls) were included. Patients with MA had statistically significant lower PT compared with controls when a circular coil was used (MD -28.33; 95 % CI -36.09 to -20.58); a similar result was found in MwA patients (MD -17.12; 95 % CI -23.81 to -10.43); using a figure-of-eight coil the difference was not statistically significant. There was a significantly higher phosphene prevalence in MA patients compared with control subjects (OR 4.21; 95 % CI 1.18-15.01). No significant differences were found either in phosphene reporting between patients with MwA and controls, or in PT values obtained with a figure-of-eight coil in MA and MwA patients versus controls. Overall considered, these results support the hypothesis of a primary visual cortex hyper-excitability in MA, providing not enough evidence for MwA. A significant statistical heterogeneity reflects clinical and methodological differences across studies, and higher temporal variabilities among PT measurements over time, related to unstable excitability levels. Patients should therefore be evaluated in the true interictal period with an adequate headache-free interval. Furthermore, skull thickness and ovarian cycle should be assessed as possible confounding variables, and sham stimulation should be performed to reduce the rate of false positives. Phosphene prevalence alone cannot be considered a measure of cortical excitability, but should be integrated with PT evaluation.

  4. Hospital costs associated with pediatric burn injury.

    Science.gov (United States)

    Klein, Matthew B; Hollingworth, William; Rivara, Frederick P; Kramer, C Bradley; Askay, Shelley W; Heimbach, David M; Gibran, Nicole S

    2008-01-01

    Modern burn care is a resource intensive endeavor requiring specialized equipment, personnel, and facilities in order to provide optimum care. The costs associated with burn injury to both patients and society as a whole can be multifaceted and large. The purpose of this study was to evaluate the association between hospital costs, patient characteristics, and injury factors in a cohort of pediatric patients admitted to a regional burn center. We performed a review of the hospital charges accrued by pediatric patients (age dollar costs using an inflation index and a cost to charge ratio. Univariate and multivariate regressions were performed to identify the factors most significantly associated with cost. In addition, we performed a subset cost analysis for patients with burns more than 20% TBSA. A total of 1443 pediatric patients (age dollars was dollars 9026 (SD = dollars 25,483; median = dollars 2138). Area of full thickness burn was the only patient or injury factor significantly associated with greater hospital costs (P < .05) on multivariate analysis. No single anatomic area was associated with increased hospital costs when adjusted for total overall burn size. Injury severity was the most significant factor impacting index hospitalization costs following pediatric burn injury. Further studies defining the long-term societal costs impact of burn injury are needed as are studies that evaluate the impact of burn injury on quality of life.

  5. Burns, hypertrophic scar and galactorrhea.

    Science.gov (United States)

    Karimi, Hamid; Nourizad, Samad; Momeni, Mahnoush; Rahbar, Hosein; Momeni, Mazdak; Farhadi, Khosro

    2013-07-01

    An 18-year-old woman was admitted to Motahari Burn Center suffering from 30% burns. Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the high level of prolactin were detected.She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients.

  6. Burns, hypertrophic scar and galactorrhea

    Directory of Open Access Journals (Sweden)

    Hamid Karimi

    2013-07-01

    Full Text Available An 18-year old woman was admitted to Motahari Burn Center suffering from 30% burns. Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs .At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the high level of prolactin were detected. She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients.

  7. Patient-initiated second opinions: systematic review of characteristics and impact on diagnosis, treatment, and satisfaction.

    Science.gov (United States)

    Payne, Velma L; Singh, Hardeep; Meyer, Ashley N D; Levy, Lewis; Harrison, David; Graber, Mark L

    2014-05-01

    The impact of second opinions on diagnosis in radiology and pathology is well documented; however, the value of patient-initiated second opinions for diagnosis and treatment in general medical practice is unknown. We conducted a systematic review of patient-initiated second opinions to assess their impact on clinical outcomes and patient satisfaction and to determine characteristics and motivating factors of patients who seek a second opinion. We searched PubMed, EMBASE, Cochrane, and Academic OneFile databases using Medical Subject Headings (MeSH) indexes and keyword searches. Search terms included referral and consultation, patient-initiated, patient preference, patient participation, second opinion, second review, and diagnosis. Multiple reviewers screened abstracts and articles to determine eligibility and extract data. We assessed risk of bias using the Cochrane Risk of Bias Tool and rated study quality using Cochrane's GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. We screened 1342 abstracts and reviewed full text of 41 articles, identifying 7 articles that reported clinical agreement data and 10 that discussed patient characteristics, motivation, and satisfaction. We found that a second opinion typically confirms the original diagnosis or treatment regimen but that 90% of patients with poorly defined conditions remain undiagnosed. However, 10% to 62% of second opinions yield a major change in the diagnosis, treatment, or prognosis. A larger fraction of patients receive different advice on treatment than on diagnosis. Factors motivating a second opinion include diagnosis or treatment confirmation, dissatisfaction with a consultation, desire for more information, persistent symptoms, or treatment complications. Patients generally believed that second opinions were valuable. Second opinions can result in diagnostic and treatment differences. The literature on patient-initiated second opinions is limited, and the accuracy of

  8. Fluid management in major burn injuries

    Directory of Open Access Journals (Sweden)

    Haberal Mehmet

    2010-10-01

    Full Text Available It is a widely accepted fact that severe fluid loss is the greatest problem faced following major burn injuries. Therefore, effective fluid resuscitation is one of the cornerstones of modern burn treatment. The aim of this article is to review the current approaches available for modern trends in fluid management for major burn patients. As these current approaches are based on various experiences all over the world, the knowledge is essential to improve the status of this patient group.

  9. A systematic review of time studies to assess the impact of patient transfers on nurse workload.

    Science.gov (United States)

    Blay, Nicole; Duffield, Christine M; Gallagher, Robyn; Roche, Michael

    2014-12-01

    Patients in hospital are increasingly being moved between clinical units and between bedspaces; however, the impact of patient transfers and bedspace moves on nurses' workload is not known. Time studies are an established observational research method that can be used to determine the duration of time taken to perform an activity or process. This review systematically searched four databases for literature published between 2000 and 2013 for observational time study techniques and patient transfers as a nurse activity. Eleven publications from three countries were included in the review. All studies used timing techniques to explore nurse work associated with the transfer process. The review highlights the duration of time spent by nurses on certain aspects of the transfer process. However, as few studies published results from timings, the impact on nurse time is likely to be higher than indicated. Further research is recommended.

  10. Serum infliximab concentrations in psoriatic patients treated with infliximab: a systematic review.

    Science.gov (United States)

    Dannepond, Carole; Maruani, Annabel; Machet, Laurent; Ternant, David; Paintaud, Gilles; Samimi, Mahtab

    2015-04-01

    The efficacy of infliximab is influenced by individual variability in its pharmacokinetics and pharmacodynamics. Serum infliximab concentrations could therefore be related to the efficacy and tolerance of infliximab, and assist adjustment of treatment. The aim of this systematic review was to assess the value of measuring serum infliximab concentrations in psoriatic patients. A bibliographic search was performed on MEDLINE, CENTRAL, EMBASE, LILACS for original studies on serum infliximab concentrations in psoriatic patients treated with infliximab. Ten articles were included, representing evaluation of serum infliximab concentrations in 733 patients. Predictive value of higher serum infliximab concentrations on long-term response maintenance was suggested in 3 studies. There was no information regarding the value of such measurements for adjustment of infliximab dosage. Trough serum infliximab concentrations that are at least detectable (>0.1 mg/L) at steady state (week 22) seem to be associated with maintaining a clinical response in the long term.

  11. Cognitive dysfunction in patients with chronic obstructive pulmonary disease - A systematic review

    DEFF Research Database (Denmark)

    Schou, Lone; Østergaard, Birte; Rasmussen, Lars S;

    2012-01-01

    databases: Medline, PsychINFO, Cochrane Library, EMBASE, CINAHL, and SweMed up to July 2010. The articles were included if(1) participants were patients with COPD,(2) relevant outcome was cognitive function investigated by a neuropsychological test battery, and(3) the severity of COPD had been assessed......BACKGROUND: Substantial healthcare resources are spent on chronic obstructive pulmonary disease (COPD). In addition, the involvement of patients in monitoring and treatment of their condition has been suggested. However, it is important to maintain a view of self-care that takes differences...... in cognitive ability into account. The aim of this study was to determine the occurrence and severity of cognitive dysfunction in COPD patients, and to assess the association between severity of COPD and the level of cognitive function. METHODS: We conducted a systematic review, and a search in the following...

  12. First Aid: Burns

    Science.gov (United States)

    ... Your 1- to 2-Year-Old First Aid: Burns KidsHealth > For Parents > First Aid: Burns A A A Scald burns from hot water and other liquids are the most common burns in early childhood. Because burns range from mild ...

  13. First Aid: Burns

    Science.gov (United States)

    ... Old Feeding Your 8- to 12-Month-Old Feeding Your 1- to 2-Year-Old First Aid: Burns KidsHealth > For Parents > First Aid: Burns Print A A A Scald burns from hot water and other liquids are the most common burns in early childhood. Because burns range from mild to life threatening, ...

  14. Nursing Experience of Burn Patients Developed Wound Infection%烧伤患者并发创面感染的护理体会

    Institute of Scientific and Technical Information of China (English)

    黄留华; 黄颖

    2012-01-01

    Objective; To explore burn patients wound infection prevention and nursing intervention. Methods: 90 cases of burn patients were randomly divided into two groups,45 patients in each group. In the control group was given common nursing care; in the observation group, besides conventional care, the nursing of wound infection was added. Results: The observation group of wound infection rate was 8.89% and 28.89% in control group. Two groups of wound infection rates comparative differences have statistically significant ( P<0.05 ). And the observation group wound healing time was significantly lower than than in the control group ( P<0.05 ). Conclusion: Strengthening the burn wound care can effectively control the occurrence of wound infection.%目的:探讨烧伤患者防治创面感染的护理措施.方法:将烧伤病人90例随机分为两组各45例,对照组采取常规护理,观察组在常规护理基础上重点加强创面的感染护理.结果:观察组的创面感染率为8.89%,对照组为28.89%,两组创面感染率比较差异有统计学意义(P<0.05),且观察组创面愈合时间明显低于对照组(P<0.05).结论:通过加强烧伤病人的创面护理,可有效控制创面感染的发生.

  15. Carbapenem resistance and mortality in patients with Acinetobacter baumannii infection: systematic review and meta-analysis.

    Science.gov (United States)

    Lemos, E V; de la Hoz, F P; Einarson, T R; McGhan, W F; Quevedo, E; Castañeda, C; Kawai, K

    2014-05-01

    Acinetobacter baumannii has emerged as a major cause of healthcare-associated infections. Controversy exists as to whether antimicrobial resistance increases the risk of mortality. We conducted a systematic review and meta-analysis to examine this association. We searched MEDLINE and EMBASE databases up to May 2013 to identify studies comparing mortality in patients with carbapenem-resistant A. baumannii (CRAB) vs. carbapenem-susceptible A. baumannii (CSAB). A random-effects model was used to pool Odds Ratios (OR). Heterogeneity was examined using I(2). We included 16 observational studies. There were 850 reported deaths (33%) among the 2546 patients. Patients with CRAB had a significantly higher risk of mortality than patients with CSAB in the pooled analysis of crude effect estimates (crude OR = 2.22; 95% CI = 1.66, 2.98), although substantial heterogeneity was evident (heterogeneity I(2) = 55%). The association remained significant in the pooled adjusted OR of 10 studies. Studies reported that patients with CRAB compared to patients with CSAB were more likely to have severe underlying illness and also to receive inappropriate empirical antimicrobial treatment, which increases the risk of mortality. Our study suggests that carbapenem resistance may increase the risk of mortality in patients with A. baumannii infection. However, cautious interpretation is required because of the residual confounding factors and inadequate sample size in most studies.

  16. Recent changes in bacteremia in patients with cancer: a systematic review of epidemiology and antibiotic resistance.

    Science.gov (United States)

    Montassier, E; Batard, E; Gastinne, T; Potel, G; de La Cochetière, M F

    2013-07-01

    Bacteremia remains a major cause of life-threatening complication in patients with cancer. Significant changes in the spectrum of microorganisms isolated from blood culture have been reported in cancer patients over the past years. The aim of our systematic review was to inventory the recent trends in epidemiology and antibiotic resistance of microorganisms causing bacteremia in cancer patients. Data for this review was identified by searches of Medline, Scopus and Cochrane Library for indexed articles and abstracts published in English since 2008. The principal search terms were: "antimicrobial resistance", "bacteremia", "bacterial epidemiology", "bloodstream infection", "cancer patients", "carbapenem resistance", "Escherichia coli resistance", "extended-spectrum β-lactamase producing E. coli", "febrile neutropenia", "fluoroquinolone resistance", "neutropenic cancer patient", "vancomycin-resistant Enterococcus", and "multidrug resistance". Boolean operators (NOT, AND, OR) were also used in succession to narrow and widen the search. Altogether, 27 articles were selected to be analyzed in the review. We found that Gram-negative bacteria were the most frequent pathogen isolated, particularly in studies with minimal use of antibiotic prophylaxis. Another important trend is the extensive emergence of antimicrobial-resistant strains associated with increased risk of morbidity, mortality and cost. This increasing incidence of antibiotic resistance has been reported in Gram-negative bacteria as well as in Gram-positive bacteria. This exhaustive review, reporting the recent findings in epidemiology and antibiotic resistance of bacteremia in cancer patients, highlights the necessity of local continuous surveillance of bacteremia and stringent enforcement of antibiotic stewardship programs in cancer patients.

  17. Dental implants in patients with oral mucosal diseases - a systematic review.

    Science.gov (United States)

    Reichart, P A; Schmidt-Westhausen, A M; Khongkhunthian, P; Strietzel, F P

    2016-05-01

    To reveal dental implants survival rates in patients with oral mucosal diseases: oral lichen planus (OLP), Sjögren's syndrome (SjS), epidermolysis bullosa (EB) and systemic sclerosis (SSc). A systematic literature search using PubMed/Medline and Embase databases, utilising MeSH and search term combinations identified publications on clinical use implant-prosthetic rehabilitation in patients with OLP, SjS, EB, SSc reporting on study design, number, gender and age of patients, follow-up period exceeding 12 months, implant survival rate, published in English between 1980 and May 2015. After a mean observation period (mOP) of 53·9 months (standard deviation [SD] ±18·3), 191 implants in 57 patients with OLP showed a survival rate (SR) of 95·3% (SD ±21·2). For 17 patients with SjS (121 implants, mOP 48·6 ± 28·7 months), 28 patients with EB (165 implants, mOP 38·3 ± 16·9 months) and five patients with SSc (38 implants, mOP 38·3 ± 16·9 months), the respective SR was 91·7 ± 5·97% (SjS), 98·5 ± 2·7% (EB) and 97·4 ± 4·8% (SSc). Heterogeneity of data structure and quality of reporting outcomes did not allow for further comparative data analysis. For implant-prosthetic rehabilitation of patients suffering from OLP, SjS, EB and SSc, no evidence-based treatment guidelines are presently available. However, no strict contraindication for the placement of implants seems to be justified in patients with OLP, SjS, EB nor SSc. Implant survival rates are comparable to those of patients without oral mucosal diseases. Treatment guidelines as for dental implantation in patients with healthy oral mucosa should be followed.

  18. A systematic review of mobility instruments and their measurement properties for older acute medical patients

    Directory of Open Access Journals (Sweden)

    Berlowitz David J

    2008-06-01

    Full Text Available Abstract Background Independent mobility is a key factor in determining readiness for discharge for older patients following acute hospitalisation and has also been identified as a predictor of many important outcomes for this patient group. This review aimed to identify a physical performance instrument that is not disease specific that has the properties required to accurately measure and monitor the mobility of older medical patients in the acute hospital setting. Methods Databases initially searched were Medline, Cinahl, Embase, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials without language restriction or limits on year of publication until July 2005. After analysis of this yield, a second step was the systematic search of Medline, Cinahl and Embase until August 2005 for evidence of the clinical utility of each potentially suitable instrument. Reports were included in this review if instruments described had face validity for measuring from bed bound to independent levels of ambulation, the items were suitable for application in an acute hospital setting and the instrument required observation (rather than self-report of physical performance. Evidence of the clinical utility of each potentially suitable instrument was considered if data on measurement properties were reported. Results Three instruments, the Elderly Mobility Scale (EMS, Hierarchical Assessment of Balance and Mobility (HABAM and the Physical Performance Mobility Examination (PPME were identified as potentially relevant. Clinimetric evaluation indicated that the HABAM has the most desirable properties of these three instruments. However, the HABAM has the limitation of a ceiling effect in an older acute medical patient population and reliability and minimally clinically important difference (MCID estimates have not been reported for the Rasch refined HABAM. These limitations support the proposal that a new mobility instrument is

  19. Indicators of patients with major depressive disorder in need of highly specialized care: A systematic review

    Science.gov (United States)

    Kaddouri, Meriam; Goorden, Maartje; van Balkom, Anton J. L. M.; Bockting, Claudi L. H.; Peeters, Frenk P. M. L.; Hakkaart-van Roijen, Leona

    2017-01-01

    Objectives Early identification of patients with major depressive disorder (MDD) that cannot be managed by secondary mental health services and who require highly specialized mental healthcare could enhance need-based patient stratification. This, in turn, may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response. The development of a valid tool to identify patients with MDD in need of highly specialized care is hampered by the lack of a comprehensive understanding of indicators that distinguish patients with and without a need for highly specialized MDD care. The aim of this study, therefore, was to systematically review studies on indicators of patients with MDD likely in need of highly specialized care. Methods A structured literature search was performed on the PubMed and PsycINFO databases following PRISMA guidelines. Two reviewers independently assessed study eligibility and determined the quality of the identified studies. Three reviewers independently executed data extraction by using a pre-piloted, standardized extraction form. The resulting indicators were grouped by topical similarity, creating a concise summary of the findings. Results The systematic search of all databases yielded a total of 7,360 references, of which sixteen were eligible for inclusion. The sixteen papers yielded a total of 48 unique indicators. Overall, a more pronounced depression severity, a younger age of onset, a history of prior poor treatment response, psychiatric comorbidity, somatic comorbidity, childhood trauma, psychosocial impairment, older age, and a socioeconomically disadvantaged status were found to be associated with proxies of need for highly specialized MDD care. Conclusions Several indicators are associated with the need for highly specialized MDD care. These indicators provide easily measurable factors that may serve as a starting point for the development of a valid tool to identify patients with MDD in need of highly

  20. Nutritional Status in Nocturnal Hemodialysis Patients - A Systematic Review with Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Karin J R Ipema

    Full Text Available Hemodialysis patients experience an elevated risk of malnutrition associated with increased morbidity and mortality. Nocturnal hemodialysis (NHD results in more effective removal of waste products and fluids. Therefore, diet and fluid restrictions are less restricted in NHD patients. However, it is ambiguous whether transition from conventional hemodialysis (CHD to NHD leads to improved intake and nutritional status. We studied the effect of NHD on protein intake, laboratory indices of nutritional status, and body composition.Systematic review with meta-analysis.NHD patients.Systematic literature search from databases, Medline, Cinahl, EMBASE and The Cochrane Library, to identify studies reporting on nutritional status post-transition from CHD to NHD.Transition from CHD to NHD.Albumin, normalized protein catabolic rate (nPCR, dry body weight (DBW, body mass index (BMI, phase angle, protein intake, and energy intake.Systematic literature search revealed 13 studies comprising 282 patients that made the transition from CHD to NHD. Meta-analysis included nine studies in 229 patients. In control group controlled studies (n = 4, serum albumin increased significantly from baseline to 4-6 months in NHD patients compared with patients that remained on CHD (mean difference 1.3 g/l, 95% CI 0.02; 2.58, p = 0.05. In baseline controlled studies, from baseline to 4-6 months of NHD treatment, significant increases were ascertained in serum albumin (mean difference (MD 1.63 g/l, 95% CI 0.73-2.53, p<0.001; nPCR (MD 0.16 g/kg/day; 95% CI 0.04-0.29, p = 0.01; protein intake (MD 18.9 g, 95% CI 9.7-28.2, p<0.001; and energy intake (MD 183.2 kcal, 95% CI 16.8-349.7, p = 0.03. Homogeneity was rejected only for nPCR (baseline versus 4-6 months. DBW, BMI, and phase angle did not significantly change. Similar results were obtained for comparison between baseline and 8-12 months of NHD treatment.Most studies had moderate sample sizes; some had incomplete dietary records

  1. LA50 in burn injuries.

    Science.gov (United States)

    Seyed-Forootan, K; Karimi, H; Motevalian, S A; Momeni, M; Safari, R; Ghadarjani, M

    2016-03-31

    Burn injuries put a huge financial burden on patients and healthcare systems. They are the 8th leading cause of mortality and the 13th most common cause of morbidity in our country. We used data from our Burn Registry Program to evaluate risk factors for mortality and lethal area fifty percent (LA50) in all burn patients admitted over two years. We used multiple logistic regressions to identify risk factors for mortality. LA50 is a reliable aggregate index for hospital care quality and a good measure for comparing results, also with those of other countries. 28,690 burn patients sought medical attention in the Emergency Department, and 1721 of them were admitted. Male to female ratio was 1,75:1. 514 patients were under 15 years old. Median age was 25 (range: 3 months - 93 years). Overall, probability of death was 8.4%. LA50 was 62.31% (CI 95%: 56.57-70.02) for patients aged 15 and over and 72.52% (CI 95%: 61.01-100) for those under 15. In the final model, we found that Adjusted OR was significant for age, female sex, TBSA and inhalation injury (P age and inhalation injury were the main risk factors for death. Authorities should pay special attention to these variables, especially in prevention programs, to reduce mortality and improve patient outcome. Children have better outcome than adults given equal burn size. Suicide rates are higher for women than men in our country.

  2. Non-Invasive Ventilation in Patients with Heart Failure: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Bittencourt, Hugo Souza; dos Reis, Helena França Correia; Lima, Melissa Santos; Gomes Neto, Mansueto

    2017-01-01

    Non-invasive ventilation (NIV) may perfect respiratory and cardiac performance in patients with heart failure (HF). The objective of the study to establish, through systematic review and meta-analysis, NIV influence on functional capacity of HF patients. A systematic review with meta-analysis of randomized studies was carried out through research of databases of Cochrane Library, SciELO, Pubmed and PEDro, using the key-words: heart failure, non-invasive ventilation, exercise tolerance; and the free terms: bi-level positive airway pressure (BIPAP), continuous positive airway pressure (CPAP), and functional capacity (terms were searched for in English and Portuguese) using the Boolean operators AND and OR. Methodological quality was ensured through PEDro scale. Weighted averages and a 95% confidence interval (CI) were calculated. The meta-analysis was done thorugh the software Review Manager, version 5.3 (Cochrane Collaboration). Four randomized clinical trials were included. Individual studies suggest NIV improved functional capacity. NIV resulted in improvement in the distance of the six-minute walk test (6MWT) (68.7m 95%CI: 52.6 to 84.9) in comparison to the control group. We conclude that the NIV is an intervention that promotes important effects in the improvement of functional capacity of HF patients. However, there is a gap in literature on which are the most adequate parameters for the application of this technique. PMID:28099587

  3. Measurement properties of patient-reported outcome measures (PROMS) in Patellofemoral Pain Syndrome: a systematic review.

    Science.gov (United States)

    Green, Andrew; Liles, Clive; Rushton, Alison; Kyte, Derek G

    2014-12-01

    This systematic review investigated the measurement properties of disease-specific patient-reported outcome measures used in Patellofemoral Pain Syndrome. Two independent reviewers conducted a systematic search of key databases (MEDLINE, EMBASE, AMED, CINHAL+ and the Cochrane Library from inception to August 2013) to identify relevant studies. A third reviewer mediated in the event of disagreement. Methodological quality was evaluated using the validated COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) tool. Data synthesis across studies determined the level of evidence for each patient-reported outcome measure. The search strategy returned 2177 citations. Following the eligibility review phase, seven studies, evaluating twelve different patient-reported outcome measures, met inclusion criteria. A 'moderate' level of evidence supported the structural validity of several measures: the Flandry Questionnaire, Anterior Knee Pain Scale, Functional Index Questionnaire, Eng and Pierrynowski Questionnaire and Visual Analogue Scales for 'usual' and 'worst' pain. In addition, there was a 'Limited' level of evidence supporting the test-retest reliability and validity (cross-cultural, hypothesis testing) of the Persian version of the Anterior Knee Pain Scale. Other measurement properties were evaluated with poor methodological quality, and many properties were not evaluated in any of the included papers. Current disease-specific outcome measures for Patellofemoral Pain Syndrome require further investigation. Future studies should evaluate all important measurement properties, utilising an appropriate framework such as COSMIN to guide study design, to facilitate optimal methodological quality.

  4. Chronic coinfections in patients diagnosed with chronic Lyme disease: a systematic literature review

    Science.gov (United States)

    Lantos, Paul M.; Wormser, Gary P.

    2014-01-01

    Purpose The controversial diagnosis of chronic Lyme disease is often given to patients with prolonged, medically unexplained physical symptoms. Many such patients are also treated for chronic co-infections with Babesia, Anaplasma, or Bartonella in the absence of typical presentations, objective clinical findings, or laboratory confirmation of active infection. We have undertaken a systematic review of the literature to evaluate several aspects of this practice. Methods Five systematic literature searches were performed using Boolean operators and the PubMed search engine. Results The literature searches did not demonstrate convincing evidence of 1) chronic anaplasmosis infection, 2) treatment responsive symptomatic chronic babesiosis in immunocompetent persons in the absence of fever, laboratory abnormalities and detectable parasitemia, 3) either geographically widespread or treatment responsive symptomatic chronic infection with Babesia duncani in the absence of fever, laboratory abnormalities and detectable parasitemia, 4) tick-borne transmission of Bartonella species, or 5) simultaneous Lyme disease and Bartonella infection. Conclusions The medical literature does not support the diagnosis of chronic, atypical tick-borne coinfections in patients with chronic, nonspecific illnesses. PMID:24929022

  5. Prognostic value of circulating tumor DNA in patients with colon cancer: Systematic review

    Science.gov (United States)

    Fan, Gaowei; Zhang, Kuo; Yang, Xin; Ding, Jiansheng; Wang, Zujian; Li, Jinming

    2017-01-01

    The application of circulating tumor DNA(ctDNA) represents a non-invasive method for tumor detection. Its prognostic significance in patients with colorectal cancer is controversial. We performed a systematic review of data from published studies to assess the prognostic values of ctDNA in patients with colorectal cancer. We searched Medline, Embase, Web of Science, the Cochrane Library, and Scopus databases to identify eligible studies reporting disease-free survival (DFS) and overall survival (OS) stratified by ctDNA prior to December 6, 2016. We evaluated the quality and design of these studies. A total of 22 studies were eligible for systematic review. Among them, 11 studies investigated the prognostic value of ctDNA on disease-free survival (DFS). Seven of 11 studies showed that ctDNA was an independent variable to estimate the probability of DFS by multivariate analyses. Thirteen studies assessed the relationship between ctDNA and overall survival (OS). Eight of 13 studies showed that ctDNA was an independent predictor of worse OS through the use of multivariate analyses. This analysis provides evidence that ctDNA may be a prognostic biomarker, negatively correlated with the survival of patients with colorectal cancer. PMID:28187169

  6. Palliative sedation in advanced cancer patients: Does it shorten survival time? - A systematic review

    Directory of Open Access Journals (Sweden)

    B Barathi

    2013-01-01

    Full Text Available Background: Patients with advanced cancer often suffer from multiple refractory symptoms in the terminal phase of their life. Palliative sedation is one of the few ways to relieve this refractory suffering. Objectives: This systematic review investigated the effect of palliative sedation on survival time in terminally ill cancer patients. Materials and Methods: Six electronic databases were searched for both prospective and retrospective studies which evaluated the effect of palliative sedation on survival time. Only those studies which had a comparison group that did not receive palliative sedation were selected for the review. Abstracts of all retrieved studies were screened to include the most relevant studies and only studies which met inclusion criteria were selected. References of all retrieved studies were also screened for relevant studies. Selected studies were assessed for quality and data extraction was done using the structured data extraction form. Results: Eleven studies including four prospective and seven retrospective studies were identified. Mean survival time (MST was measured as the time from last admission until death. A careful analysis of the results of all the 11 studies indicated that MST of sedated and non-sedated group was not statistically different in any of the studies. Conclusion: This systematic review supports the fact that palliative sedation does not shorten survival in terminally ill cancer patients. However, this conclusion needs to be taken with consideration of the methodology, study design, and the population studied of the included studies in this review.