Burns : journal of the International Society for Burn Injuries
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Overuse of antibiotics and failure to apply basic infection control policies and procedures have contributed to the increasing multi-drug resistance of many nosocomial pathogens. The alarming increase of multi-drug-resistant bacteria (e.g. Pseudomonas aeruginosa, methicilin-resistant Staphylococci, vancomycin-resistant Enterococci) causes infected wounds associated with high mortality and morbidity in burned patients and focuses attention on the need for better treatment and prevention of wound infections. The review points out and discusses some emerging alternatives to antibiotics used in clinical practice, with special emphasis on the role of the innate immune response and potential application of human host defense peptides in thermal injury.
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The aim of this study was to investigate differences in characteristics of burn patients who had attempted suicide, as compared with other burn patients admitted to the Helsinki Burn Centre during 1989-97. Burn patients were first drawn from a computerised register, after which a psychiatrist examined their medical records and ascertained the suicide attempters. Of the total of 811 burn patients, 46 (5.7%) had attempted suicide. ⋯ Flame was a much more common cause of burns among suicide attempters (82.1%) than among the remainder (44.5%, P < 0.001). Suicide attempters were also more often unemployed (28.2 versus 12.9%) or on disability pension (30.8 versus 7.1%) before the injury (P < 0.001). Although the proportion with self-inflicted burns among all burn patients was not high, the markedly higher severity of their burns makes them an important clinical subgroup for further study.
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In estimating small areas of burns, it is traditionally taught that the patient's palm is 1% of the body surface area. Whether the palm means the palmar surface of the whole hand or palm excluding the fingers, has not been very clear and is a source of confusion to many junior doctors. ⋯ It was done through a literature search, telephonic interviews and a review of Web-pages related to burns area estimation. The results highlighted the existing confusion on the topic and the need for educating junior doctors.
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Review
Measuring functional outcome in paediatric patients with burns: methodological considerations.
Methodological criticisms of research undertaken in the area of paediatric burns are widespread. To date, quasi-experimental research designs have most frequently been used to examine the impact of impairments such as scarring and reduced range of motion on functional outcomes. ⋯ Until recently, there had been little attempt to develop and/or test a theoretical model of functional outcome with these children. Using a conceptual model of functional outcome based on the International Classification of Functioning, Disability and Health, this review paper outlines the current state of the research literature and presents explanatory case study methodology as an alternative research design to further advance the study of functional outcome post-burn injury.
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Review Case Reports
The role of Acticoat with nanocrystalline silver in the management of burns.
Silver is an effective antimicrobial agent, but older silver-containing formulations are rapidly inactivated by the wound environment, requiring frequent replenishment. These older formulations may also be pro-inflammatory and may delay healing. ⋯ Despite extensive testing and clinical experience, no evidence has emerged of resistance or cytotoxicity to nanocrystalline silver. This article collects together a number of presentations that were given at the 2003 European Burns Association Meeting on the use of Acticoat in the management of burns.