The Journal of burn care & rehabilitation
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Secure positioning of orally or nasally placed endotracheal and gastric tubes is a necessity for the patient with burns. This article describes a technique for securing these tubes with a simple modification to avoid compression on the ear that may lead to subsequent necrosis and infection.
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J Burn Care Rehabil · May 1990
A knowledge-based information system for advice in the crisis management of the patient with burns.
A knowledge-based information system that has been designed to be used as an electronic advisor to guide in fluid resuscitation and in the management of the most frequently occurring complications during the first 48 hours after burn injury is described. The system was also developed for training physicians and nurses and may eventually be used for peer review of the management of patients in the burn unit. Ten data screens are used for entry of the administrative data, the clinical background, and the monitored data. ⋯ The system's conclusions, the fluid and ventilation prescription, and other required patient management measures are then displayed as a report. The underlying reasoning for each case may be explored by means of the system's explanation facility. The system has been successfully validated by 125 hypothetic cases that represent typical situations of patients with severe burns.
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A reliable, objective, and universal method of assessing burn scars does not exist in today's burn literature. Such a method is necessary to provide a descriptive terminology for the comparison of burn scars and the results of treatment. The method should be applicable to patients both within an institution and between burn centers. ⋯ For each parameter a Cohen's kappa statistic of approximately 0.5 +/- 0.1 indicates a statistically significant agreement between observers. These values were found to improve with time. This appears to be a useful tool for the assessment of burn scars, allowing objective comparison of the same scar by different observers.
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J Burn Care Rehabil · May 1990
Post-traumatic stress disorder in hospitalized patients with burn injuries.
The degree to which patients hospitalized for a major burn displayed symptoms of post-traumatic stress disorder or met the full criteria for this disorder was assessed during the course of hospitalization. Fifty-four consecutive patients were screened weekly for symptoms of post-traumatic stress disorder. ⋯ Post-traumatic stress disorder was found to be related to patients' total body surface area burn, length of hospital stay, sex (female patients), and lack of responsibility for the injury. The results suggest that although post-traumatic stress disorder in patients with burn injuries generally resolves without interventions other than standard hospital care, it might be preventable if patients who are at risk for developing it receive appropriate psychologic treatment soon after the injury.
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A patient acuity classification is required by the Joint Commission on Accreditation of Healthcare Organizations, and this is vital in providing safe, cost-effective nursing care. The Workload Management System for Nurses (WMSN), which is based on direct and indirect nursing care research, prospectively classifies patients on the basis of direct care requirements and then establishes staffing levels on the basis of both direct care and indirect care workloads. Application of the Department of Defense WMSN to the military burn research center is feasible and has provided data for objective staffing adjustments and validated staffing requirements. In addition, several other quality assurance implications have been realized as a result of implementation of the system.