The Journal of burn care & rehabilitation
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As funding for health care becomes a national concern, and workman's compensation and private health insurance companies attempt to limit their expenditures in the treatment of the client with burns, it may become the responsibility of the burn specialists to create a cost-effective approach to quality burn rehabilitation. Our outpatient rehabilitation program has taken a cost-effective approach that limits the use of inpatient rehabilitation, emphasizes the burn team guiding the client to a quick functional return to home and work, and concentrates costs for therapy rather than room and board. This cost-effective rehabilitation approach emphasizes an intensive 6-hours-per day, 5-days-per-week outpatient program that begins immediately after discharge. ⋯ In the cost-effective rehabilitation approach, 82% of the health care costs are concentrated for therapy. In the traditional inpatient rehabilitation program, room and board costs comprise 57% of the charges. Because it is the responsibility of the burn specialists to educate the health care payers, a program description to implement the cost-effective approach to burn rehabilitation is provided.
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J Burn Care Rehabil · Sep 1995
Serum copper and zinc concentrations in patients with burns in relation to burn surface area.
Serum zinc and copper concentrations were measured by flame atomic absorption spectroscopy in 34 patients between 1 and 3 weeks after thermal injury. Mean (range) admission burn surface area was 29.8% (10% to 79%), and mean (range) serum zinc and copper concentrations within the first postburn week were 0.59 (0.2 to 1.5) and 0.74 (0.1 to 1.6) mg/L, respectively. Serum copper concentration was inversely correlated with burn surface area (r = -0.611, p < 0.01), whereas serum zinc concentration showed no such association. ⋯ Hypocupremia only resolved in the patient with 79% burns when skin healing was almost complete 75 days after burns. Postburn hypozincemia was found to be very variable and not associated with either serum albumin concentration or periods of clinical sepsis. Because major burn injuries are associated with hypocupremia, serial monitoring is recommended with appropriate copper supplementation.
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J Burn Care Rehabil · Sep 1995
Randomized Controlled Trial Clinical TrialProspective, randomized study of the efficacy of pressure garment therapy in patients with burns.
A randomized, prospective study was undertaken to determine the efficacy of pressure garment therapy in patients with burns. Patients were randomly assigned to receive either pressure garment therapy or no pressure garment therapy. ⋯ Eight of the patients receiving pressure garment therapy and nine receiving no pressure garment therapy were not involved in the follow-up. No significant differences were found between the two groups when age, body surface area burn, length of hospital stay, or time to wound maturation were compared.
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J Burn Care Rehabil · Sep 1995
Management of skin-grafted burn wounds with Xeroform and layers of dry coarse-mesh gauze dressing results in excellent graft take and minimal nursing time.
The goals of postoperative treatment for split-thickness skin grafts (STSGs) are to maintain graft integrity, prevent graft and wound desiccation, and minimize infections. As we documented in a telephone survey of 16 burn centers, dressings for skin grafts usually consist of multiple layers of coarse-mesh gauze; the dressings receive frequent applications of aqueous solutions that contain antimicrobial agents to control bacterial growth and to maintain a moist environment at the wound surface. We prospectively studied the efficacy of our standard dressing of one layer of Xeroform (Kendall Inc., Mansfield, Mass.), which consists of fine-mesh gauze impregnated with bismuth tribromophenate, applied to the STSG surface followed by layers of dry gauze dressings wrapped in Kerlix (Kendall Inc.); the entire dressings were left intact until postoperative day 5. ⋯ Patients' grafts were evaluated on postoperative day 5 for the percentage of "take" and subgraft fluid collected; this evaluation was then repeated every other day for 10 days. On postoperative day 5 evaluations, mean skin graft take in all patients was 98.54% +/- 0.72%. Xeroform and coarse-mesh gauze dressings used to cover STSGs and left intact for 5 days until the initial dressing change, resulted in highly successful graft outcomes, with minimal postoperative nursing care compared with other dressing methods for skin grafts.
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The share of total hospital Canadian burn care provided by 17 of Canada's 27 present burn units increased marginally to 18.3% in 1991 from 17.0% in 1981 (p = 0.0506), and the mortality rate decreased from 5.6% in 1981 to 3.5% in 1991 (p < 0.05). In 10 units providing serial data, patients with burns undergoing ventilation therapy for a concomitant smoke inhalation injury increased from 6.3% (n = 58) of 1981 admissions to 11.1% (n = 73) of 1991 admissions (p < 0.05). In 1991 Canada's 27 burn units treated 32.4% of Canada's hospitalized patients with burns and provided 50.6% of hospital burn care days. Although the total number of patients with burns hospitalized in Canada decreased by 35% from 7923 in 1981 to 5161 in 1991 (32.6 to 18.9 per 100,000 population), with a proportional decrease in patients treated in burn units, the requirement for intensive care unit capability to treat patients undergoing ventilation therapy has remained the same or is greater and must be preserved as burn units shrink.