The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Jul 2000
Case Reports Randomized Controlled Trial Clinical TrialControlled clinical study of deep partial-thickness burns treated with frozen cultured human allogeneic epidermal sheets.
Numerous studies, many uncontrolled, have suggested that the application of freshly prepared human allogeneic epidermal cultures promotes faster re-epithelialization of skin donor sites and deep partial-thickness burns. We describe the results of a study of deep partial-thickness burns treated with such cultures preserved in the frozen state. The study was controlled, side-by-side comparative, and randomized. ⋯ For 5 of the patients with deep partial-thickness burns, the wounds treated with frozen cultures healed in a mean time of 5.6 days, whereas the control wounds healed in 12.2 days. More importantly, for the 4 other patients with deep partial-thickness burns, the wounds treated with the frozen cultures underwent complete re-epithelialization in a mean time of 4.2 days, but the control wounds were partially or mostly unhealed at up to 14 days. The results show that the frozen cultures not only accelerate the re-epithelialization of deep and superficial partial-thickness burns but also make it possible to heal such wounds that otherwise would not heal.
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Burn center verification requires the use of autopsy as one method of quality assurance in a burn center. Because of the decreasing rates of autopsies worldwide and improved diagnostic accuracy in our critical care units, we tested the hypothesis that autopsy diagnosis would not alter our clinical diagnosis. A chart review of all deaths (N = 94) that occurred during a 6-year period (1989-1994) was performed. ⋯ Five class I errors were found in 4 patients (4.5%), and 15 class II errors were found in 13 patients (14.7%). Although the rate of potentially serious errors was low (only 4.5% of the patients in this study) postmortem examinations revealed clinical diagnostic errors. The results of this study support the continued use of autopsies as a means of quality assurance, despite our ability to closely monitor our critically ill patients with burns.
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J Burn Care Rehabil · Jul 2000
The management of self-inflicted burn injuries and disruptive behavior for patients with borderline personality disorder.
One of the greatest behavioral and ethical challenges faced by a burn team is the treatment of a patient whose burn injury is the result of parasuicidal behavior. Parasuicidal behavior is defined as intentional self-injurious behavior that, although not fatal, may result in tissue damage or risk of death. ⋯ We describe the nature of borderline personality disorder and how it leads to disruptive behavior, including self-harm behavior, on the burn unit, We also argue that if staff members fail to recognize the borderline personality disorder diagnosis, it will lead to responses from staff that can heighten disruptive behavior. We present a series of recommendations for treating such patients with burns and an illustrative case report.
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Unlike household burn injuries, the characteristics of burn injuries in the workplace have not been well described. In an effort to understand the causes and effects of occupation-related burn injuries and to aid in prevention, we sought to describe work-related burn injuries by frequency, burn type, age of the patients, body parts burned, and occupation of the patients. This was a statewide, cross-sectional study of all burns that occurred in the workplace during 1994. ⋯ Unlike the flame burns that occur in homes, exposure to caustics and hot objects and substances caused the majority of on-the-job burn injuries. Protective gear for the head and upper extremities may prevent a significant number of burns. Education and prevention programs may best be directed at workers with high-risk occupations and workers in the 25- to 35-year age range.