The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Sep 1987
Comparative StudyComparison of energy expenditure measurement techniques in severely burned patients.
The degree of accuracy of existing formulas for calculating energy expenditure can be determined by comparing them to the measured energy expenditure via indirect calorimetry. As a result, one can modify traditional predicted recommendations for nutrition alimentation of the burn patient with real-time data. In this study, 21 sequential adult admissions with second- and third-degree total body surface area (TBSA) burn wounds (range 21%-81% TBSA) underwent serial assessments of energy expenditure by indirect calorimetry. ⋯ No significant difference was noted between the mean MEE at maximum (MEEM) and the mean CEEA or the mean MBEEA. This indicates excessive overfeeding of the burn patient from admission to discharge by both standard formulas. Actual measured data provide a better indicator of varying nutritional needs throughout the hospital course than the standard formulas, and their use would result in significant savings in the expenses of enteral/parenteral nutritional supplements.
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J Burn Care Rehabil · Sep 1987
Randomized Controlled Trial Comparative Study Clinical TrialA prospective controlled trial of Biobrane versus scarlet red on skin graft donor areas.
A prospective trial of Biobrane versus scarlet red as a skin graft donor site dressing was done in 21 burn patients with mean total body surface area burns of 31.9%. Corresponding body areas were randomly selected on each patient to receive one of the dressings. Daily evaluations were made of subjective expression of pain, exudate formation and infection, and time of separation of the dressing from the wound. ⋯ Occlusive dressings have previously been shown to have a high incidence of complications (30%). In extensive burns, isolating the donor site from the wound is difficult and may lead to increased complications. Scarlet red appears to be superior to Biobrane for skin graft donor sites in this patient population.
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J Burn Care Rehabil · Jul 1987
Adult psychosocial adjustment following childhood injury: the effect of disfigurement.
The literature investigating the psychosocial adjustment of burn survivors is limited and that addressing such adjustment in burned children is contradictory. Forty-two adults, burned in childhood, were assembled into burn severity cohorts and compared as to burn severity, intensity of stress, and extent of disfigurement and disability. The findings substantiated the hypothesis that the biologic variables of years since burn and severity would not explain psychosocial adjustment in adulthood; lower adjustment correlated with visible disfigurement and less peer support rather than with severity of burn.
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The staff of a burn unit was surveyed concerning attitudes about their patients and the treatment procedure. Previous research indicates that in such medical settings paradoxical interactions (double binds) may occur among staff, patient, and family. We hypothesized that the paradoxical environment of burn care units facilitates individuals who can change their perspective (or reframe these situations) and that this ability is related to attitudes and feelings about burn patients and their treatment. ⋯ Staff members are quite positive about burn treatment and agree that the staff instills hope. The staff's endorsement of providing accurate information, while behaving optimistically even if pessimistic about the patient's condition, does represent possible double-binding communication patterns. Nursing managers with high reframing ability may facilitate staff coping with these issues.