The Journal of burn care & rehabilitation
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Many patients with minor burn wounds will initially be evaluated in an emergency department (ED) and incur unnecessary costs that could be avoided through a direct referral to a burn center. In June 1997, use of an ED burn triage protocol was begun at our hospital. Adults with uncomplicated burns that covered more than 1% and less than 15% of total body surface area (TBSA) and children with burns that covered more than 1% and less than 10% of TBSA were to be triaged directly to the outpatient clinic of the burn center without registering in the ED. ⋯ The average ED visit time for these patients was 103 minutes versus 44 minutes for patients who were sent directly to the burn clinic. An estimated $125,000 per year decrease in charges would occur with use of the protocol. Implementation of an ED triage protocol leads to avoidance of emergency room visits for the majority of patients with minor burn injuries, which results in more efficient, less expensive, faster care.
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J Burn Care Rehabil · Nov 1999
The 1999 clinical research award. Cultured skin substitutes combined with Integra Artificial Skin to replace native skin autograft and allograft for the closure of excised full-thickness burns.
Prompt and permanent closure of excised full-thickness burns remains a critical factor in a patient's recovery from massive burn injuries. Hypothetically, Integra Artificial Skin (Integra) may replace the need for allografts for immediate wound coverage, and cultured skin substitutes (CSS) that contain stratified epithelium may replace the need for autografts for definitive wound closure. To test this hypothesis, 3 patients with full-thickness burns of greater than 60% of their total body surface areas had their eschar excised within 14 days of admission. ⋯ These results demonstrate that the combination of CSS and Integra can accomplish functionally stable and cosmetically acceptable wound closure in patients with extensive full-thickness burns. This combination of alternatives to the conventional grafting of split-thickness skin permits the substitution of cadaveric allograft with Integra and the substitution of donor autograft with CSS. This approach to the closure of excised full-thickness burns is expected to reduce greatly the time to definitive closure of burn wounds and to reduce the morbidity associated with the harvesting of donor sites for split-thickness skin autografts.
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Facial burns present many psychological and rehabilitation challenges. Many of our patients with facial burns who are children and adolescents have expressed that they prefer to wear the transparent face mask instead of the Jobst hood (Beiersdorf Jobst Inc, Charlotte, NC) with an underlying silicone face pad. ⋯ No significant difference in pressure was observed between the transparent facemask and the silicone face pad with a Jobst hood. We recommend the use of the transparent face mask on patients with severe facial burns who may require pressure to improve the appearance of their scars.
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J Burn Care Rehabil · Nov 1999
A qualitative analysis of family member needs and concerns in the population of patients with burns.
The importance of family support to ameliorate the recovery of a patient with burns has been documented in the literature. However, there is a dearth of research that identifies family members' needs and concerns during the hospitalization of patients with burns. Study aims were as follows: (1) identify support needs and concerns of family members of adult and pediatric patients currently in a burn center and (2) explore the relationship between family needs and the patient's severity of injury. ⋯ Satisfaction of personal needs, financial support, and information needs were greater among family members of intensive care unit patients in comparison with step-down patients. These findings underscore the importance of communication and reassurance between the burn team and the family members. Alterations to the support provided to families can be made on the basis of study subjects' responses.
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J Burn Care Rehabil · Nov 1999
The relationship of burnout, stress, and hardiness in nurses in a military medical center: a replicated descriptive study.
The purpose of this descriptive study was to determine whether the personality trait of hardiness is a predictor of burnout and whether it can buffer the effect of stress on burnout. Forty-nine registered nurses working in 7 special care units completed the Tedium Burnout Scale, the Nursing Stress Scale, and the Hardiness Test. Results indicate that burnout, stress, and hardiness had a significant relationship (P < .001). ⋯ However, in this study, nurses from the Burn Intensive Care Unit had the highest burnout and stress scores and the lowest hardiness scores of nurses from the 7 units. This study confirms findings by a previous study that hardiness is a predictor of burnout but is not a buffer in the stress-burnout relationship. To further understand burnout and hardiness, longitudinal and multisite studies that include burn units are recommended.