The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Sep 1996
Comparative StudyProcedural burn pain intensity under conditions of varying physical control by the patient.
Ten adult patients hospitalized as a result of major burn injury participated in a study that used a single-subject, repeated reversal design in which subject-reported pain during patient-performed washing was compared with subject-reported pain during nurse-performed washing. Analysis, by repeated-measures ANOVA, of verbal numeric pain scores obtained at regular intervals intraprocedurally, indicated that each of the 10 subjects experienced significantly less pain under the condition of patient-performed washing compared with the condition of nurse-performed washing (p < 0.001 through p < 0.05). The quality of washing did not differ significantly (p < 0.05) between conditions, nor did the amount of opioid medication administered (p < 0.05). Results support the active participation of patients with burn injuries in their dressing changes.
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J Burn Care Rehabil · Sep 1996
Comparative StudyPositive self-regard as a coping mechanism for pediatric burn survivors.
Pediatric burn survivors are reported to present optimistic pictures of themselves; it has been suggested that their reports of high self-esteem may reflects a coping mechanism. The purpose of this study was to compare burned children's self-perceptions of competence and adequacy to normative population with the use of two standardized instruments. ⋯ Also, the relationship between the children's perceived self-worth in each domain, and the importance they attributed to that domain, indicate that the burned children are satisfied with themselves in those areas they perceive as important. Results from both tests suggest that the burn survivors' report of positive self-esteem may reflect a necessary defense mechanism in the adjustment process, which should be supported by the burn team.
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J Burn Care Rehabil · Sep 1996
Mathematic model to estimate change in burn scar length required for joint range of motion.
Burn scar contracture results from an insufficient amount of extensible tissue to permit complete range of motion. The purpose of this study was to develop a mathematic model to estimate additional tissue length required for full range of motion in the presence of a scar contracture. Seven areas with a known predilection for burn scar contracture were assessed. ⋯ Changes in limb length through range of motion were documented. On the basis of these changes, a mathematic model was developed to estimate the additional amount of tissue length required to complete range of motion for each area. This information may be useful to determine burn patient rehabilitation potential or need for reconstructive surgery.
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J Burn Care Rehabil · Sep 1996
Substance P has a role in neurogenic mediation of human burn wound healing.
Knowledge of biochemical and molecular events during burn wound healing may optimize treatment of patients with thermal injuries. Substance P (SP), a neuropeptide present in C fibers of the skin, has been implicated as a mediator of inflammation and wound healing. This neuropeptide induces vasodilitation and vascular permeability by stimulating endothelial cells to round up, vascular smooth cells to relax, and mast cells to release histamine. ⋯ Our data corroborate published reports of SP+ fiber regeneration in guinea pig burns and correlates with clinical observations of pain and pruritus in patients with thermal injuries. The absence of SP+ fibers in the early wounds with SP immunostaining in the epidermis and extracellular matrix suggests that SP may be released from injured nerves and supports neurogenic mediation of inflammation and vasodilitation in early wound repair. Repopulation of the wound beds with SP+ fibers appeared to follow neovascularization originating in the deep reticular dermis and wound edge.
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Present day economics have challenged health care providers to minimize the length of hospitalization without sacrificing quality of care. Within this context, the purpose of this study was to determine whether supporting the hand and wrist with an Unna's boot dressing (Medicopaste bandage; Graham-Field, Inc., Hauppauge, N. Y.) and splint, and covering the skin graft donor site with calcium alginate (Kaltostat; Calgon Vestal, St. ⋯ This and subsequent follow-up visits revealed a 95% or more take on all skin grafts, without any infectious complications. These results demonstrate the efficacy of Unna's boot support and calcium alginate dressings of donor sites in limited skin graft procedures. Furthermore, these results suggest that more extensive surgical debridements and skin graftings may be successfully shifted to outpatient procedures with use of these adjuvants.