The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Mar 1992
Comparative StudyCold stress response in patients with severe burns after beta-blockade.
Adrenergic receptor blockade has been shown to be of benefit in the treatment of adverse cardiovascular changes in patients with burns during the hypermetabolic phase. This article examines the stress response to cold exposure in adults and children with 33% to 95% total body surface area burns with and without beta-blockade. Resting energy expenditures were measured by indirect calorimetry; the test subjects were exposed to mean temperatures of 27.5 degrees C (room temperature) or 24.6 degrees C (cold). ⋯ Data suggest that patients with septic burns already have a maximal metabolic response and that cold stress does not further increase this response. Males, ages 17 to 54 years, were found to increase their resting energy expenditures by 11.4 kcal/m2/day for each percent total body surface area burn. We conclude that beta-blockade with propranolol in therapeutic doses may be used in patients with burns without adversely affecting the cold stress response.
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J Burn Care Rehabil · Mar 1992
Decreasing mortality and morbidity rates after the institution of a statewide burn program.
During the late 1970s, a statewide system for burn treatment and prevention was developed in Maine; it was assumed that such a system would reduce mortality and morbidity rates. To examine the effect of this intervention and the validity of its underlying hypothesis, data for the period from 1973 to 1988 were collected from burn unit registries inside and outside of the state and from hospital discharge abstracts, death certificates, and published sources. In Maine, the annual number of deaths per million persons that resulted from fire- and burn-related injuries declined from 41 in the years 1973-1980 to 25 in the years 1981-1988, which is a significantly greater decrease than for the United States as a whole (p less than 0.001). ⋯ Since a state system was instituted, hospital mortality rates, when grouped by age and burn area, were not significantly different from those reported by the most prominent burn unit in New England. The population-based methods of data collection and linkage that were developed for this investigation may be useful for other studies of injury epidemiology. A statewide burn program appears to have contributed to a reduction in mortality and morbidity rates, primarily through preventive efforts.
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J Burn Care Rehabil · Jan 1992
Multicenter Study Clinical TrialAddendum: multicenter experience with cultured epidermal autograft for treatment of burns.
Since 1989 BioSurface Technology, Inc. (Cambridge, Mass.) has provided over 37,000 cultured epidermal autografts (CEAs) for more than 240 patients in 79 different burn centers in the United States and Europe. The average burn treated with BioSurface's CEA has been 70% total body surface area, half of that being full-thickness. Data, verified for 104 patients, indicate an average final "take" of about 60%, with half of all patients achieving a final take greater than or equal to 70% and 22% with final take greater than or equal to 90%. ⋯ Early excision followed by temporary coverage with homograft, which is allowed to engraft, was found to be associated with a low infection rate and a higher rate of CEA take. When engrafted homograft was only partially excised, leaving a layer of "allodermis" as the graft bed for CEA, take averaged 90% among 14 patients. Thus, our analysis of the extensive experience of many burn centers now permits more specific and helpful recommendations on standards of care to maximize efficacy of CEA.
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J Burn Care Rehabil · Jan 1992
ReviewPsychometric assessment of psychologic factors influencing adult burn rehabilitation.
This article describes psychometric assessment instruments that are available for the screening of psychosocial problems that can interfere with patient rehabilitation. Structured assessment of patient depression, anxiety, substance abuse, social support, and willingness to take control and responsibility for health care is important throughout all stages of the patient's treatment. There are psychometrically sound, relatively brief, and nonintrusive measures with which to assess these variables. ⋯ Future clinical research will hopefully compare and contrast the efficacy and relevance of these measures. Furthermore, future clinical evaluation and research will need to relate the influence of psychosocial factors on the patient's total health functioning. Structured psychometric evaluation of the psychosocial and health characteristics will ensure that patients who have been burned will attain the most fulfilling quality of life that is available to them.
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J Burn Care Rehabil · Jan 1992
ReviewThe role of the psychiatrist in the team treatment of the adult patient with burns.
Improved survival rates for patients with major burn injuries and the consistent finding of significant long-term psychologic disability among survivors of burn trauma call for a redefinition of the role of the psychiatric consultant in the care of patients with burns. In addition to the traditional functions of diagnosis and treatment of discrete psychiatric disorders in patients with burns, this expanded role includes assisting the patient's normal process of psychologic adaptation after injury, assessing and managing burn pain, and facilitating communication among all members of the burn team. The functions of the psychiatrist are most effectively carried out when the psychiatrist is able to participate on a regular basis in the care of every patient as a member of the burn team.