共查询到10条相似文献，搜索用时 359 毫秒
1.
Marianne J.E. van der Heijden Alette de Jong Heinz Rode Roux Martinez Monique van Dijk 《Burns : journal of the International Society for Burn Injuries》2018,44(1):175-182
Objective
While the prevalence of burns in children is highest in low and middle-income countries, most research on burn-related pain intensity and distress is carried out in high-income countries. In this study we assessed pain intensity and distress in paediatric patients with burns undergoing wound care procedures without distraction and parental presence in a South-African children’s hospital and sought to identify predictors for the outcomes.Methods
This observational study, carried out as part of a randomized controlled trial, took place at a burns unit in Cape Town, South Africa and included patients between the ages of 0 and 13 years undergoing their first or second wound care procedure. We measured pain intensity and distress using the COMFORT Behavioural scale (COMFORT-B) across four distinct phases of wound care procedures: removal of bandage; washing the wound; administering wound care; putting on new dressings. COMFORT-B scores ≥21 indicate severe pain intensity and distress.Results
124 patients were included, median age 21.2 months (IQR 14.9–39.5 months), 90% suffered scalds, and median total body surface 8% (IQR 5–14%). Assessment scores for the majority of patients were indicative of severe pain intensity and distress during wound care procedures. Median COMFORT-B scores across the four phases were 24, 25, 25 and 22 respectively. Across the four phases respectively 76%; 89%; 81% and 62% of the patients were indicated with severe pain intensity and distress. Age was a predictor for pain intensity and distress as younger children were assigned higher scores than older children (Unstandardized B ?.052; 95% CI ?.071 to ?.032 p < 0.001).Conclusions
In this study children received wound care procedures without distraction or parental presence and were assessed to have high pain intensity and distress. There is a correlation between age and COMFORT-B scores: younger children show higher distress, indicating a great need for better pain and distress control during wound care procedures. It is difficult to identify whether pain or distress is the specific primary cause for the high COMFORT-B scores. 相似文献2.
Sarah-Claude Provençal Suzie Bond Elie Rizkallah Ghassan El-Baalbaki 《Burns : journal of the International Society for Burn Injuries》2018,44(8):1870-1881
Background
Evidence from clinical trials suggests psychological interventions should be considered as an adjunct to medications.Objective
The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of clinical hypnosis on pain, anxiety and medication needs during wound care in adults suffering from a burn injury.Data sources
Medline, PsychINFO, CINAHL, Embase, ISI, SCOPUS, Cochrane, and Proquest databases were searched for randomized controlled trials comparing hypnosis to other interventions during dressing change in adult patients.Data synthesis
Two independent reviewers extracted relevant articles and assessed their methodological quality. Only six studies met the inclusion criteria and were described in detail. Available data was pooled with Revman 5.3.Results
For the primary outcome, we found a statistically significant difference in pain intensity ratings favoring hypnosis (MD = ?8.90, 95% CI ?16.28, ?1.52). For the secondary outcomes, there was a statistically significant difference in anxiety ratings favoring hypnosis (MD = ?21.78, 95% CI ?35.64, ?7.93) and no difference in medication usage (MD = ?0.07, 95% CI ?0.32, 0.17).Conclusion
These results suggest that hypnosis reduces pain intensity and anxiety ratings in adults undergoing burn wound care. However, because of the limitations discussed, clinical recommendations are still premature. 相似文献3.
Sam J. Egger Ross J. Calopedos Dianne L. O’Connell Suzanne K. Chambers Henry H. Woo David P. Smith 《European urology》2018,73(6):859-867
Background
Long-term psychological well-being and quality-of-life are important considerations when deciding whether to undergo active treatment for low-risk localised prostate cancer.Objective
To assess the long-term effects of active surveillance (AS) and/or watchful waiting (WW) on psychological and quality-of-life outcomes for low-risk localised prostate cancer patients.Design, setting, and participants
The Prostate Cancer Care and Outcome Study is a population-based prospective cohort study in New South Wales, Australia. Participants for these analyses were low-risk localised prostate cancer patients aged <70 yr at diagnosis and participated in the 10-yr follow-up.Outcome measurements and statistical analysis
Validated instruments assessed outcomes relating to six health-related quality-of-life and nine psychological domains relevant to prostate cancer patients. Adjusted mean differences (AMDs) in outcome scores between prostate cancer treatment groups were estimated using linear regression.Results and limitations
At 9–11 yr after diagnosis, patients who started AS/WW initially had (1) higher levels of distress and hyperarousal than initial radiation/high-dose-rate brachytherapy patients (AMD = 5.9; 95% confidence interval or CI [0.5, 11.3] and AMD = 5.4; 95% CI [0.2, 10.5], respectively), (2) higher levels of distress and avoidance than initial low-dose-rate brachytherapy patients (AMD = 5.3; 95% CI [0.2, 10.3] and AMD = 7.0; 95% CI [0.5, 13.5], respectively), (3) better urinary incontinence scores than initial radical prostatectomy patients (AMD = –9.1; 95% CI [–16.3, –2.0]), and (4) less bowel bother than initial radiation/high-dose-rate brachytherapy patients (AMD = –16.8; 95% CI [–27.6, –6.0]). No other significant differences were found. Limitations include participant attrition, inability to assess urinary voiding and storage symptoms, and nonrandom treatment allocation.Conclusions
Notwithstanding some long-term differences between AS/WW and various active treatment groups in terms of distress, hyperarousal, avoidance, urinary incontinence, and bowel bother, most long-term outcomes were similar between these groups.Patient summary
This study assessed the long-term psychological and quality-of-life impacts of initially monitoring rather than actively treating low-risk prostate cancer. The results suggest that initial monitoring rather than active treatment has only a minor impact on subsequent long-term psychological and quality-of-life outcomes. 相似文献4.
David F. Friedlander Quoc-Dien Trinh Anna Krasnova Stuart R. Lipsitz Maxine Sun Paul L. Nguyen Adam S. Kibel Toni K. Choueiri Joel S. Weissman Mani Menon Firas Abdollah 《European urology》2018,73(3):445-451
Background
The gap in prostate cancer (PCa) survival between Blacks and Whites has widened over the past decade. Investigators hypothesize that this disparity may be partially attributable to differences in rates of definitive therapy between races.Objective
To examine facility level variation in the use of definitive therapy among Black and White men for localized PCa.Design, setting, and participants
Using data from the National Cancer Data Base, we identified 223 873 White and 59 262 Black men ≥40 yr of age receiving care within the USA with biopsy confirmed localized intermediate/high-risk PCa diagnosed between January 2004 and December 2013.Outcome measurements and statistical analysis
Multilevel logistic regression was fitted to predict the odds of receiving definitive therapy for PCa. Sensitivity and subgroup analyses were performed to adjust for inherent patient and facility-level differences when appropriate.Results and limitations
Eighty-three percent (n = 185 647) of White men received definitive therapy compared with 74% (n = 43 662) of Black men between 2004 and 2013. Overall rates of definitive therapy during that time increased for both White (81% vs 83%, p < 0.001) and Black (73% vs 75%, p = 0.001) men. However, 39% of treating facilities demonstrated significantly higher rates of definitive therapy in White men, compared with just 1% favoring Black men. Our study is limited by potential selection bias and effect modification.Conclusions
After adjusting for sociodemographic and clinical factors, we found that most facilities favored definitive therapy in Whites. Health care providers should be aware of these inherit biases when counseling patients on treatment options for localized PCa. Our study is limited by the retrospective nature of the cohort.Patient summary
We found significant differences in rates of radiation and surgical treatment for prostate cancer among White and Black men, with most facilities favoring Whites. Nonclinical factors such as treatment facility type and location influenced rates of therapy. 相似文献5.
Ramy Boles Justin P. Gawaziuk Nora Cristall Sarvesh Logsetty 《Burns : journal of the International Society for Burn Injuries》2018,44(7)
Objective
To describe frostbite (freezing cold injured tissue) in children and intrinsic (psychological and behavioral) and extrinsic (meteorological and safety hazard) factors related to the injury.Methods
Retrospective chart review of children <18 years old referred to a regional pediatric hospital for frostbite, to determine the demographics, environment, and risk factors related to injuries.Results
47 patients met the inclusion criteria. Median age was 15 years (IQR 12–16). All injuries occurred between November and March. 49% were admitted to the hospital and frostbite was associated with use of alcohol (53%), cigarettes (34%), marijuana (23%), and symptoms of depression (with and without suicidal ideation) (32%). Frostbite injury treated with conservative wound management presented at < ?6 °C and injury that underwent surgical procedures occurred at temperatures ≤ ?23 °C (p = 0.001). Longer exposure duration also significantly increased the likelihood of a surgical procedure (p < 0.001). Intoxication and lack of supervision were two common factors, with lack of supervision at time of injury most common among patients 0–12 years (64%), and intoxication most common among patients ages 13–17 (61%).Conclusion
Frostbite injuries in children begins at temperatures < ?6 °C; with risk of tissue loss increasing at temperatures below ?23 °C. Lack of supervision and intoxication are major risk factors for frostbite in children. Two-thirds of younger children were unsupervised, whereas intoxication was frequently related to frostbite in adolescents. Both of these factors can be addressed through an education-based prevention program. 相似文献6.
Sophie Maria Pierrette Nieuwendijk Iris Johanne de Korte Mereille Marren Pursad Monique van Dijk Heinz Rode 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1151-1158
Background
Pruritus is a common problem seen in the healing process of a burn wound and gives great discomfort for the patient. Most research in this field has been done in the adult population, so evidence in the pediatric population is still lackingPurpose
The aims of this study were to assess the incidence and severity of post-burn pruritus, identify predictors for pruritus and evaluate the pharmacological treatments in a pediatric setting.Methods
Pruritus was assessed in this prospective observational study using a numeric rating scale and the Itch Man Scale applied by the patients’ caregiver. The predictive values of candidate predictors for pruritus were compared using Fisher exact tests and Kruskal–Wallis tests.Results
413 patients were included in this study. Pruritus was reported in 71.7% of the patients. Complete symptom relief was only achieved in 29.8% of the patients who used medication. Time since burn (p < 0.001), depth of the injury (p = 0.017), TBSA burned (p = 0.001) and skin grafting (p = 0.001) were found to be significant predictors for post-burn pruritus.Conclusion
Post-burn pruritus is still a highly prevalent problem in pediatric burn care. Its intensity and frequency are higher especially in the first three months or with a deeper wound or a higher TBSA. 相似文献7.
8.
Josefin Sveen Mimmie Willebrand 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1135-1140
Objectives
The aim was to examine guilt and embitterment in mothers and fathers of children with burns and its associations with depression and burn severity.Methods
Parents (N = 61, mothers n = 41, fathers n = 20) completed self-report questionnaires on guilt and embitterment, 0.8–5.6 years after their child’s burn. Burn severity and socio-demographic variables were obtained from medical records and symptoms of depression were assessed with the Montgomery–Åsberg Depression Rating Scale (MADRS).Results
The parents reported low levels of guilt, embitterment and depression. Burn-specific and general guilt were higher in mothers than fathers, but there were no differences in embitterment or symptoms of depression. General guilt was associated with depression, whereas burn-specific guilt and embitterment were not.Conclusions
Parents with general guilt may suffer from symptoms of depression. An implication is that clinicians should address guilt feelings among parents in order to alleviate distress and to identify any need for further counseling. 相似文献9.
Huang-Kai Kao Charles Yuen Yung Loh Hao-Wei Kou Kuo-Chin Kao Han-Chung Hu Chia-Ming Chang Chia-Hui Lee Hsiang-Hao Hsu 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1077-1082
Background
Majority of current research focuses on pre-hospital care in mass casualty incidents (MCI) whereas this study is the first to examine multifactorial aspects of intensive care unit (ICU) resource management during a surge in massive burn injury (MBI) patients whilst identifying key outcome predictors that resulted in successful disaster managements.Methods
Both critical care, surgical parameters and cost-effectiveness are investigated in patients admitted with severe burns resulting from the explosion. A fully integrated trauma response and expansion of critical care resources in Linkou Chang Gung Memorial Hospital (CGMH) in this incident is analyzed.Results
52 burn patients were treated in CGMH and 27 patients (51.9%) had TBSA greater than 45% with the mean TBSA of 44.6 ± 20.3%. ICU based management of MBI including early debridement and resource strategizing.The overall mortality rate was 2/52 (3.85%). Patients had an average of 14.8 days on mechanical ventilation and 43 days as an inpatient in total. Operative treatment wise, 44.2% of patients received escharotomies and each patient received an average of 2 skin grafting procedures. The initial TBSA was a significant predictor for burn wound infection (OR 1.107, 95% CI 1.023–1.298; p = 0.011). Each patient cost an average of USD 1035 per TBSA% with an average total cost of USD 50415.Conclusion
With ever increasing chances of terrorist activity in urban areas, hospitals can hopefully increase their preparedness using outcome-predictors presented in this study. 相似文献10.
K. Whale J.C. Ingram S. George F. Spickett-Jones A. Sack A.E. Young 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1251-1258