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991.
Monique van Dijk Linda Anne O’Flaherty Tessa Hoedemaker Joost van Rosmalen Heinz Rode 《Burns : journal of the International Society for Burn Injuries》2018,44(1):99-107
Importance
In a previous observational study we found that massage therapy reduced anxiety and stress in pediatric burn patients. We aimed to test this effect in a randomized controlled trial.Objective
To determine whether (1) aromatherapy massage can provide relaxation to hospitalized children with burns; (2) massage with aromatherapy oil is more effective than without; and (3) massage sessions are more effective when repeated.Design, setting, and participants
Randomized controlled clinical trial with 3 arms conducted in a burns unit from April 2013 to December 2014 in Cape Town, South Africa.Interventions
Massage with carrier oil, massage with aromatherapy oil, and standard nursing care only.Main outcomes and measures
Scores on the Muscle Tension Inventory (MTI) and Behavioral Relaxation Scale (BRS) to assess level of relaxation. Scores on the COMFORT behaviour scale and Numeric Rating Scale Distress to assess level of distress. Secondary outcomes were heart rate and oxygen saturation levels. Linear mixed models were used to determine the effect of condition and session number (1 to a maximum of 5 sessions per child) correcting for baseline outcomes of COMFORT behaviour scores and heart rates after sessions. Secondary analyses included the addition of sex, age, and total body surface area (TBSA) burned as covariates.Results
We included 284 children aged 5 weeks to 13 years with TBSA burned between 10 and 45%. Two-thirds (65.5%) were under the age of 3 years. Mixed model analyses revealed no significant difference in reduction of COMFORT behavior scores (p=0.18), or heart rates (p=0.18) between the three study arms. These outcomes were also not associated with the session number (p=0.92 and p=0.13, respectively). Level of relaxation could not be reliably assessed with the MTI and BRS because 119 patients (41.9%) had bandages covering the larger part of the face, and in 40.1% of cases the child was not in the required position.Conclusion and relevance
Massage therapy with or without essential oil was not effective in reducing distress behavior or heart rate in hospitalized children with burns. Evaluating the effectiveness of massage in terms of relaxation proved difficult in young children.Trial registration
The Netherlands National Trial Registry: NRT3929. 相似文献992.
Dipen D. Patel Marta Rosenberg Laura Rosenberg Guillermo Foncerrada Clark R. Andersen Karel D. Capek Jesus Leal Jong O. Lee Carlos Jimenez Ludwik Branski Walter J. Meyer David N. Herndon 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1269-1278
Introduction
Children 5 and younger are at risk for sustaining serious burn injuries. The causes of burns vary depending on demographic, cultural and socioeconomic variables. At this pediatric burn center we provided medical care to children from Mexico with severe injuries. The purpose of this study was to understand the impact of demographic distribution and modifiable risk factors of burns in young children to help guide prevention.Methods
A retrospective chart review was performed with children 5 and younger from Mexico who were injured from 2000–2013. The medical records of 447 acute patients were reviewed. Frequency counts and percentages were used to identify geographic distribution and calculate incidence of burns. Microsoft Powermap software was used to create a geographical map of Mexico based on types of burns. A binomial logistic regression was used to model the incidence of flame burns as opposed to scald burns in each state with relation to population density and poverty percentage. In all statistical tests, alpha = 0.05 for a 95% level of confidence.Results
Burns were primarily caused by flame and scald injuries. Admissions from flame injuries were mainly from explosions of propane tanks and gas lines and house fires. Flame injuries were predominantly from the states of Jalisco, Chihuahua, and Distrito Federal. Scalds were attributed to falling in large containers of hot water or food on the ground, and spills of hot liquids. Scald injuries were largely from the states of Oaxaca, Distrito Federal, and Hidalgo. The odds of a patient having flame burns were significantly associated with poverty percentage (p < 0.0001) and population density (p = 0.0085). Increasing levels of poverty led to decrease in odds of a flame burn, but an increase in the odds of scald burns. Similarly, we found that increasing population density led to a decrease in the odds of a flame burn, but an increase in the odds of a scald burn.Conclusions
Burns in young children from Mexico who received medical care at this pediatric burn center were attributed to flame and scalds. Potential demographic associations have been identified. Different states in Mexico have diverse cultural and socioeconomic variables that may influence the etiology of burns in young children and this information may help efficiently tailor burn prevention campaigns for burn prevention efforts in each region.Applicability of research to practice
This information will be used to develop and help modify existing prevention campaigns. 相似文献993.
Raquel Pan Bruna Domingos dos Santos Lucila Castanheira Nascimento Lídia Aparecida Rossi Rinie Geenen Nancy E. Van Loey 《Burns : journal of the International Society for Burn Injuries》2018,44(3):494-511
Background
The school is an essential context for children’s social interaction with peers and to develop academic skills. Therefore, a fast reintegration can help children with burns to normalize their life. Thus, school reintegration is an important outcome after burns. The aim of this review was to systematically synthesize the literature addressing school reintegration programs of pediatric burns survivors.Methods
Five electronic databases were searched independently by two reviewers. The search yielded 13 eligible publications. A qualitative content analysis was conducted.Results
The two themes identified centered around (1) the roles, obstacles, and support for the different stakeholders (i.e., the child, parents and teacher) and (2) the contents of the school reintegration programs in which subthemes such as purpose, planning, essential elements, team, and effect were distinguished. The results show that return to school should start as soon as the child is admitted to the hospital and the program should acknowledge the different stakeholders’ needs and tailor the program to these needs.Conclusion
The review emphasizes the necessity of an integrated school reintegration program empowering both the child, the parents and the teachers and tailored to the child’s specific situation. Furthermore, it offers recommendations for further improvement of the field. 相似文献994.
Ali Ahmadabadi Majid Khadem-Rezaiyan Alireza Sedaghat Seyed Hasan Tavousi Nastaran Khorrampazhouh Atiyeh Mohsenpour Zeinab Goudarzi Masoumeh Hassanpour 《Burns : journal of the International Society for Burn Injuries》2018,44(6):1468-1474
Background
Burn injuries impose a considerable burden on healthcare systems. It is among the top ten causes of mortality and a major cause of disability. This study aimed to calculate and compare the lethal area fifty percent (LA50) and standardized mortality ratio (SMR) in patients with burns.Methods
This is a five-year cross-sectional study. The study population consisted of 3284 patients with acute burns who were admitted to the Burn Department of Imam Reza Hospital in Mashhad, Iran, from 2010 to 2015. LA50 and SMR were calculated. SPSS 16 was used for logistic regression analysis.Results
The mean percentage of burn total body surface area (TBSA%) was 37.0 (25.5), and deceased patients with burns had a significantly higher burn TBSA% than alive discharged patients (70.3 (24.2) vs. 28.1 (17.1), p < 0.001). The most common cause of burn was fire (71.7%). The total case fatality rate was 21.2%. However, this index was more than double in females than in males (31.9% vs. 14.3%, p < 0.001). The SMR, based on the abbreviated burn severity index (ABSI), increased from 61% to 80% during the 5-year period. LA50 for total admitted patients was 63.8% (95% confidence interval [CI] = 60.4–67.7). LA50 for scalds was the highest (72.1%) compared to those of other types of mechanisms of burn injuries. TBSA, age, and gender were found to be mutually independent predictors of death.Conclusion
The trend of LA50 in these five years declined by 12%, whereas the SMR was below 100%. Improvement in burn management quality in high-risk groups including the elderly, females, and patients with extensive burns may improve LA50 in burn units. However, LA50 alone is not a conclusive index for the performance of a burn department, and it should be interpreted alongside with SMR. 相似文献995.
Ingrid Steinvall Matilda Karlsson Moustafa Elmasry 《Burns : journal of the International Society for Burn Injuries》2018,44(3):718-723
Background
Scalds are the most common cause of burns in children, yet there is little information available about the inflammatory response. The aim of the study was to investigate the response to treatment with antibiotics among scalded children by following the C-reactive protein (CRP) concentration, procalcitonin (PCT) concentration, and white blood cell count (WCC) during the first two weeks after injury.Methods
All children with scalds who presented to the Burn Centre during 2010–2016 were included in this retrospective study. All measurements of CRP, PCT, and WCC from the first 14 days after injury were recorded, and each patient’s maximum values during days 0–2, 3–7, and 8–14 were used for calculations. Multivariable regression for panel data was used to study the inflammatory response after antibiotic treatment.Results
A total of 216 children were included. C-reactive protein was 45 mg/L (p < 0.001) higher in the group treated with antibiotics, and decreased with 8.8 mg/L per day over the studied time in this group, which was more than twice as fast as among the children who were not given antibiotics.Conclusion
The CRP response, among children with minor scalds treated with antibiotics, shows an appreciable rise during the first week of injury that subsided rapidly during the second week. 相似文献996.
G. van Niekerk S. Adams H. Rode 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1259-1268
Background
Since 2003 we have used the scalp as a donor site for split skin grafts (SSGs) in major burns when there was a shortage of conventional donor areas. However, we seen a high incidence of complications, contrary to international experience.Objective
The aim of this study was to analyze the results and complications related to the scalp as a donor site and to determine whether there is an association between our specific patient population and the complications encountered.Methods
A retrospective review of our scalp donor site outcomes over a 12-year period was conducted. The cohort included 25 patients, 15 of black African descent, nine of mixed race and one Caucasian. The various hair types were identified based on ethnicity and classified into eight types. Most of our patients had hair types VI–VIII. None of these patients had scalp burns and all received standard burn treatment. The SSGs were taken with an electric dermatome with a standard micrometric setting of 0.2 mm. Complications were categorized into short- or long-term, with a mean follow-up time of 1.59 years.Results
The mean age of the 25 children was 5.7 years. Nineteen sustained flame burns and 6 sustained hot water burns, with a mean total body surface area of 44.9%. A total of 43 scalp procurements were performed in the 25 patients studied. The group of 15 black African patients (hair types VI–VIII) had a total of 22 procurements, the nine patients of mixed race (hair types III–V) had 18 procurements and the single Caucasian patient (hair types II–III) had two procurements. The median healing time was 15 days, 11.8 days and 8.5 days, respectively, per group. Significant complications were encountered, including folliculitis 44%, non-healing wounds 52%, alopecia 16% and visible, hypopigmented scars 3%. One patient had a hypertrophic scar and no hair transfers to the recipient areas were observed. The various hair types correlated with the complications encountered. Five children, with an average burn size of 65.2% (range: 40–85%) died of sepsis. Due to the small sample size, the only statistically significant findings were related to the total body surface area of the burn and the number of times skin was harvested from the scalp, with a p-value of 0.005. The p-values for the healing times related to the first, second and third croppings, were p = 0.022, p = 0.00032 and p < 0.001 respectively.Conclusion
Our study suggests that in pediatric patients of black African descent (hair types VI–VIII) the scalp is not an ideal donor area, due to the unacceptably high incidence of complications. Hence, every precaution should be taken when it becomes necessary to harvest donor skin from the scalp. 相似文献997.
Rebecca Bern Kevin Serror Rémi Alvo Marc Chaouat Maurice Mimoun Magali Schmidt David Boccara 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1357-1360
In burn patients, meshed split thickness skin grafts are commonly used on large and non-flat areas whom immobilization is difficult to achieve. The frequent mobilizations of burn patients can make the graft slip and prevent the revascularization and therefore the taking of the skin graft. In order to prevent this pitfall, we modified and adapted the tie-over dressing procedure. The giant running tie-over dressing enables large skin grafts to be applied to their wound bed and therefore helps revascularization. Some cautions are necessary in order to avoid any infection. This original and easy-to-perform procedure answers to the difficulties of large split-thickness skin grafts in burn patients. 相似文献
998.
Emily C. Dore Molly Marino Pengsheng Ni Julieta Lomelin-Gascon Lily Sonis Flor Amaya Colleen M. Ryan Jeffrey C. Schneider Alan M. Jette Lewis E. Kazis 《Burns : journal of the International Society for Burn Injuries》2018,44(7)
Background
The Life Impact Burn Recovery Evaluation (LIBRE) Profile© was developed using Item Response Theory methods to assess social participation after a burn injury. The LIBRE Profile measures six areas of social participation: Relationships with Family & Friends, Social Interactions, Social Activities, Work & Employment, Romantic Relationships, and Sexual Relationships. It can be administered through a computerized adaptive test or through fixed short forms. The goal of this study was to further examine the psychometric properties of the LIBRE Profile, including reliability and validity.Methods
We examined the validity of the LIBRE Profile by administering the six LIBRE Profile scales as well as legacy measures that assessed similar constructs. We calculated the Pearson correlations between the LIBRE Profile scales and the scores on the same-domain and cross-domain legacy measures to evaluate convergent and divergent validity. We then administered the LIBRE Profile scales a second time, seven to ten days after the first administration, to a sample of adult burn survivors to evaluate test–retest reliability. We calculated repeatability coefficients, standard error of measurement, and minimal detectable change to establish the threshold beyond which the amount of change observed across an episode of care cannot be explained as measurement error.Results
For reliability, the repeatability coefficients ranged from 7.31 to 9.27 and SEMs ranged from 2.62 to 3.39 for all six scales. MDC90 values ranged from 6.08 to 7.86 points, and MDC95 values ranged from 7.26 to 9.40 points. All correlations between the LIBRE Profile scales and legacy measures are significant (p < 0.05) and in the expected directions for both convergent and divergent validity.Conclusions
This study provided evidence for the reliability and validity of the LIBRE Profile, one of the first tools that measures exclusively the social participation after a burn injury. 相似文献999.
目的:观察N-甲基-D-天冬氨酸(N-methyl-D-aspartate,NMDA)受体的过度激活对大鼠严重创伤血清炎性细胞因子水平的影响,为探索从中枢的某一环节着手,来抑制严重创伤后的炎性反应失调提供理论依据。方法:以30%TBSAⅢ度烧伤为严重创伤模型,利用ELISA方法检测激活NMDA受体对血清炎性细胞因子肿瘤坏死因子(TNF-α)、白介素-1#(IL-1β)、白介素-6(IL-6)水平的影响;通过膜片钳技术检测严重烧伤能否导致大鼠神经元NMDA受体的过度开放;再观察阻断NMDA受体能否抑制严重烧伤后血清炎性细胞因子TNF-α、IL-1β、IL-6水平的上升。结果:(1)与对照组相比,使用NMDA0.5mg/kg激活NMDA受体,血清TNF-α、IL-1β、IL-6明显升高,加大剂量(2mg/kg)可以使血清TNF-α、IL-1β、IL-6进一步升高;(2)在35pS电导水平的开放中,烧伤使通道开放概率增加非常显著,在100pS电导水平的开放中,开放时间常数τ、通道开放概率增加非常显著;(3)腹腔注射MK-1801(3mg/kg)阻断NMDA受体可以抑制烧伤后血清TNF-α、IL-1β、IL-6水平的上升,加大注射剂量(5mg/kg)可以进一步抑制烧伤后血清TNF-α、IL-1β、IL-6水平的上升。结论:NMDA受体是严重创伤(烧伤)后大鼠血清炎性细胞因子过度升高的重要环节。 相似文献
1000.