共查询到20条相似文献，搜索用时 31 毫秒
1.
2.
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3.
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4.
Lisa Martin Michelle Byrnes Sarah McGarry Suzanne Rea Fiona Wood 《Burns : journal of the International Society for Burn Injuries》2017,43(1):76-83
Introduction
Visible scarring after burn causes social challenges which impact on interpersonal connection. These have health impacts which may worsen outcomes for burn patients and reduce the potential for posttraumatic growth (PTG).Aim
The aim of the study was to investigate adult burn survivors’ experiences of interpersonal relationships as potential barriers to posttraumatic recovery following hand or face burns.Method
This qualitative study explored patient experiences of interpersonal situations. A purposive sample (n = 16) who had visible burn scarring were interviewed more than two years after their burn.Results
Emotional barriers included the fear of rejection, feelings of self-consciousness, embarrassment and humiliation. Situational barriers included inquisitive questions, comments and behaviours of others. Responses depended on the relationship with the person, how they were asked and the social situation. Active coping strategies included positive reframing, humour, changing the self, and pre-empting questions. Avoidant coping strategies included avoidance of eye contact, closed body language, hiding scars, and learning to shut down conversations.Conclusion
Emotional and situational barriers reduced social connection and avoidant coping strategies reduced the interaction of people with burns with others. Active coping strategies need to be taught to assist with social reintegration. This highlights the need for peer support, family support and education, and social skills training. 相似文献5.
Atulya Prasad Katarzyna M. Sawicka Kelly B. Pablo Lauren K. Macri Jerome Felsenstein James J. Wynne Richard A.F. Clark 《Burns : journal of the International Society for Burn Injuries》2018,44(3):589-595
Introduction
Recent evidence indicates that early removal of eschar by tangential debridement can promote healing. Laser debridement can be used for debridement of areas that prove challenging for debridement using tangential excision. In particular, irradiation with an ArF excimer laser ablates desiccated eschar and is self-terminating, preserving hydrated or viable tissue.Methods
Thermal burns were created on the flanks of two outbred, female Yorkshire pigs using aluminum bars heated to 70 °C and applied for different lengths of time. Three days after injury, burns were debrided using an ArF excimer laser (193 nm). Tissue was harvested immediately after debridement and 7 days after debridement (10 days after burn).Results
Data from a pilot study demonstrates that ArF excimer laser irradiation removes burn eschar and promotes healing at 10 days after burn. ArF excimer laser debridement is self-terminating and preserves underlying and adjacent perfused tissue. Potentially, this modality would be ideal for the complex curvilinear structures of the body. 相似文献6.
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7.
Sebastian Q. Vrouwe Marc G. Jeschke Joel S. Fish 《Burns : journal of the International Society for Burn Injuries》2018,44(4):1000-1004
Introduction
Specialized burn care is categorized as an essential component in the criteria for provincial/state and regional trauma systems. Studies in the United States and New Zealand found a need for more burn surgeons and anticipated a severe shortage in the future. The purpose of this study is to describe the current active workforce of burn surgeons in Canada and forecast any perceived shortages in the future.Methods
Burn care providers were identified from each metropolitan area across Canada. A survey was modified from a previous study and distributed electronically via SurveyMonkey? to representatives from 26 centres.Results
Twenty-six centres responded to the questionnaire (response rate = 100%). Four of these centres self-identified as providing dedicated burn care, 19 identified themselves as being integrated into surgical programs at their institution, and two stated they no longer treated burn injuries. The mean number of acute burn admissions per year was 67.2 (range 2–290). Of the centres admitting over 75 burns per year, 44% (4/9) are currently looking for a surgeon, 56% (5/9) will be looking for another surgeon in five years, and 44% (4/9) are having or feel they will have trouble finding a surgeon to manage burns.Discussion
Canada is facing a shortage of burn care specialists similar to other developed nations. Active mentorship of surgical trainees is essential to maintain the delivery of high quality of burn care in Canada. 相似文献8.
Zhao-Kai Low Wai-Yee Ng Stephanie Fook-Chong Bien-Keem Tan Si-Jack Chong Jolie Hwee Sook-Muay Tay 《Burns : journal of the International Society for Burn Injuries》2017,43(2):436-444
Objective
Diabetic burns patients may be at risk of worse clinical outcomes. This study aims to further investigate the impact of diabetes mellitus on clinical outcomes in burns patients in Singapore.Methods
A 3-year retrospective review was performed at the Singapore General Hospital Burns Centre (2011–2013). Pure inhalational burns were excluded. Diabetic (N = 53) and non-diabetic (N = 533) patients were compared, and the impact of diabetes on clinical outcomes, adjusting for confounders, was investigated using multivariate logistic regression.Results
The diabetic group had a significantly higher incidence of wound infection and severe renal impairment, as well as a longer length of stay, higher number of operations and higher rate of unplanned readmission. ICU admission was significantly associated with hyperglycaemia (OR 5.44 [2.61–11.35], p < 0.001) and a higher total body surface area of burn (OR per 1% TBSA 1.07 [1.05–1.09], p < 0.001). Unplanned readmission was significantly associated with wound infection (OR 4.29 [1.70–10.83], p = 0.002), and mortality associated with a higher TBSA (OR per 1% TBSA 1.1 [1.07–1.14], p < 0.001). After adjusting for confounders, diabetes mellitus was not significantly associated with unplanned readmission or mortality.Conclusions
Diabetic burns patients have an increased risk of worse clinical outcomes, including wound infections, renal impairment and longer length of stay. 相似文献9.
Gina L. Griffith Barbara Wirostko Hee-Kyoung Lee Lauren E. Cornell Jennifer S. McDaniel David O. Zamora Anthony J. Johnson 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1179-1186
Purpose
The study objective was to test the utilization of a crosslinked, thiolated hyaluronic acid (CMHA-S) film for treating corneal chemical burns.Methods
Burns 5.5 mm in diameter were created on 10 anesthetized, male New Zealand white rabbits by placing a 1N NaOH soaked circular filter paper onto the cornea for 30 s. Wounds were immediately rinsed with balanced salt solution (BSS). CMHA-S films were placed in the left inferior fornix of five injured and five uninjured animals. Five animals received no treatment. At 0 h, 48 h, 96 h, and on day 14 post chemical burn creation, eyes were evaluated by white light imaging, fluorescein staining, and optical coherence tomography (OCT). Corneal histology was performed using H&E and Masson's Trichrome stains.Results
Image analysis indicated biocompatible CMHA-S treatment resulted in significant decreases in the areas of corneal opacity at 48 h, 96 h, and on day 14 postoperatively. A significant increase in re-epithelialization was seen 14 days post injury. CMHA-S treated corneas showed significantly less edema than untreated burns. No pathological differences were observed in corneal histological samples as a result of CMHA-S treatment.Conclusions
CMHA-S films facilitate re-epithelialization and decrease the area of corneal opacity in our corneal alkali burn rabbit model. 相似文献10.
Tessa Garside Fiona M. Wood Ann-Maree Vallence 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1195-1202
Objective
The study aimed to investigate intracortical inhibition following a burn injury, and to establish transcranial magnetic stimulation (TMS) as a useful and sensitive tool to investigate the cortical response to a burn injury.Methods
Thirteen burn injured patients and 12 uninjured subjects underwent TMS to measure the cortical silent period (cSP), a marker of intracortical inhibition.Results
In burn injury patients, cSP was similar in the burn-injured and less-injured arm (133 and 132 ms respectively; p = 0.96). cSP was numerically shorter in burns patients than control subjects, however, these differences were not statistically significant (133 vs 148 ms, p = 0.24). Subgroup analysis revealed cSP was shorter in the burn arm of patients compared to the uninjured control subjects in patients with upper-limb burn (cSP 120 ms vs 148 ms, p = 0.03), those with <10% TBSA (cSP 120 ms vs 148 ms, p = 0.01), those <2 years’ post-burn (cSP 110 ms vs 148 ms, p = 0.01), and patients with partial thickness burns (cSP 120 ms vs 148 ms, p = 0.02).Conclusions
These results demonstrate significantly shorter cSP in the burned arm in patients with upper limb burn sustained <2 years ago, those with partial thickness burns, those with upper limb burns only, and those with burns of less than 10% TBSA. The results are consistent with the existing literature, which demonstrates a reduction in cSP duration in patients with a range of peripheral nerve injuries. There is a strong suggestion that cortical inhibition is altered following burn injury, and that TMS is a useful and sensitive method for investigating changes in cortical inhibition in burn patients. 相似文献11.
Clifford C. Sheckter Kay S. Hung Danielle Rochlin Zeshaan Maan Yvonne Karanas Catherine Curtin 《Burns : journal of the International Society for Burn Injuries》2018,44(8):1903-1909
Introduction
Despite advances in critical care and the surgical management of major burns, highly moribund patients are unlikely to survive. Little is known regarding the utilization and effects of palliative care services in this population.Methods
All major burn hospitalizations were identified within the Nationwide Inpatient Sample. Patients were characterized by burn, demographic, facility, and diseases factors. Palliative care services were identified with International Classification Disease 9th edition code V6.67. Temporal trends were assessed with Poisson modeling. Inpatient mortality and death without surgical intervention were assessed with logistic regression. Outcomes were stratified by modified Baux scores.Results
7424 major burns were included; 1.9% received palliative care services. Patients receiving palliation had a mean age of 63.6 years (SD 19.6), mean total body surface area of 62.2% (SD 24.9%), and mean modified Baux score of 127.1 (SD 26.7). Adjusting for covariates, the incidence rate ratio was 1.42 over the 10-year period (95% CI, 1.31–1.54, p < 0.001). Independent predictors of palliative consultations included older age, larger burns, deeper burns, and higher Elixhauser comorbidity score. Among patients with modified Baux scores between 100–153, those receiving palliative care services were significantly more likely to die without surgery, OR 3.24 (95% CI 1.13–10.39, p = 0.029), with no significant difference in mortality, OR 11.72 (95% CI 0.87–22.57, p = 0.051)Conclusion and relevance
Palliative care services were increasingly used during the study period. Palliative care services in highly moribund burn patients do not impact survival and may decrease the likelihood of surgical intervention in select patients. 相似文献12.
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13.
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14.
Raimo Palmu Timo Partonen Kirsi Suominen Jyrki Vuola Erkki Isometsä 《Burns : journal of the International Society for Burn Injuries》2018,44(1):158-167
Objective
We investigated alcohol use and smoking at time of burn and their relationships with severity of burn and presence of mental disorders.Methods
Consecutive acute burn patients (N = 107) admitted to the Helsinki Burn Center were assessed with the structured clinical interview for mental disorders (SCID) at baseline and after 6 months. Information regarding being under the influence of alcohol and having smoking-related activity at burn as well as about hazardous drinking (Alcohol Use Disorders Identification Test) and heavy smoking before the burn was recorded.Results
Around half (52%) of the acute burn patients were under the influence of alcohol and 19% had been both drinking and smoking at the time of the burn. Patients under the influence at the time of burn had significantly higher prevalence of lifetime mental disorders compared to those patients who were not under the influence of alcohol (73.2% vs. 45.1%, p = 0.003), especially alcohol dependence (55.4% vs. 13.7%, p < 0.001) and anxiety disorders (28.6% vs. 9.8%, p = 0.015). Patients who had both alcohol use and smoking at burn had even more often at least one mental disorder (95.0% vs. 51.7%, p < 0.001), in specific alcohol dependence (90.0% vs. 23.0%, p < 0.001), or psychotic disorder (25.0% vs. 6.9%, p = 0.016). The main characteristics of the burns themselves did not differ significantly between these groups.Conclusion
Half of the burn patients were under the influence of alcohol at the time of the burn in this study. In almost all patients where alcohol and smoking contributed to the burn a diagnosable alcohol use disorder was present. Interventions for those with alcohol use disorders and the associated risk behaviors are important for the prevention of burns. 相似文献15.
Holger J. Klein Fabienne Lehner Riccardo Schweizer Barbara Rüsi-Elsener Jakob Nilsson Jan A. Plock 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1330-1335
Background
Since the inception of clinical VCA almost two decades ago, burn victims have been identified as immunologically complex patients owing to preformed HLA antibodies. However, it remains unclear whether the detected HLA antibodies are the result of former alloantigenic events or if their de novo formation occurs during primary burn care.Methods
Patients with burns >20% of total body surface area (TBSA) admitted to Zurich Burn Centre between May 2015 and September 2016 were screened for HLA antibodies at admission and 6 months post trauma. The influence of glycerol-preserved donor skin and red blood cell transfusion on HLA antibody formation was investigated.Results
Thirty-seven patients (7 females and 30 males) with an average age of 45.2 ± 19.1 years and average affected TBSA of 38.5% ± 18.9% were screened for HLA antibodies. Five patients (13.5%) showed preformed HLA antibodies at admission. Only 3 patients demonstrated verified de novo sensitization during acute burn care. Six patients treated with donor skin and blood transfusions showed no occurrence of HLA antibodies after 6 months. One patient died after 2 weeks due to infectious and thromboembolic complications – however, HLA antibodies were already detected.Conclusion
Formation of HLA antibodies during acute burn care might be lower than that previously expected by using glycerol-preserved donor skin and restrictive administration of blood products. Modern concepts of burn care may contribute to a revised outlook on burn patients as potential candidates for VCA. 相似文献16.
Laura Pompermaier Ingrid Steinvall Mats Fredrikson Johan Thorfinn Folke Sjöberg 《Burns : journal of the International Society for Burn Injuries》2017,43(1):157-161
Introduction
As widely reported, the progress in burn care during recent decades has reduced the hospital mortality. The effect of the burns on long-term outcome has not received so much attention, and more study is indicated. The aim of this retrospective study was to investigate the long-time survival among patients who had been treated for burns.Methods
We studied 1487 patients who were discharged alive from the Linköping University Hospital Burn Centre during the period 1993 until the end of December 2012. We used Cox's regression analysis to study the effect of burns on long-term survival after adjustment for different factors.Results
Age and a full-thickness burn were significantly associated with mortality after discharge (p < 0.001), whereas percentage of total body surface area burned (TBSA %), need for mechanical ventilation, and gender were not. Less than 1% of the patients with burns (13/1487) died within 30 days of discharge and a total of 176/1487 (12%) died during follow-up.Conclusion
Age and full-thickness burns reduce the long-time survival after discharge from the Burn Centre, whereas the effect of TBSA% and need for artificial ventilation ends with discharge 相似文献17.
Jianfen Zhang Liangfang Ni Xinhua Jiang Zuliang Hu Chunmao Han Bin Xu Yuanhai Zhang Xingang Wang 《Burns : journal of the International Society for Burn Injuries》2018,44(8):2074-2079
Objective
We investigated the urinary fluoride level in patients with hydrofluoric acid (HF) burns of different severities and explored the clinical significance of these levels in the diagnosis of acute HF burn.Methods
Data from 260 patients with HF burns were collected from the Department of Burns, Zhejiang Quhua Hospital, between July 2006 and June 2016. According to burn severity, patients were divided into non-poisoning, mild poisoning, moderate poisoning, and severe poisoning groups. In addition, 25 healthy controls were recruited from fluorine chemical companies. The urinary fluoride level was measured using a fluoride-selective electrode and values were compared amongst groups. The urinary fluoride level was also measured periodically after exposure to investigate dynamic changes in the moderate and severe poisoning groups.Results
Urinary fluoride levels were 0.32–520.0 mg/L (n = 260) on admission to the emergency department, and 182 patients had levels >1.7 mg/L. The levels in controls and the non-poisoning group were lower than in the other two groups, and increased significantly with an increase in severity. Thirty-three patients were admitted 4 h after injury; of these patients, fluoride levels were significantly higher in those with severe poisoning than in those with moderate poisoning. Levels peaked 4 h after injury and then dropped and returned to normal 6 days after injury.Conclusion
Urinary fluoride level can be used for the early diagnosis of HF burns and to determine the severity of fluoride poisoning, which is crucial for early treatment. 相似文献18.
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19.
Sarah-Jayne Edmondson Irfan Ali Jumabhoy Alexandra Murray 《Burns : journal of the International Society for Burn Injuries》2018,44(7)
Aims
Dermal preservation during acute burn excision is key to obtaining superior healing/scar outcomes, however, determining the most appropriate excision tool is an ongoing challenge. Novel tool development means the knife is no longer our only option, yet for the majority it remains the gold standard. This systematic review aims to evaluate evidence for burns excision approaches (knife/hydrosurgery/enzymatic).Methods
CENTRAL, EMBASE, MEDLINE (1946–2017) were searched with MeSH terms: ‘debridement’, ‘burns’, ‘sharp’, ‘enzymatic’, ‘hydrosurgery’. Relevant randomised control trials (RCTs)/non-randomised controlled case series/trials were extracted/analysed. In vitro/burn non-specific studies were excluded. Main methodological parameters were intervention/excision efficacy.Results
Eighteen articles met inclusion criteria (n = 7148): three were RCTs, involving comparator enzymatic (NexoBrid? (EDNX)) or hydrosurgical (Versajet?) excision to surgical Standard of Care. Both showed statistically significant decreased need for excisional excision and auto-grafting by viable tissue preservation allowing spontaneous healing by epithelialisation.Conclusion
Level 1 Evidence comparing excision modalities for acute burns is sparse. Although early excision with a knife is still often considered best practice, there is no tool choice consensus or robust comparison with alternate, possibly superior, tools. EDNX or Versajet? should be considered alternatively. Further RCTs are indicated, with regards final scar outcomes and to allow consensus within current evidence. 相似文献20.
Laquanda Knowlin Paula D. Strassle Felicia N. Williams Richard Thompson Samuel Jones David J. Weber David van Duin Bruce A. Cairns Anthony Charles 《Burns : journal of the International Society for Burn Injuries》2018,44(2):272-279