Minor Burns: A Review

Two million burns occur annually in the USA, of which 95% aretreated in an out-patient setting. The treatment of burns iscontroversial. There are few data from controlled studies toprovide rational guidelines for the frequency of both dressingchanges and patient visits for the physician. Conclusions concerninginfection drawn from studies on major burns are misleading whenapplied to the management of minor burns. Trauma to regeneratingepithelium caused by frequent dressing change is of relativelyless importance in treating major burns, because the controlof infection is of overriding importance. In the treatment ofminor burns, the traumatic consequences of too frequent changesof dressing may assume greater importance. There is a clearneed to study the variables in the treatment of minor burnsand to generate criteria for their clinical management thatare distinct from those of major burn management. Collaborativestudies of out-patient populations by providers of primary healthcare are suggested as a useful approach to such investigation.The effects of several additional therapies are reviewed, includinginitial cold therapy, debridement of blisters and antibiotics.     

Estimation of the potential digestibility and rate of degradation of water-insoluble dietary fiber in the pig cecum with a modified nylon bag technique

Potential digestibility and rate of degradation of water-insoluble material (WIM) prepared from rutabaga, wheat bran and digesta recovered from the terminal ileum of pigs fed bran- or rutabaga-based diets were measured in the cecum of surgically modified pigs. WIM samples recovered from the cecum after fixed incubation times were analyzed and the rate of total disappearance of organic matter, cellulose, uronic acid and noncellulosic neutral sugars was calculated. Maximum degradation of each WIM occurred within 48 h after incubation and was for rutabaga and its ileal digesta 90 and 70%, respectively, and for bran and bran ileal digesta 55 and 45%, respectively. Cellulose and uronic acid in bran samples did not appear to be degraded, material disappearance being attributable to the loss of noncellulosic neutral sugars. Estimation of potential organic matter digestibility showed rutabaga to be 93%, rutabaga digesta 79%, bran 56% and bran digesta 43% digestible. Fractional rates of digestion in rutabaga samples were significantly faster than in corresponding bran samples. When related to the role of fiber in nutrition the results obtained suggest that cereal fiber would be only slightly modified during gut transit, unlike vegetable fiber in which microbial digestion would probably result in the total destruction of the fiber cell wall matrix.     

Factors relating to the sensory acuity of limbs with peripheral vascular insufficiency

We examined several possible causes for the high incidence of poor sensory acuity in the limbs of 176 patients with moderate to severe peripheral vascular insufficiency. We investigated the relationships of diabetes, alcoholism, and smoking, as well as the severity of peripheral vascular disease, to the integrity of basic sensory modalities such as two-point discrimination and perception of light touch. The presence or absence of diabetes exerted the strongest effect on peripheral sensation. In patients who did not have diabetes, sensation in the limbs was most strongly affected by whether the patient was an alcoholic. Smoking did not have a significant effect on limb sensation. Among nondiabetic, nonalcoholic patients, there was a weak residual effect related to the severity of the peripheral vascular insufficiency. Even among these patients, however, systemic factors predominated in determining the loss of sensation. We also examined the extent to which loss of sensation might be related to the development of ulcers. Among patients who were not diabetic, there was a highly significant relationship between loss of sensation and the presence of limb ulceration. Surprisingly, however, there was no discernable relationship between the presence of ulcers in diabetic patients and the degree of loss of peripheral sensation. This result suggests that a large percentage of ulcers seen in diabetic patients are not of neurogenic origin.     

Work therapy and return to work

In summary, data were selected for 1 year on patients treated in the Work Tolerance Program at the Hand Rehabilitation Center in Philadelphia. The type of information obtained has been used to obtain a profile of the patient population in the Work Tolerance Program. Statistical analysis was used, not only to formulate patient demographics, but also to evaluate the length of treatment of patients in the Work Tolerance Program. This period averaged 6 weeks. The statistical analysis also revealed there was significant interaction between the type of injury and the patient's diagnosis, and the rate of return to work. The patients with injuries to bone and nerve required longer periods of treatment until they returned to work than did patients with injuries to soft tissue or combination injuries. Our statistical analysis revealed that in 1982, 75 per cent of the patients in the Work Tolerance Program returned to work to regular or modified jobs. The length of time from injury to return to work was 63 per cent longer for patients with Workers' Compensation coverage than for patients with private insurance coverage. Because the statistical analysis that 60 per cent of the patients treated in the Work Tolerance Program were Workers' Compensation insured, and 80 per cent of the patients treated in the Work Tolerance Program were secondarily referred, it should be recognized that all patients with severe hand injuries would benefit from an immediate referral to a Hand Rehabilitation Center of excellence to facilitate their therapeutic management and expedite their recovery from time of injury to return to work. This study was restricted to the analysis of length of treatment and rate of return to work. Future studies should study the effect of early referral and the application of specific treatments.     

High power, low frequency components of cardiac, renal, splenic and vertebral sympathetic nerve activities are uniformly reduced by spinal cord transection

Others have reported that spinal cord transection non-uniformly affects the activities of the cardiac, renal and splenic nerves. We were unable to confirm this finding while recording the wide band (1-1000 Hz) discharges of these sympathetic nerves in baroreceptor-denervated, chloralose-anesthetized cats. Most of the power in nerve discharges was below 6 Hz. There was high coherence between the low frequency discharges of different nerves, and power below 15 Hz was essentially eliminated by spinal transection. Evidence is presented that the disparities between this and past studies are, in part, due to the use of a 30-Hz high-pass filter in the earlier studies.     

Improving organizational performance. Administrative nurse specialist

The Executive Nurse Council was challenged to develop strategies designed to empower staff nurses and nurse managers and create opportunities for professional growth. Implementation of these strategies resulted in broad-sweeping changes in roles and functions of groups and individuals at all levels of the organization. The authors describe a support role, administrative nurse specialist, designed to support staff and managers striving to actualize changes in a shared governance framework.