Journal of burn care & research : official publication of the American Burn Association
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Pharmacologic modulation of hypermetabolism clearly benefits children with major burns, however, its role in adult burns remains to be defined. Oxandrolone appears to be a promising anabolic agent although few outcome data are as yet available. We examined whether early oxandrolone treatment in severely burned adults was associated with improved outcomes during acute hospitalization. ⋯ Oxandrolone treatment was independently associated with higher survival by adjusted analyses (P = .02). Examination of early oxandrolone treatment in this cohort of severely burned adults suggests that this therapy is safe and may be associated with improved survival. Further studies are necessary to define the exact mechanisms by which oxandrolone is beneficial during inpatient treatment.
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Low voltage electrical injury is associated with minor or no cutaneous burns and its symptoms rarely appear on initial examination. The purpose of this study was to determine the ability to return to work among patients with low voltage electrical injury. A retrospective hospital chart review was conducted among patients with low voltage electrical injury admitted to the outpatient burn clinic of a rehabilitation hospital between January 1, 2002 and March 21, 2006. ⋯ Low voltage electrical injury can significantly impact a patient's ability to return to work because of the psychological, neurological, and musculoskeletal symptoms, which are observed. Recognition of low voltage injury as a potentially permanent source of symptoms is important and has to date not been well established. More effective preventive measures should be implemented at work to reduce the risk of these injuries.
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Randomized Controlled Trial
Systemic perioperative antibiotic prophylaxis may improve skin autograft survival in patients with acute burns.
Skin autograft is the most important definitive treatment for acute-deep burns. Wound infection is the most important cause of autograft loss. Prior clinical studies have not shown any significant difference in the autograft survival rate and the use of perioperative systemic antibiotics. ⋯ The rate of autograft survival for the AP group was 97% and for the NP group was 87% (P < .01) There was a partial autograft loss in 10 procedures (23%) in the AP group and 23 procedures (50%) in the NP group (P < .01). Patients with acute deep burns treated with autografts may benefit from systemic perioperative antibiotics prophylaxis, as antibiotics seem to be associated with increase autograft survival rate. The risk of colonization in other parts of the body with multidrug resistant bacteria warrants further study.
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Burn care, especially for serious burn injuries, represents a considerable challenge for the healthcare system. The American Burn Association has established a number of strategies for the management of burn patients and dedicates its efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention, often in collaboration with other organizations. The American Burn Association has recommended that patients with serious burns be referred to a designated burn center, ie, a hospital outfitted with specialized personnel and equipment dedicated to burn care. ⋯ Burn surgeon shortages have also been identified, stemming, in part, from a lack of specialized burn care training opportunities. There is currently a lack of quality outcome data to support evidence-based recommendations for burn care, and burn care centers are compromised by problems obtaining reimbursement for the care of uninsured and publicly insured out-of-state burn patients. Initiatives are underway to maintain efficient burn care facilities that are fully funded, easily accessible, and most importantly, provide optimal, evidence-based care on a daily basis, and are well-equipped to handle a surge of patients during a disaster situation.
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Accounts of self-inflicted death by fire are numerous and are found from antiquity to present times. We review selected examples of self-immolation from historical record, in mythology and as part of religious and cultural tradition. ⋯ We offer motives for this horrifying act and discuss how it has been used as a form of protest for political reasons or for individual maltreatment or as a means to end intense personal suffering. Finally, we explore what setting oneself alight may represent from a psychodynamic perspective.