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Biomedical subjects

G Warden

Publications and source records attributed to G Warden.

At least 37 records · Page 2Linked to original sources
PubMed1984

Conservative approach to the elderly patient with burns.

A retrospective analysis of 55 elderly patients (more than 60 years of age) was undertaken to compare results of conservative management to standard operative treatment. Thirty-one percent of the patients died early from their injury. Twenty-three patients were treated without operation, with emphasis on careful outpatient wound care and physical therapy. The remaining 15 patients required excision and grafting of burn wounds or amputation. Conservatively managed patients had fewer complications, a shorter hospital stay, and functional results equal to the operative group. These results suggest that many elderly burn patients can be managed without operation with good outcome and lessened morbidity.

Aged↗
PubMed1979

HMOs and hospitals: what are the options?

Each individual hospital must assess the relationship it wishes to have with HMOs/It is clear, however, that hospitals should get involved in the effort to deliver comprehensive health care services to their communities.

Community-Institutional Relations↗
PubMed1978

Board self-assessment: changing the governing structure to meet changing times.

Continual evaluation of the governing structure is required if the hospital is to respond quickly, reasonably, and confidently to the changing health care environment. Aspects that should be reviewed periodically include the size and composition of the board; the performance of its members; the committee structure; established liaisons with the medical staff; and external relationships with the community.

Decision Making↗
PubMed1975

Xenotransplantation of piscine islets into hyperglycemic rats.

Xenotransplantation of piscine islets into hyperglycemic rats usually lowers the blood sugar level of the recipient. The duration of this effect is prolonged by irradiation of the host or by enclosing donor tissue in synthetic envelopes. This prolongation appears to be related to interference with the host's ability to reject the graft; the duration of the prolongation may be limited by the host tissue reaction surrounding the envelope. The availability of anatomically separate piscine islet tissue makes it potentially useful for xenotransplantation into mammals.

Animals↗
PubMedDate not supplied

Continuous intravenous infusion of methadone for control of burn pain.

Seventeen patients with acute, severe burns were treated with a two-stage continuous, intravenous infusion of methadone to control pain. An initial loading infusion was run for 2 hours at 0.1 mg/kg/hr of methadone; then a maintenance infusion was continued at 0.01 mg/kg/hr of methadone. Median visual analog scale scores were 70% pain relief after the 2-hour loading infusion and 80% after 24 hours. Cardiovascular parameters were stable. There was a significant decrease in the respiratory rate of the patients. It appears that continuous intravenous methadone is an effective analgesic agent for the patient with acute, severe burns. Administration of the drug should be on an individualized basis with conservative dosing in a well-monitored environment because somnolence and respiratory depression can occur.

Adult↗
PubMedDate not supplied

To splint or not to splint--past philosophy and present practice: Part I.

The purposes of this study were to document (1) the historical use of splints, (2) record the current practice of splint application, and (3) compare splint philosophy of the past with present practice. One hundred burn references were reviewed for information on the past use of splints. Present practice was determined on the basis of a survey of 99 burn centers. Information is presented as to when splints are applied to burn patients in their course of recovery for 12 body areas prone to scar contracture. The influence of burn depth is noted. A change in the practice of applying splints to burn patients appears to have occurred. Part I of this series describes the global results and details whether splints are necessary.

Burn Units↗
PubMedDate not supplied

Return to school as an outcome measure after a burn injury.

Outcome measures have become an important tool to assist with monitoring the efficacy of burn care. One such measurement for children is the time required for them to return to school, as well as their behavior and academic performance in school after a burn injury. The purpose of this study was to relate demographic data with return-to-school time and school performance. Through medical record review and interviews with patients, parents, and school teachers, information was obtained regarding the patient's burn injury, as well as home and school status before and after the burn injury. School information before the burn injury was obtained after patient admission. Schools were contacted 6 months after hospital discharge for data after the burn injury. Thirty-four patients aged 6 to 16 years had their outcomes evaluated from September 1993 to June 1995. Average total body surface area burned was 25.9%; the mean area of full-thickness burn was 17.5%. Length of stay averaged 30.8 days. Sixty-five percent of patients were discharged with splints, and all were discharged with a pressure program. Children returned to school an average of 7.4 days after discharge, and the average number of missed school days was 22. Thirty-four percent of the children had a school reentry visit, and either a phone call, written material, or both were provided in lieu of a visit to the other schools. For this population, burn injury did not appear to impact outcome negatively as it related to a child's return or function in school. These children returned to school rather rapidly after discharge and functioned as well or better after injury. Little loss of grade was noted, and only those children with problems in school before the burn injury had problems after the burn injury. Contact with the child's school before reentry might have assisted with the smooth transition.

Adolescent↗
PubMedDate not supplied

Lorazepam given the night before surgery reduces preoperative anxiety in children undergoing reconstructive burn surgery.

A high level of preoperative anxiety frequently occurs in children undergoing reconstructive burn surgery. Reduction of this anxiety may have a number of physiological and psychological benefits. Various pharmaceutical and nonpharmaceutical regimens to reduce preoperative anxiety have been devised; however, most regimens are not initiated until the period immediately before surgery. Many of the children in our institution report high levels of anxiety beginning the night before surgery. Therefore we hypothesized that sedation the night before surgery would be beneficial. Oral lorazepam 0.025 mg/kg or placebo was given the night before surgery to 45 patients in a prospective, randomized, double-blind fashion; in addition, all patients received preoperative sedation per protocol on the day of surgery. Immediately before induction of anesthesia, all patients (mean age 12.5 +/- 0.9 years, range 6 to 18 years) performed an anxiety self-rating with the use of a validated visual analog scale (VAS). Patient anxiety and quality of anesthesia induction was also rated by one of the investigators. Postoperatively, patients rated their recall of anxiety with the use of the VAS. When queried preoperatively, patients who received lorazepam the night before surgery self-reported significantly less anxiety than those receiving placebo. Investigator observations did not detect this difference; this reinforces the assertion that patient self-rating of anxiety may be the best tool for rating anxiety.

Adolescent↗
PubMedDate not supplied

Pediatric patients experiencing postoperative nausea and vomiting after burn reconstruction surgery: an analysis.

Nausea and vomiting after a surgical procedure has a significant impact on a patient's hospital course. A perceived increased incidence of postoperative nausea and vomiting (PONV) in pediatric patients undergoing reconstructive scalp surgery had been clinically observed. A chart review to determine if a relationship existed between the surgical procedure and the incidence of PONV was conducted by selecting patients who were 5 to 12 years old and whose surgery fell between April 1995 and August 1995. Thirty-eight patients were evaluated for 46 procedures; 8 patients were evaluated for both insertion and removal of scalp expanders. No differences were identified between groups for previous history of PONV, length of anesthesia, or position during surgery. Data from the retrospective review suggested that pediatric patients with reconstructive surgeries of the scalp experienced PONV at 100% (24 procedures), whereas only 45% (10 procedures) of patients whose surgeries did not involve the scalp experienced PONV. In addition, despite significant earlier return of bowel sounds, episodes of PONV and time to oral intake were also increased in the group of patients whose operations involved the scalp. On the basis of these findings, a prospective study has been initiated to determine if changes in the perioperative protocol will improve patient outcomes and reduce the incidence of PONV.

Burns↗