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Biomedical subjects

P Silverstein

Publications and source records attributed to P Silverstein.

35 records · Page 2Linked to original sources
PubMed1967

Photography.

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Dentistry↗
PubMedDate not supplied

Comparison of energy expenditure measurement techniques in severely burned patients.

The degree of accuracy of existing formulas for calculating energy expenditure can be determined by comparing them to the measured energy expenditure via indirect calorimetry. As a result, one can modify traditional predicted recommendations for nutrition alimentation of the burn patient with real-time data. In this study, 21 sequential adult admissions with second- and third-degree total body surface area (TBSA) burn wounds (range 21%-81% TBSA) underwent serial assessments of energy expenditure by indirect calorimetry. On admission, maximum, and discharge, measured energy expenditure (MEE) was compared with the calculations for predicted energy expenditure by the Curreri (CEE) and modified Harris-Benedict (MBEE) equations. The mean energy expenditure calculated from the Curreri equation on admission (CEEA) overestimated the mean MEE on admission (MEEA) by 25% (P less than 0.001) and on discharge (MEED) by 36% (P less than 0.0005). The mean modified Harris-Benedict equation overestimated the mean MEEA by 32% (P less than 0.0005) and the mean MEED by 39% (P less than 0.0005). No significant difference was noted between the mean MEE at maximum (MEEM) and the mean CEEA or the mean MBEEA. This indicates excessive overfeeding of the burn patient from admission to discharge by both standard formulas. Actual measured data provide a better indicator of varying nutritional needs throughout the hospital course than the standard formulas, and their use would result in significant savings in the expenses of enteral/parenteral nutritional supplements.

Adolescent↗
PubMedDate not supplied

Sildimac: a new delivery system for silver sulfadiazine in the treatment of full-thickness burn injuries.

Wound care is painful for the patient with a burn injury and tedious for the burn unit staff but necessary to remove exudates and debris and to limit infections. In an effort to circumvent daily dressing changes while ensuring optimal wound protection, Sildimac (Marion Laboratories, Kansas City, Mo.), a new drug delivery system for silver sulfadiazine, was developed. When silver sulfadiazine, a topical antimicrobial commonly used for the treatment of burns, is incorporated into the delivery system, the drug is released in a sustained fashion. We report here the results of a multicenter evaluation of the safety and efficiency of Sildimac for treatment of full-thickness burn wounds. Sildimac, when left in place for up to 4 days, appears to be as effective as twice-daily wound cleansing and application of Silvadene cream 1% (Marion Laboratories, Kansas City, Mo.) for the treatment of full-thickness burns.

Acrylates↗
PubMedDate not supplied

Patient perception of quality of life after burn injury. Results of an eleven-year survey.

The purpose of this study was to assess how patients with burns perceive their physical, psychological, social, and economic status since their burn injuries and to examine the question, "Does burn severity or age at the time of injury affect the patient's perception of his or her quality of life after burn injury?" A 25-item questionnaire was mailed to 1837 former patients who had been hospitalized in our adult burn center from 1975 to 1987, and 245 (13.1%) completed questionnaires were returned. The chi 2 test suggests that the patient sample overall did not experience a change in perceptions after burn injuries. However, when the adult group is divided by burn severity (grouped into low and high percent of burn) and by age at the time of injury (grouped into young and old), both the young and the older persons with high burn severity identify impairments in their quality of life after burn injury.

Adaptation, Psychological↗
PubMedDate not supplied

The relationship of patient stress to burn injury.

The stress of burn injury can have an especially profound psychologic effect on individuals with recent histories of stress life events. A review of the literature reveals a model for this effect and documents the possibility of burn-prone patients, a concept that may explain the high number of patients with burns who also report a high level of stress before injury. This study was designed to assess the proportion of patients with burns reporting previous stress and to assess the relationship of this stress to burn injury and its exacerbating effects. A definite correlation between previous stress and burn injury was found, indicating that many patients with burns may have been in a vulnerable state at injury. Since such vulnerable patients will show a more severe reaction and more serious level of psychologic dysfunction than the seriousness of their injuries might indicate, their identification would have decided benefits in their psychologic rehabilitation.

Adaptation, Psychological↗
PubMedDate not supplied

Burn center reimbursement analysis.

If burn centers are to survive in the current fixed-payment environment, managers and physicians must be knowledgeable of the parameters and regulators of reimbursement. The purpose of this study was to assess the reimbursement status of a burn center in a private, not-for-profit facility. The analysis included both internal and external constraints imposed on the hospital. Data from fiscal year 1989-90 were used to identify the most frequently coded burn diagnosis-related groups and third-party payers. Actual reimbursement rates per diagnosis-related group were examined, and the average charge per patient discharge was compared with reimbursement per patient. Total billed charges versus received revenue for Medicaid patients were explored. Problems and solutions were identified and discussed after completion of the assessment.

Accounts Payable and Receivable↗
PubMedDate not supplied

"Burn repeaters" and injury control.

The purposes of this study were (1) to identify the percentage of patients with burns or intergenerational family members who have had previous burn injuries that required hospitalization and (2) to assess the need for an inpatient burn prevention program for patients and families. This study revealed an increase from 8% to 19% "burn repeaters," with a yearly average of 13% in a 5-year census and a 20.1% etiologic fraction related to the marker of increased risk (previous burn injury). These results strongly substantiate the necessity for an inpatient prevention program for patients and families to promote injury control by reduction of subsequent burn injury and thus break the burn injury cycle.

Accident Prevention↗