Pruritus in burns. Comments from Brookside Hospital Burn Center, San Pablo, California.
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Bandages↗
Biomedical subjects
S Smith
Publications and source records attributed to S Smith.
Emergency room management of minor burn injuries: a quality management evaluation.
The vast majority of acute burns are initially seen and treated in emergency departments (EDs). Most of the individuals caring for these patients have little or no specialized training in the multidisciplinary approach to the burned patient. Burns of limited severity are treated immediately and then followed on an outpatient basis; therefore reviews of documented practices in emergency departments were not found. It was hypothesized that follow-up care may be suboptimal in this population. The medical records of 791 patients treated at three EDs in a Midwestern regional referral area from January 1991 through December 1991 were evaluated to assess the documentation of care provided. The three hospitals included a tertiary care teaching facility, a pediatric facility, and a community-based teaching hospital. Only the charts of patients treated and released from the ED were evaluated. The data demonstrate that there was suboptimal documentation of diagnosis, treatment, and follow-up care of the thermally injured patients who were initially treated in these EDs. Burn team members should develop educational and clinical relationships with EDs in the referral area to optimize both the delivery and documentation of outpatient burn care. This is especially important in today's health care environment, in which reimbursement is based on services rendered.
Adult↗
The search for cost-effective prevention of postoperative nausea and vomiting in the child undergoing reconstructive burn surgery: ondansetron versus dimenhydrinate.
Postoperative nausea and vomiting (PONV) is a common and unpleasant problem for children with burns who are undergoing reconstructive burn surgery. Ondansetron and dimenhydrinate have been found to be effective for the prevention of PONV in other patient populations, but they have not been directly compared in the pediatric population. A prospective, randomized, double-blind, placebo-controlled comparison of ondansetron and dimenhydrinate was performed. One hundred patients with a mean age of 11.8 years who were undergoing reconstructive burn surgery with general anesthesia were randomly assigned to receive either a placebo, 0.1 mg/kg of ondansetron, or 0.5 mg/kg of dimenhydrinate. The 3 groups were well matched for all demographic and procedural variables. The study drugs were given twice, first at the end of surgery and again 4 hours later, to ensure adequate blood levels during the 8-hour study period. Postoperatively, on the basis of the presence and amount of PONV experienced, all patients were assigned a PONV score by a blinded investigator. Statistically significant reductions in the incidence of PONV in the patients who received ondansetron or dimenhydrinate were found, as compared with the results of patients who received placebo. Postoperative vomiting was reduced from 61% in the placebo group to 29% and 40% in the ondansetron and dimenhydrinate groups, respectively, and PONV was similarly reduced from 69% to 47% and 40%, respectively. The differences between ondansetron and dimenhydrinate were not significant. The average cost to our pharmacy for the prescribed dose of ondansetron was $19.34; the cost for dimenhydrinate was $0.90. In this patient population, dimenhydrinate was as effective as ondansetron for the prevention of PONV and postoperative vomiting, and it was much less expensive.
Adolescent↗
MR evaluation of the temporomandibular joint in juvenile rheumatoid arthritis.
Temporomandibular joint (TMJ) disease is uncommon in children but frequently occurs in juvenile rheumatoid arthritis (JRA). Involvement is often asymptomatic; however, it can lead to growth disturbances and facial deformity. Thirty TMJs in 15 children (11 girls and 4 boys aged 3.5-18 years) with JRA were evaluated clinically and by MRI. Plain films were reviewed when available. Magnetic resonance imaging parameters included T1-weighted and in some cases T2-weighted or gradient recall echo sequences. We assessed condylar configuration, glenoid fossa changes, presence of erosions, disk abnormality, range of motion, and presence of joint effusions or pannus. Abnormalities included cortical erosions (n = 19), disk thinning (n = 18), and perforation (n = 2). Reduction of joint movement (n = 20), joint locking (n = 3), and pannus/effusions (n = 5) were also found. Magnetic resonance imaging is a useful technique for the detection of TMJ involvement in JRA. Early detection and therapeutic intervention may lessen or prevent subsequent deformities.
Adolescent↗
Economic, management, and business content in the nursing curriculum.
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Administrative Personnel↗
The role of denial in recovery from coronary heart disease.
This longitudinal study investigated the relationship between denial of illness and the course of recovery in patients with coronary heart disease. Using a newly developed interview instrument, the Levine Denial of Illness Scale (LDIS), the level and modes of denial were assessed in 45 male patients who were hospitalized for myocardial infarction or for coronary bypass surgery, of whom 30 were followed for 1 year after discharge. The reliability, internal consistency, and validity of the LDIS were found to be satisfactory. Furthermore, the LDIS showed discriminant validity from trait measures of denial. LDIS scores were not associated with severity of illness or risk factors. High deniers spent fewer days in intensive care and had fewer signs of cardiac dysfunction during their hospitalization relative to low deniers. However, in the year following discharge, high deniers adapted more poorly than low deniers: high deniers were more noncompliant with medical recommendations and required more days of rehospitalization. The findings suggest that denial of illness is adaptive during acute hospital recovery, but is maladaptive in the long-run after hospital discharge.
Adaptation, Psychological↗
Spontaneous visual improvement in the first affected eye of patients with bilateral disciform scars.
Patients with macular disciform degeneration may undergo spontaneous improvement in visual acuity of the first affected eye when the second eye later undergoes a decrease in vision. Three hundred twenty-nine cases of age-related macular degeneration (AMD) and presumed ocular histoplasmosis syndrome (POH) were examined. There were 20 patients who strictly met the criteria of a disciform scar causing visual acuity of 20/200 or worse in one eye, and 20/50 or better vision in the second eye, who subsequently developed involvement of the second eye with a decrease in visual acuity to 20/200 or less. Six of these 20 patients (30%), after mean follow-up of 32.8 months, achieved spontaneous visual acuity improvement, defined as at least a five-line improvement on a decimal (logarithmic) scale, with an average increase of 7.6 lines in the first affected eye. At extended mean follow-up of 50.1 months, two of the six lost vision, so that four of the 20 (20%) had five lines or more of improvement.
Adult↗
Multicenter, comparative study of enoxacin and ceftriaxone for treatment of uncomplicated gonorrhea.
The efficacy of single dose enoxacin, 400 mg was compared to ceftriaxone, 250 mg IM for therapy of uncomplicated gonorrhea in 152 evaluable patients attending sexually transmitted disease clinics in Baltimore, Indianapolis and Seattle. Anogenital gonorrhea was cured in 75 (99%) of 76 patients treated with enoxacin and 73 (97%) of 75 patients treated with ceftriaxone. Three of three patients with pharyngeal gonorrhea were not cured by enoxacin while all three ceftriaxone treated cases of pharyngeal gonorrhea were cured. All cases of anogenital gonorrhea caused by beta-lactamase producing Neisseria gonorrheae (11 patients), gonococci with high-level, plasmid-mediated tetracycline resistance (11 patients), or gonococci with chromosomally mediated penicillin resistance (22 patients) were cured. The IC90 for enoxacin of N. gonorrhoeae isolated in this study was 0.06 microgram/ml. Enoxacin appears to be a well tolerated, efficacious alternative to currently recommended therapy for patients with uncomplicated, anogenital gonorrhea including cases potentially caused by antibiotic resistant N. gonorrhoeae.
Adult↗
Outcomes related to burn-related child abuse: a case series.
Nationally, approximately 10% of child abuse cases involve burning, and up to 20% of pediatric burn admissions involve abuse or neglect. Historically, these cases have been more difficult to prosecute than nonburn cases for multiple reasons. Between 1995 and 1999, there were 285 pediatric (under 18) patients admitted to the Spectrum Health Regional Burn Center. Of these cases, 18 of the alleged perpetrators were legally investigated for suspicion of child abuse, and 7 received punitive sentences. We found that men tended to be prosecuted and convicted more often than women and that cases involving multiple instances of injury tended to be prosecuted more frequently. Similarly, we found that cases involving more severe injuries tended to be prosecuted more successfully. There are many psychological and social factors involved in handling burn abuse cases. However, by successful prosecution of these crimes, victims tend to fare better both socially and psychologically.
Adolescent↗
Use of the reciprocating gait orthosis in myelodysplasia.
There are advantages to an upright posture and ambulation in pediatric myelodysplasia patients. The reciprocating gait orthosis (RGO) is a useful tool to enable this activity in selected individuals. We evaluated the long-term usage, pitfalls, and contraindications of this orthosis. Mean daily usage was 6.9 h/day, requiring an average of 10 min to don or doff; all patients required assistance. Obesity, advanced age, lack of patient or family motivation, scoliosis, and spasticity were significant negative factors in long-term usage of the RGO. Good upper extremity strength, trunk balance, previous standing or walking, and active hip flexion were important positive variables. Eleven of 21 patients did not persist with long-term usage of this orthosis, averaging 25.8 months of usage. An energy study was performed on three patients, comparing the efficiency of reciprocating gait and swing-through gait. All three were more energy efficient and two were faster with the swing-through gait but each preferred the reciprocating pattern. Care should be taken when selecting patients for RGO usage because not all children with myelomeningocele are able to function effectively with this orthosis.
Braces↗
Combined keratectomy, strontium-90 irradiation and permanent bulbar conjunctival grafts for corneolimbal squamous cell carcinomas in horses (1990-2002): 38 horses.
OBJECTIVE: The purpose of this study was to evaluate the effectiveness of postoperative beta-irradiation with strontium-90 as an adjunctive treatment to superficial keratectomy and permanent bulbar conjunctival graft for removal of equine corneolimbal squamous cell carcinoma (SCC), in decreasing recurrence rate. STUDY: The retrospective case study included 38 horses diagnosed and treated for SCC of the eye that involved the limbus and/or cornea. The patients were treated between 1990 and 2002, with strontium-90 irradiation immediately after corneal and conjunctival graft surgery. Recurrence was defined as the postoperative and postirradiation regrowth of SCC in the same site and globe that was previously treated. RESULTS: The Appaloosa was the most commonly represented breed and horses that had more than one base coat color represented the majority of the cases (53%). The coat colors of white, chestnut/sorrel and gray were the most commonly represented colors of the horses treated. Eight horses (21%) could not be assessed for tumor recurrence due to lack of two or more post-treatment examinations, and another horse was enucleated 6 days postoperatively due to progressive corneal ulceration. Twenty-four horses (63% of the entire study population; 83% of the followed cases) had a mean +/- SD of 1754 +/- 1319 days without tumor recurrence, ranging from 14 days to 5110 days. Five horses (13% of the entire study population; 17% of the assessed horses) had tumor recurrence at a mean +/- SD of 449 +/- 339 days with a range of 29 days to 900 days. For the five recurrences, treatment included local excision (n = 1), enucleation (n = 2), and additional strontium-90 therapy (n = 3). CONCLUSIONS: The combination of superficial keratectomy, beta-irradiation and permanent bulbar conjunctival grafts for limbal, corneal or corneolimbal SCC in horses is effective in at least 83% of the horses. Recurrence occurred in about 17% of the horses. Multiple biannual re-examinations are recommended to observe for tumor recurrence.
Animals↗
Outpatient video-EEG monitoring in children.
Video-EEG monitoring enables correlation of behavioral activity with EEG activity, which is useful in recognition of pseudoepileptic seizures and in investigation of patients for epilepsy surgery. Because most patients are monitored for a prolonged time as in-patients, the cost of the procedure is high. We investigated the value of brief (2-3 h) outpatient video-EEG monitoring in 43 children with frequent seizures, most of whom had symptomatic generalized epilepsy. Indications for monitoring included differentiation of epileptic from nonepileptic behavior, seizure classification, and determination of seizure frequency. Clinical episodes were recorded in 36 of 43 children (83%). A definite diagnosis was established in 9 of the 17 patients investigated to determine the nature of the clinical behavior. Seizures were classified in 15 of the 25 patients investigated to determine seizure type, and classification was different from the original in 9 of the 15 children. A change in epilepsy syndrome classification was made in 9 children. The video-EEG allowed diagnosis in 25 of the 43 children (59.5%). Video-EEG appears to be an effective method for outpatient investigation of children with frequent seizures, particularly those with symptomatic generalized epilepsy.
Adolescent↗
Evaluation of virtual reality bronchoscopy as a learning and assessment tool.
BACKGROUND: Conventional training in bronchoscopy involves a trainee performing on a real patient under supervision. This method of training is not only expensive, but there is also potential for increased patient discomfort. Simulators permit the acquisition of necessary technical skills required for the procedure. Virtual reality (VR) has been an integral part of training in aviation, and the application of this technology in medical training needs to be evaluated. OBJECTIVE: This study was conducted to evaluate the efficacy of a VR bronchoscopy simulator as a learning and assessment tool. METHODS: The bronchoscopic simulator (HT Medical Systems, Maryland, USA) is a VR computer programme. The simulator has the ability to assess competence by a set of parameters, which formed the data for the study. Nine novices without previous bronchoscopic experience formed the study group (group 1). Nine experienced bronchoscopists having performed between 200 and 1000 bronchoscopies formed the other group (group 2). We assessed the efficacy of the system as a learning tool by studying whether there was a significant difference between the first and subsequent sessions of the subjects from group 1 and by comparing the performance of the two groups. Statistical analysis was done using the Mann-Whitney U test and the Wilcoxon signed ranks test. RESULTS: There was a significant difference in performance between the first attempt of group 1 and the performance of the experts in terms of percentage of segments visualised and number of wall collisions and the economy of performance. Among the subjects from group 1, there was a significant improvement in percentage of segments visualised by the third attempt (p = 0.04), in the economy of performance by the sixth attempt (0.008) and in the number of wall collisions by the sixth attempt (0.024). When each attempt of the novices was compared with the performance of group 2, the significance in the difference of the percentage of segments studied (p = 0.09) and the economy of performance disappeared by the third attempt (0.06), while the difference in the number of wall collisions disappeared by the fifth attempt (p = 0.06). CONCLUSIONS: This study has been able to establish the face, construct and content validity of the simulator and the potential for it to be an effective training tool.
Bronchoscopy↗
Effect of seizures on progression of dementia of the Alzheimer type.
A survey of institutionalized patients with clinical diagnosis of probable dementia of the Alzheimer type (DAT) indicated that 21% of patients developed seizures after the onset of DAT. Of the total of 27 patients, 11 developed seizures at home and 16 after institutionalization. In 9 of 11 patients (82%), who suffered the initial seizure at home, the patients' condition suddenly worsened and required long-term care admission within 6 months of the seizure onset. Language function declined significantly more rapidly in 5 patients with seizures than in controls matched by age and duration of DAT.
Age of Onset↗
Altered immunologic function and nitrogen metabolism associated with depression of plasma growth hormone.
The specific role of endogenous growth hormone in regulating nitrogen metabolism during surgical stress and infection remains unclear. We have studied splanchnic amino acid uptake and plasma concentrations in patient groups exhibiting growth hormone hypersecretion or relative growth hormone depression in response to stress. Splanchnic amino acid uptake was similar in both groups although plasma levels were significantly higher in the presence of depressed growth hormone production suggesting increased net peripheral proteolysis. In association with this latter observation. T lymphocyte subset analysis revealed a greater incidence of depressed helper to suppressor cell ratios in the presence of depressed growth hormone suggesting a greater impairment of cellular immunity.
Aged↗
Endocrine mediators of metabolism associated with injury and sepsis.
We have studied the endocrine characteristics of 13 seriously ill patients with the use of a provocative intravenous glucose bolus. Notable in this stressed patient population was that no major interpatient differences in response to glucose were found for insulin, glucagon, cortisol, or epinephrine. However, following glucose challenge half of this group (7/13) exhibited a prominent "paradoxical" mean human growth hormone (hGH) elevation (26.4 +/- 9.3 microU/ml) whereas the others (6/13) exhibited only a minor increase (7.8 +/- 2.9 microU/ml). In addition, norepinephrine levels were significantly higher in the latter group suggesting that the adrenergic nervous system plays a major role in regulating hGH in stress.
Aged↗
Superior ultra-audiometric hearing: a new type of hearing loss which correlates highly with unusually good speech in the "profoundly deaf".
This paper reports 42 severely-to-profoundly deaf subjects, 6 of whom have better hearing in the range of 8 to 14 kHz than below 8 kHz. Data on speech capabilities in these six subjects suggest that this ultra-audiometric range may contribute to their speech comprehension and control.
Adult↗
Comfort and incidence of abnormal serum sodium, BUN, creatinine and osmolality in dehydration of terminal illness.
This prospective clinical study was undertaken to evaluate the effect of spontaneous food/fluid intake on serum sodium and comfort levels in a population of terminal patients (n = 31) receiving clysis or intravenous hydration. The median and mode of serum sodium were within normal limits and 56 percent of the patients were eunatremic. There was no statistically significant difference in comfort scores between predehydration and dehydration phases, and 85 percent had an optimal comfort score. A statistically significant difference was found (p < 0.5) between mean daily comfort scores of those with normal sodium versus those with abnormal sodium; those with hypernatremia were lower but still in the top third comfort levels. Because the sodium was tested using a Chem7, we also were able to calculate the BUN, creatinine, and osmolality. These are presented and compared to other study results. The findings of this study reinforce the belief that fluid depletion in dying patients results in relatively benign symptoms, that serum sodium levels are not always altered with limited intake and that comfort levels can be maintained when the serum sodium is abnormal.
Adult↗