[Standardisation of the Initial Treatment of Severely Burned Patients: The Necessary Transfer of Concepts from Trauma Care]. / Standardisierung der Initialbehandlung von Schwerbrandverletzten: Die notwendige Übertragung von Konzepten aus der Schwerverletztenversorgung.

The initial treatment of severely burned patients remains a huge challenge for first responders in emergency services as well as emergency doctors who do not work in a centre for severe burn injuries. The reason for this is the low number of cases in developed countries and a lack of training concepts for the specific aspects of the initial treatment of severe burn injuries. Because of guidelines with limited evidence (S1, S2k) and a lack of structured treatment approaches, uncertainties with respect to initial treatment are still visible. Even within the professional societies and on international comparison, controversial aspects remain. In contrast, optimised and standardised procedures are available for the treatment of severely injured (trauma) patients, based on PHTLS® (Pre Hospital Trauma Life Support) for preclinical and ATLS® (Advanced Trauma Life Support) for in-hospital first aid. This article takes stock of the current structure of care and the relevant evidence for the initial treatment of severe burns. Also it discusses a possible transfer and further development of concepts for primary trauma care by all disciplines involved. Nine essential steps in the primary care of burned patients are identified and evaluated. The need for the introduction of a uniform treatment algorithm is illustrated. The treatment algorithm presented in this article addresses all first responders who are faced with initial treatment in the first 24 hours outside of burn centres. As an essential, new aspect, it offers a transfer and adaptation of concepts from trauma care to standardise the care of severely burned patients.

A Comparative Study Into Procedures for Postmortem Inspection for Finishing Pigs.

A postmortem meat inspection system based primarily on visual inspection without palpation or incision was compared with regular meat inspection procedures based on European Community (EC) regulations, which consists of visual inspection, palpation, and incision of organs. Two experiments included 31,682 finishing pigs. Three inspection procedures were followed: visual, i.e., an inspection without manipulation of the carcass; regular, i.e., based on EC regulations; and extra, i.e., based on EC regulations with more time allowed for the inspection. The reproducibility and accuracy of the visual and regular inspection methods were compared with those of the extra inspection. Twelve postmortem abnormalities and four additional findings were compared. The reproducibility of the visual inspection, measured with Cohen's kappa (CK), was poor to fair (CK from 0.14 to 0.64), and the regular inspection also had a poor to fair reproducibility (CK from 0.24 to 0.73). The specificity and sensitivity of the visual and regular inspection methods did not differ significantly for most of the abnormalities and additional findings. The sensitivity was low (range 0-76%) and the number of false-negative findings was sometimes high. It can be concluded that many abnormalities and additional findings are detected equally well by visual and regular postmortem inspection procedures. It is concluded that since both inspection procedures are far from perfect, risk assessment should be performed.

Resources for vocational planning applied to the job title of PHYSICAL THERAPIST.

Industrial rehabilitation is a rapidly developing area of health care. As a result, physical therapists need to become functionally familiar with common vocational planning processes and resources. Therefore, the purpose of this article is to describe a process called Vocational Diagnosis and Assessment of Residual Employability (VDARE), which is based on the Dictionary of Occupational Titles (DOT) and Classification of Jobs (COJ) resources. We have provided the DOT and COJ classifications for the job title of PHYSICAL THERAPIST as an example of their terminology. A critique of the DOT and COJ, applied to several occupational examples, suggests these resources be used with supplemental task analyses for a given job. The physical therapist, however, can use the VDARE process and the DOT and COJ resources to identify specific and achievable job targets for clients rather than relying solely on traditional trial and error, on-the-job evaluation.