Development and evaluation of a DVD for the education of burn patients who were not admitted to hospital.

Patient involvement is an important component of burn care and is necessary to produce good outcomes. Patient education using multimedia resources is useful in facilitating self-management and recovery from burn injury. The study aims to provide and evaluate an instructional DVD to assist burn patients with their self-management. The project was divided into three phases: 1) research about the needs of patients, 2) production of the DVD based on those needs, and 3) evaluation of the effectiveness of the DVD. In phase III, 49 burn patients (73% male; median age 32 years, median TBSA 3%) completed a survey on confidence in their burn care before development of an educational DVD, the results of which were compared with those of 55 burn patients (58% male; median age 35 years, median TBSA 3%) who completed the same survey questions after viewing a burn care DVD. Patient confidence in all self-management activities showed a statistically significant improvement (P < .01). An instructional burns DVD improves confidence in self-management of patients who have not been admitted to hospital and is a useful adjunct to current burn practice.

Local and systemic treatments for acute edema after burn injury: a systematic review of the literature.

Burn injury is a complex trauma that results in local and generalized edema. Edema fluid limits the exchange of vital nutrients in healing the burn wound and will compromise vulnerable tissues. Although the importance of edema control in tissue salvage is recognized, treatments targeted at edema control have not been critically reviewed. Thus, the objective was to assess the evidence for the effectiveness of local and systemic treatments for edema management immediately after burn injury. Searches for randomized controlled trials were conducted of online databases, research and thesis registers, and grey literature repositories. Handsearches included journals, bibliographies, and proceedings. Authors were contacted to clarify and submit extra study details. Eight studies were included. Management of acute major burn resuscitation including colloid increases lung edema (mean difference [MD], 0.04 ml/ml alv vol; 95% confidence interval [CI], 0.03-0.04; P < .00001) and mortality (risk ratio, 3.67; 95% CI, 1.16-11.58; P = .03). Continuous administration of vitamin C in acute burn resuscitation reduces local wound edema (MD, -3.50 ml/g; 95% CI, -4.63 to -2.37; P < .00001) and systemic fluid retention (MD, -8.60 kg; 95% CI, -13.47 to -3.73; P = .0005). Local acute hand burn edema is reduced (MD, -29.00 ml; 95% CI, -53.14 to -4.86; P = .02), and active hand motion increased (MD, 10.00°; 95% CI, 4.58-15.42; P = .0003), using electrical stimulation with usual physiotherapy. Each review outcome was based on a small single-facility study. Thus, future research in intervention for acute burn edema must focus on multicentre trials and validation of outcome measures in the burn population.

Measurement of acute edema shifts in human burn survivors--the reliability and sensitivity of bioimpedence spectroscopy as an objective clinical measure.

Improvements in treatment for acute burn edema have stalled in comparison with other areas of burn care. Designing acute edema treatment studies in humans is hindered by the lack of objective, sensitive methods of measurement in the burn population. Bioimpedence spectroscopy (BIS) is a noninvasive method of measuring fluid volumes in the body. The aim of this study was to examine the reliability and sensitivity of BIS in the measurement of acute edema shifts in burn survivors, including assessment across different wound conditions. BIS measurements were collected in triplicate from 21 burn patients in total. Phase I (n = 13) examined BIS under three different dressing conditions. Phase II (n = 8) considered only patients with dressings intact. Sensitivity (minimum detectable difference [MDD]) was examined with total body water, extracellular fluid (ECF), and intracellular fluid volume measurements. BIS demonstrated excellent reliability across all dressings conditions, including when open wounds were present (intraclass correlation coefficient = 0.975-1.00, 95% confidence intervals = 0.938-1.00). Clinically useful levels of sensitivity, or MDD, were calculated. BIS MDD for total body water (open wounds) = 360 ml, ECF (open wounds) = < or = 10 ml, ECF (new dressings) = 540 ml, and intracellular fluid (open wounds) = 310 ml. BIS analysis is clinically applicable for real-time, noninvasive monitoring of whole-body fluid shifts in acute burn survivors with < or = 30% TBSA.

First response, rehabilitation, and outcomes of hand and upper limb function: survivors of the bali bombing disaster. A case series report.

In October 2002, two bombs exploded in Bali injuring hundreds, and killing 202 people. The purpose of this paper is to report the organization of the first response, rehabilitation strategies, and outcome of a series of patients evacuated to the Royal Perth Hospital (RPH), a civilian hospital in Australia. The initial medical response in Bali was primarily conducted by holidaying health professionals supporting the hospital on the island. The Australian Defence Force was primarily responsible for the ongoing acute clinical management during the evacuation and repatriation of survivors to all major burn units in Australia. At the RPH, hospital adaptations included novel staffing and treatment strategies to sustain a team effort beyond the acute phase of the disaster to manage the surge of 28 patients (15% of yearly admissions) in 7 days. Data collected were related to service delivery and patient outcomes (shoulder active range of motion, grip strength, and the Burns Specific Health Scale). Data were compared to baseline, similar data collected during normal practice and population norms. Bali patients received 3.2% more therapy treatment sessions and 6.8% less contact hours than usual protocols. Shoulder AROM recovered to normal limits by 3 months postdischarge. Grip strength for women was shown to reach population norms by 1 month after discharge and by 6 months for males. Self-rated physical recovery exceeded major burn population norms at 6 months postdischarge. Physical therapy outcome measures demonstrated upper limb recovery as usual in the Bali group, despite a mass casualty situation. To achieve this required support from the multidisciplinary team, in combination with community, government, and hospital administrative assistance.

Objective measurement of scarring by multiple assessors: is the tissue tonometer a reliable option?

Depending on the patient population, the incidence of scarring is as great as 75% after burns. Skin pliability and functional recovery are affected negatively by hypertrophic scarring. Therapists use various treatment strategies to improve scar outcomes. However, a simple, objective, clinically useful method of measuring scar response to treatment eludes us. This study examines the inter-rater reliability and validity of scar pliability measures using the modified tissue tonometer (MTT). Twenty-four patients were tested by two blinded, randomly allocated raters. The MTT was used to assess scar pliability with a standardized, repeated-measures design. One normal and up to three scar points were assessed for each subject. One subject was excluded from the data analyses. Concerning inter-rater reliability, the intraclass correlation coefficient for averaged measures between measurers was 0.957, and the standard error of measurement was 0.025 mm. For validity, a significant difference (P = .0000) between scar (2.64 +/- 0.5 mm) and normal tissue (3.23 +/- 0.46 mm) measurements was demonstrated. Scar pliability scores between raters are extremely reliable and reproducible using the MTT. It can differentiate between injured and uninjured tissue. Hence, it provides clinicians with a reliable, transportable, and objective tool to document scar outcomes. The MTT provides a standardized method to longitudinally measure scar tissue pliability after burn injury.