Mutual respect in healthcare: assessing cultural competence for the University of Utah Interdisciplinary Health Sciences.

INTRODUCTION: The University initiated an Interdisciplinary Health Sciences Students (IHSS) education program, Cultural Competency & Mutual Respect (CCMR), for medicine (MED), pharmacy (PHARM), nursing (NSG), physical (PT) and occupational therapy (OT). This study assessed CCMR pre/post learning outcomes through the Inventory for Assessing the Process of Cultural Competence-Revised((c)) (IAPCC-R). METHODS: Subjects included: 100 MED, 140 NSG, 36 PT, 11 OT and 53 PHARM IHSS. IAPCC-R(c) completed by IHSS: 263 Fall, 2003; 48 Spring, 2004. Controls included 100 MED and 36 PT. Pre/post test scores were calculated. Paired analyses performed, comparing overall CC scores and constructs, p < 0.05. RESULTS: Overall pre versus post mean scores: 2003: 69.75 and 71.62; 2004: 66.77 and 71.85. Paired t-test 2003: MED t = -3.1976 P > t = 0.0020; NSG t = 0.5196 P > t = 0.6064; PT t = 4.7181 P > t=0.0000; 2004: PHARM t =-3.7861 P > t=0.0006; All other t = -1.7392 P > t = 0.1425. Two sample t-test, significant only for post-module for Hispanic/Asian/other, 77.50, White, Non-Hispanic 70.37. DISCUSSION: Results indicate PT, MED, PHARM attained significant scores for constructs: Attitudes, Knowledge, and Skills; but not Encounters and Desires. Post-test scores indicated progressions approaching CC, however not yet Culturally Proficient. CONCLUSION: Results indicate IHSS are becoming more Culturally Aware as a result of CCMR participation; however, they have not achieved Cultural Proficiency. The constructs of Cultural Desire and Encounters warrant curricular enhancement for progression towards Cultural Proficiency.

Burn rehabilitation and research: proceedings of a consensus summit.

Burn rehabilitation is an essential component of successful patient care. In May 2008, a group of burn rehabilitation clinicians met to discuss the status and future needs of burn rehabilitation. Fifteen topic areas pertinent to clinical burn rehabilitation were addressed. Consensus positions and suggested future research directions regarding the physical aspects of burn rehabilitation are shared.

A clarion to recommit and reaffirm burn rehabilitation.

Burn rehabilitation has been a part of burn care and treatment for many years. Yet, despite of its longevity, the rehabilitation outcome of patients with severe burns is less than optimal and appears to have leveled off. Patient survival from burn injury is at an all-time high. Burn rehabilitation must progress to the point where physical outcomes parallel survival statistics in terms of improved patient well-being. This position article is a treatise on burn rehabilitation and the state of burn rehabilitation patient outcomes. It describes burn rehabilitation interventions in brief and why a need is felt to bring this issue to the forefront. The article discusses areas for change and the challenges facing burn rehabilitation. Finally, the relegation and acceptance of this responsibility are addressed.

Splinting strategies and controversies.

Splinting is a common burn care intervention strategy based on logical anatomic and biomechanical principles. The persistence of scar contraction requires countermeasures, frequently splints, and most clinicians would concur that splints are valuable in opposing these contraction forces. Clinical decisions about splinting are often made on respected opinion, leading mainly to design and application options. Variables that affect splinting strategy include the risk-to-benefit ratio of the splint, the timing of the application, the choice of splint design, and duration of the splinting intervention. The most common of these variables reported in the literature is simply unique designs for splints. Although there are different splint designs for similar problems, no data exist to favor one design over another. Controversy about splinting in burn care is not based on the rationale for and success of splinting but exists because of the paucity of validation of its use.

Home treadmill friction injuries: a five-year review.

Treadmills are popular home fitness machines in American homes. Young children are at risk for friction injuries if they contact moving treadmills. The purpose of this study was to determine the impact of treatment of treadmill friction injuries in children. A review of 1,211 pediatric patients younger than 6 years treated at the Intermountain Burn Center between July 1997 and June 2002 was conducted. Forty-eight of these cases (4%) were treadmill friction injuries. The mean TBSA of these burns was 0.5%. The volar surface of the hand was the most common site of injury. Twenty-two (46%) of the 48 identified patients had full-thickness injuries that were treated surgically. Medical costs associated with treadmill friction injuries averaged US 2,385 dollars. The number of treadmill friction accidents resulting in friction injuries to children less than 6 years of age deserves serious attention and increased public awareness.

Substance P axons and sensory threshold increase in burn-graft human skin.

BACKGROUND: Our knowledge of afferent nerve fiber reinnervation of grafted skin following third-degree burn is limited by a lack of quantitative histological and psychophysical assessment from the same cutaneous area. The current study compares fiber profile and functional recovery measurements in injured and control skin from the same subject. MATERIALS AND METHODS: Nerve regeneration and modality-specific sensory thresholds were compared using immunocytochemical labeling with protein gene product 9.5 antibody to stain all axons and anti-substance P to label substance P axons (which are predominantly unmyelinated), as well as computerized instrumentation to obtain psychophysical estimates. RESULTS: Compared to control skin, threshold measures of pinprick (P < 0.001), warming (P < 0.001), touch (P < 0.001), and vibration (P < 0.01) were significantly elevated in burn-graft skin and correlated with histological analysis of skin biopsies obtained from the same site. Immunohistochemical staining of all axons innervating the dermis and epidermis revealed a significant reduction in burn-graft relative to control skin (54% decrease, P < 0.0001). In contrast, the incidence of substance P nerve fibers was significantly elevated in burn-graft (177% increase, P < 0.05) and appeared to correlate with patient reports of pruritus and pain. CONCLUSIONS: Observations support the hypothesis that sensory regeneration is fiber-size-dependent in burn-graft skin. The findings that substance P fiber growth increased while total fiber count decreased and that thermal threshold showed the greatest degree of functional recovery suggest that unmyelinated neurons have the greater ability to transverse scar tissue and reinnervate grafted skin following third-degree burn injury.