Support For Burn Patients Research Articles

Prevalence of Depressive symptoms, Anxiety symptoms, disturbed Self Image and Role of Social Support in Burn Patients

Prevalence of Depressive symptoms, Anxiety symptoms, disturbed Self Image and Role of Social Support in Burn Patients

The relationship between posttraumatic growth, self-efficacy, and social support in burn patients: A cross-sectional study

AimsTo explore the effects of self-efficacy and social support on posttraumatic growth among burn patients. MethodsThis study adopted a cross-sectional design and used convenience sampling method to recruit moderate and severe burn patients. The study was conducted from January to July, 2018 in a tertiary hospital in Linyi, China. Self-administered questionnaires were used to collect data on posttraumatic growth, social support, and self-efficacy. Path analysis conducted using SPSS AMOS 21.0 software was used to explore the relationship between the above three variables. ResultsThe mean scores for posttraumatic growth, social support, and self-efficacy were 58.11 ± 9.60, 43.48 ± 6.81, and 24.97 ± 5.71, respectively. Self-efficacy and social support were directly and positively related to posttraumatic growth among burn patients. Social support was also indirectly and positively associated with posttraumatic growth. Self-efficacy partially mediated the relationship between social support and posttraumatic growth. ConclusionsSelf-efficacy was an important mediator for burn patients’ social support and posttraumatic growth. Therefore, self-efficacy and social support should be considered when designing and implementing of interventions for posttraumatic growth among burn patients.

Epidermal Protein C Levels Correspond to Local Injury Severity and Increased Clinical Support in Burn Patients

The protein C (PC) system has proven to be a crucial cascade in systemic inflammatory and coagulopathic disorders such as severe sepsis and, more recently, in severe burns. We aimed to conflate our recent systemic findings with further investigations in the local tissue effects of a severe burn injury on the expression of PC and its main receptor endothelial protein C receptor (EPCR). Of the 86 patients enrolled in our recent study, 34 consented to biopsies of both normal and burn edge tissue. These were examined histologically and immunostained for PC, EPCR, and CD68. The burn samples expressed lower PC (p = 0.0027) and higher EPCR (p = 0.0253) than the normal samples in a histological severity-dependent manner. There was also a negative association between PC expression and CD68 positive macrophage infiltration (τb = −0.214, p = 0.020), which was expectedly higher in burn edge samples (p < 0.0005). Interestingly, while there were no correlations between tissue and plasma PC or EPCR, local PC expression was also prognostic of our previously established outcome of a patient requiring increased medical support (OR 0.217 (95%CI 0.052 to 0.901), p = 0.035). The results suggest that local PC cascade changes from a burn injury may be a separate process to the systemic effects and that the local levels may provide useful information in addition to the diagnostic and prognostic abilities we previously found in the circulating PC system.

Relationship between self-esteem and perceived social support in burn patients in Sina Hospital of Tabriz.

AimVisible scars and damage to self‐esteem make it difficult to endure difficult conditions and have some detrimental psychological and physical consequences for patients with burns. Social support plays an important role in enhancing the mental image and self‐esteem of burn patients in the rehabilitation stages of burn patients. The aim of this study was to determine the relationship between perceived social support and self‐esteem in burn patients referred to Sina Hospital in Tabriz in 2019–2018.DesignDescriptive correlational study.MethodsIn this descriptive correlational study, 120 patients with different degrees of burn were selected using the convenience sampling method. After obtaining validity and reliability, the data were collected using demographic questionnaires, Rosenberg self‐esteem and Zimet Multi‐dimensional Perceived Social Support. Then, they were analysed using descriptive and analytical tests and SPSS software.ResultsThere was a positive and significant correlation between the main variables of the research (p < .001, r = 0.288). Duration of hospitalization, percentage of burns and education were effective factors in self‐esteem (p < .005). Based on the findings, more support for burn patients will increase patients' self‐esteem and greater adaptation, as well as a better return to their lives in the rehabilitation phase.

40 Implementation of a Nursing-driven Volume-based Enteral Feeding Protocol

Abstract Introduction Nutrition in the burn patient is vital to proper wound healing and graft take, counteracting the hypermetabolic response, and improving patient outcomes. Studies support early, aggressive enteral nutrition for burn patients. Enteral nutrition is often interrupted during hospitalization, causing patients to fail to achieve their nutritional goals. To maximize nutritional support for burn patients, our institution implemented a nurse-driven, volume-based enteral infusion protocol (VBP). The goal of this quality improvement project was to compare clinical outcomes and volume of enteral nutrition received by the burn patient pre- and post-VBP. Methods A single-center retrospective analysis was conducted at one adult burn center comparing pre- and post-implementation of a VBP. Patients aged 18–89 years admitted to the SICU for initial management of burn injury between November 2014 – May 2015 (pre-VBP) and June 2015 – January 2016 (post-VBP) were included; for stepdown patients the time period ranged from June 2017 – December 2017 (pre-VBP) and February 2018 – September 2018 (post-VBP). Pertinent demographic and burn-related data were collected. Clinical outcomes included length of stay (LOS), complications as defined by National Burn Repository, duration of mechanical ventilation, percent weight gain or loss, and percent of enteral volume received. Results In the SICU, there were 10 patients pre-protocol and 12 patients post-protocol. When comparing pre-VBP to post-VBP demographics, mean TBSA was 19.6% (1–40.5) vs 24.83% (2–61.5%), with a mean age of 64.4 vs 60.7 years. For clinical outcomes, mean number of complications was 1.6 vs 2, with mean ventilator days of 16.2 vs 16.4, SICU mean length of stay/TBSA 1.99 vs 2.23 days, and hospital mean LOS/TBSA 3.83 vs 2.54 days. Overall prescribed amount of enteral nutrition received pre-VBP was 105% vs post-VBP amount received at 95% (p=0.09). For the step-down unit, there were 8 patients pre-protocol and 6 patients post-protocol. Overall prescribed amount of enteral nutrition received pre-VBP was 83% vs post-VBP amount received at 89% (p=0.3815). Conclusions While clinical outcomes remain unchanged during the evaluation period, our patients met their prescribed enteral nutrition volume requirements when a nurse-driven VBP was initiated. In addition, for non-ICU patients, a trend was seen towards increased tube feeds with VBP. Applicability of Research to Practice Nurse-driven VBPs allow for RNs to adjust the rate of enteral nutrition by “catching up” for interruptions in feeding to meet the patient’s nutritional goals for the day.

Relationship between post-traumatic growth and self-efficacy and social support in burn patients

Objective To explore the relationship of post-traumatic growth and self-efficacy and social support in burned patients. Methods A total of 80 cases of patients with burns admitted to the hospital from January 2016 to December 2016 were investigated by post-traumatic growth inventory(PTGI), self-efficacy scale and social support scale.The relationship between post-traumatic growth and self-efficacy and social support in burn patients was analyzed. Results Total posttraumatic growth score of the burn patients was(65.98±4.98)points, self-efficacy score was(32.25±3.98)points and the total score of social support was(3.25±4.85)points. There were statistically significant differences in posttraumatic growth, self-efficacy and social support scores among patients of different ages, education levels, family economic status and burn severity(P<0.05). Married patients received more social support than unmarried patients(P<0.05). Pearson single factor analysis showed that the total growth score of burn patients after trauma was positively correlated with the total self-efficacy and social support score(P<0.05). It was positively correlated with other people's relationship, self-efficacy, total social support score and support utilization(P<0.05). Conclusions Post-traumatic growth of burn patients is closely related to self-efficacy and social support.Enhancing self-efficacy of burn patients and giving them adequate social support are helpful to improve their post-traumatic growth. Key words: Burns; Post-traumatic growth; Self-efficacy; Social support; Correlation

Predictors of withdrawal of life support after burn injury

IntroductionDiscussions regarding withdrawal of life support after burn injury are challenging and complex. Often, providers may facilitate this discussion when the extent of injury makes survival highly unlikely or when the patient’s condition deteriorates during resuscitation. Few papers have evaluated withdrawal of life support in burn patients. We therefore sought to determine the predictor of withdrawal of life support (WLS) in a regional burn center. MethodsWe conducted a retrospective analysis of all burn patients from 2002 to 2012. Patient characteristics included age, gender, burn mechanism, percentage total body surface area (%TBSA) burned, presence of inhalation injury, hospital length of stay, and pre-existing comorbidities. Patients <17years of age and patients with unknown disposition were excluded. Patients were categorized into three cohorts: Alive till discharge (Alive), death by withdrawal of life support (WLS), or death despite ongoing life support (DLS). DLS patients were then excluded from the study population. Multivariate logistic regression was used to estimate predictors of WLS. Results8,371 patients were included for analysis: 8134 Alive, 237 WLS. Females had an increased odd of WLS compared to males (OR 2.03, 95% CI 1.18–3.48; p=0.010). Based on higher CCI, patients with pre-existing comorbidities had an increased odd of WLS (OR 1.28, 95% CI 1.08–1.52; p=0.005). There was a significantly increased odds for WLS (OR 1.09, 95% CI 1.06–1.12; p<0.001) with increasing age. Similarly, there was an increased odd for WLS (OR 1.08, 95% CI 1.07–1.51; p<0.001) with increasing %TBSA. An increased odd of WLS (OR 2.47, 95% CI 1.05–5.78; p=0.038) was also found in patients with inhalation injury. ConclusionThe decision to withdraw life support is a complex and difficult decision. Our current understanding of predictors of withdrawal of life support suggests that they mirror those factors which increase a patient’s risk of mortality. Further research is needed to fully explore end-of-life decision making in regards to burn patients. The role of patient’s sex, particularly women, in WLS decision making needs to be further explored.

Advances in the application of extracorporeal membrane oxygenation in the treatment of severe burn

Extracorporeal membrane oxygenation (ECMO) is a kind of technique that uses extracorporeal circulation system to draw patients' blood into the circuit, and then oxygenate the blood when it passes along the membrane, followed by returning the blood into patients. At present, ECMO is mainly used in treating patients with respiratory failure and circulatory failure, for whom the conventional treatment such as mechanical ventilation and vasoactive drugs are invalid. ECMO can provide cardiopulmonary support for burn patients with respiratory failure or circulatory failure, and put the heart and lung at rest. The purpose of this paper is to review the application of ECMO in the treatment of severe burn.

Basics in clinical nutrition: Nutritional support in burn patients

Basics in clinical nutrition: Nutritional support in burn patients

Melatonin as pharmacologic support in burn patients: A proposed solution to thermal injury–related lymphocytopenia and oxidative damage

Melatonin as pharmacologic support in burn patients: A proposed solution to thermal injury–related lymphocytopenia and oxidative damage

Melatonin as pharmacologic support in burn patients: A proposed solution to thermal injury–related lymphocytopenia and oxidative damage

To review the data that support the clinical use of melatonin in the treatment of burn patients, with special emphasis on the stimulation of the oxidative defense system, the immune system, circadian rhythm of sleep/wakefulness, and the reduction in the toxicity of therapeutic agents used in the treatment of burn victims. A MEDLINE/PubMed search from 1975 to July 2006 was conducted. The screening of the literature was examined using the key words: burn patients, lymphocytopenia, skin oxidative stress, antioxidant, melatonin, and free radicals. Thermal injury often causes damage to multiple organs remote from the original burn wound and may lead to multiple organ failure. Animal models and burn patients exhibit elevated free radical generation that may be causative in the local wound response and in the development of burn shock and distant organ injury. The suppression of nonspecific resistance and the disturbance in the adaptive immune system makes burn patients vulnerable to infections. Moreover, there is loss of sleep and the toxicity produced by drugs habitually used in the clinic for burn patients. Melatonin is a powerful antioxidant and is a potent protective agent against damage after experimental thermal injury. Some actions of melatonin as a potential supportive pharmacologic agent in burn patients include its: role as a scavenger of both oxygen and nitrogen-based reactants, stimulation of the activities of a variety of antioxidative enzymes, reduction in proinflammatory cytokines, inhibition of adhesion molecules, chronobiotic effects, and reduction in the toxicity of the drugs used in protocols to treat thermal injury patients. These combined actions of melatonin, along with its low toxicity and its ability to penetrate all morphophysiologic membranes, could make it a ubiquitously acting and highly beneficial molecule in burn patients.

An Educational Tool For Medical Residents to Improve Nutrition Support of Burn Patients

An Educational Tool For Medical Residents to Improve Nutrition Support of Burn Patients

Enteral Nutritional Support in Burn Patients

Early and continued nutritional support has been determined to be an important component of therapy for seriously burned patients. The hypermetabolic response to severe injury requires increased calorie and protein intake to blunt the catabolism and loss of lean muscle mass. Enteral feeding has been found to directly nourish the gastrointestinal tract and may help reverse the defective gut barrier which accompanies burn shock. In contrast, intravenous nutritional support appears to lack effectiveness in burn patients and may actually increase morbidity and mortality.

Cost Containment: A Contribution of Aggressive Nutritional Support in Burn Patients

Cost Containment: A Contribution of Aggressive Nutritional Support in Burn Patients

Use of indirect calorimetry in the nutritional management of burned patients.

The use of indirect calorimetry in assessing and monitoring nutritional support in burn patients is reported. Twenty-nine patients with a mean burn size of 35% TBSA were monitored with 228 measurements of resting energy expenditure (REE), calculations of respiratory quotient (RQ), and substrate metabolism. Daily weights, nitrogen balance determinations, and routine laboratory tests were also obtained. Oxygen consumption (VO2) was 186 +/- 39 ml/min/M2, corresponding to REE of 2,506 +/- 543 kcal/day. REE varied during the course of wound healing, demonstrating a biphasic course. Metabolic rate was also significantly increased with the performance of routine procedures such as dressings and surgery. Measurements of REE were a mean 76% of predictions based on the Curreri formula, and 1.47 times basal energy expenditure (BEE) calculated by the Harris-Benedict equation. Neither formula provided for the great variations observed in daily, and individual, measurements of REE. During the study, patients consumed 2,900 +/- 811 kcal/day, which exceeded REE by 1.14. This was associated with mean weight loss of 3.2% (range, -16 to 9%). RQ was less than 0.85 in 9% of determinations, but exceeded 1.0 24% of the time. Protein accounted for 17 +/- 3% of total metabolism, corresponding to a calorie:nitrogen ratio of 128:1. Practically, however, provision of this much protein proved difficult. Routine use of indirect calorimetry permits tailoring of nutritional support for burn patients, and is valuable in the early detection of significant under- or overnutrition.

The Surgical and Medical Support of Burn Patients

The Surgical and Medical Support of Burn Patients

The Surgical and Medical Support of Burn Patients

This compact, pocket-sized manual covers the procedures and treatment methods used at the Shriner's Burns Institute, Cincinnati, and carries with it the reputation of one of the most sophisticated burn treatment centers in the country. The author is the director of the institute. Clearly, it is meant to be of use to residents, nurses, burn technicians, occupational and physical therapists, dieticians, and medical students, and it would appear to achieve this objective admirably. If there is any aspect of burn treatment that is not covered succinctly but in sufficient detail to form a useful and practical guide to the problem, it is difficult to detect. Everything from initial fluid management, choice and indications of topical and systemic antibiotics, respiratory management, and nutrition, to debridement and closure of the burn wound, either temporarily or permanently, is covered. The fine line between meaningful and meaningless ritual in the operating room, dressing room,

Nutritional support of burn patients

Nutritional support of burn patients