The last decades less invasive monitoring and analytical tools have been developed for the evaluation of myocardial mechanics in clinical praxis. In critical care, these are longed-for complements to pulmonary artery catheter monitoring, additionally offering previously inaccessible information. This work is aimed, during fluid-replacement and oxygen therapy, to determine the physiological interface of ventricular and vascular mechanical properties, which result in the transfer of blood from the heart to appropriate circulatory beds. In prospective clinical studies we investigated previously cardiovascular healthy adults during hyperoxemia, and during preoperative acute normovolemic hemodilution or early fluid resuscitation of severe burn victims. Echocardiography was used in all studies, transthoracic for healthy volunteers and transesophageal for patients. For vascular parameters and for control purposes pulmonary artery Swan-Ganz catheter, calibrated external pulse recordings, whole body impedance cardiography, and transpulmonel thermodilution method were applied. We detected no significant change in blood pressure or heart rate, the two most often used parameters for patient monitoring. During preoperative acute normovolemic hemodilution a reduction of hemoglobin to 80 g/l did not compromise systolic or diastolic myocardial function. Cardiac volumes and flow increased with a concomitant fall in systemic vascular resistance while oxygen delivery seemed maintained. Supplemental oxygen therapy resulted in a linear dose-response between arterial oxygen and cardiovascular parameters, suggesting a direct vascular effect. Cardiac flow decreased and vascular resistance increased from hyperoxemia, and a decrease of venous return implied extracardial blood-pooling. Severe burns result in hypovolemic shock if not properly treated. The commonly used Parkland fluid replacement strategy, with urinary output and mean arterial pressure as endpoints, has recently been questioned. Applying this strategy, only transient early central hypovolemia was recorded, while dimensional preload, global left ventricular systolic function and oxygen delivery or consumption remained within normal ranges during the first 36 hours after accident. Signs of restrictive left ventricular diastolic function were detected in all patients and regional unstable systolic dysfunction was recognized in every other patient, and was consistent with myocardial marker leakage. Severe burns thereby cause myocardial stiffness and systolic regional dysfunction, which may not be prevented only by central normovolemia and adequate oxygenation. / On the day of the defence date the status of article II was: In Press.

Syfte: Syftet med studien är att belysa patienters upplevelser av det dagliga livet efter en brännskada. Bakgrund: Brännskador är ett trauma för både kropp och själ och är både ett fysiskt och psykiskt lidande. Patienterna lider av bland annat sömnsvårigheter, depression, ångest och klåda. En stor del av omvårdnaden är rehabilitering som hjälper patienten att återgå till vardagen. Hendersons omvårdnadsteori syftar till att sjuksköterskan ska hjälpa patienter att återfå oberoendet gällande sina grundläggande behov och kommer att användas vid tolkning av resultatet. Metod: Litteraturstudie utförd på ett systematiskt sätt, baserad på fem kvalitativa och sju kvantitativa vetenskapliga artiklar publicerade mellan åren 1995-2010. Resultat: Brännskador innebär både fysiska och psykiska förändringar i det dagliga livet. Resultatet är baserat på fyra kategorier; fysiska och psykiska begränsningar, vård och rehabilitering, det sociala livet och livskvalitet. Patienter upplevde bristande självförtroende, negativ påverkan på relationer, funktionshinder samt arbete och karriär, vilket kunde leda till depression och ångest. Diskussion: Rehabiliteringen var betydelsefull för patienternas tillfrisknande då det var viktigt att sjuksköterskan och anhöriga anpassade sig efter deras behov och få förståelse för den enskilda individen. Det kan vara en god idé att använda sig av Hendersons modell för att brännskadevården ska bli bättre och patienter ska klara av sin vardag på bästa sätt. / Purpose: The purpose of the study is to highlight the daily life experience of patients after burn injury. Background: There is a physical and mental experience associated with burn injuries affecting both body and soul for patients which can be defined as trauma. The outcome of burn injuries can cause the patient to suffer from depression, anxiety and itching. Henderson’s care theory aims to support nurses to help patients to recover through rehabilitation so he/she can gain independency and return back to daily life. Henderson’s theory will be used to interpret the result. Method: Literature study used in a systematic way is based on five qualitative and seven quantitative articles published between 1995-2010. Result: Burn injuries have an effect on the physical and mental change in patients daily life. Result is based on four different categories: physical and mental limitations, care and rehabilitation, ability to socialize and quality of life. Patients experienced insufficient self-confidence, functional disability and negative affect on relationships and carrier which can be a driver for depression and anxiety. Discussion: Rehabilitation is crucial for the patient to recover and it is important that the nurse and relatives adapted according to the patients need. It is also important that understanding for the individual is set in mind to support the patient. It’s a good idea to use Henderson’s model to improve the care of patients after burn injury so they can manage their daily life in the best possible way.

Syftet med denna studie var att beskriva hur patienterna upplevde Brännskadeteamets ettårsuppföljning. Studien har en deskriptiv design med såväl kvalitativa som kvantitativa data. Som underlag för studien har en utvärderingsenkät använts, svaren är insamlade under tidsperioden 2001- juni 2008. Svarsfrekvensen var hög (81,4%), 57 patienter av 70 hade besvarat enkäten. Bemötandet skattades av samtliga patienter som mycket bra (77,2%) eller bra (22,8%). Samtliga patienter som hade ställt frågor ansåg att de hade fått svar på sina frågor (93%) medan en mindre grupp svarade att de ej hade ställt några frågor (7%). Informationen innan besöket ansågs som dålig eller mindre bra av 4 patienter (7,1%), bra/tillräcklig av 33 patienter (57,9%) och mycket bra av 19 patienter (33,3%). Informationen under besöket ansågs vara bra eller mycket bra av samtliga patienter utom en som klassade den som mindre bra. Fyra av de fem kommentarerna som skrivits till frågorna gällde brister i information och förberedelse. Majoriteten av patienterna (93%) ansåg att tiden för besöket var lagom. Brännskadeteamets ettårsuppföljning är unik och den anpassas i möjligaste mån efter varje patients behov. Svaren på enkäten visar att detta lyckats ganska bra, men att informationen innan besöket behöver förbättras. / The purpose of this study was to describe the burn patients´ experience of the one-year follow-up, with a multidisciplinary team. The study has a descriptive design with both qualitative and quantitative data. An evaluation questionnaire was used to collect data. The answers are collected in the period from 2001 until June 2008. The response rate was high (81.4%), 57 patients out of 70 had responded to the survey. The patients replied that they were treated very good (77.2%) or good (22.8%). All patients that had asked any questions felt that they had received answers to their questions (93%) a smaller group replied that they had not asked any questions (7%). The information before the visit was considered as poor or less good by 4 patients (7.1%), good/sufficient by 33 patients (57.9%) and very good by 19 patients (33.3%). Information during the visit was considered to be good or very good by all patients except one who rated it as less good. Four out of the five written comments was about issues related to gaps in information and preparation. The majority of all patients (93%) were satisfied with the length of time of the visit. The multidisciplinary one-year follow-up, at the Burn Center, is unique and the aim is to adjust the follow-up visit after each patient's needs. The results show that it has succeeded quite well, but that the information given before the visit needs to be improved.

Bakgrund: Varje år brännskadas cirka 23000 personer i Sverige så svårt att de kräver vård. Smärtan som följer behandlingen av skadan är oftast väldigt intensiv och påfrestande för patienten. Syfte: Att undersöka hur olika copingstrategier kan ha en smärtlindrande effekt vid såromläggning av brännskadade patienter. Metod: En litteraturstudie med ett systematiskt arbetssätt. Resultatet bygger på 17 vetenskapliga artiklar och en licentiatavhandling. Resultat: Avledning, avslappning och hanterbarhet visade sig vara de centrala fynden vid de olika copingstrategierna. Beroende på vilken strategi patienten använder sig av varierar tyngdpunkten mellan de olika fynden. Slutsats: Smärtintensitet, aktivering och hanterbarhet var viktiga faktorer som kan påverka copingförmågan och därmed smärtlindringen. För att kunna hjälpa patienter att bemästra sin situation på ett adekvat sätt är det viktigt för sjuksköterskor att bli medvetna om betydelsen av dessa faktorer. / Background: Each year about 23,000 people in Sweden are burned so badly that they require care. The pain resulting from treatment of the burns is usually very intense and stressful for the patient. Aim: To investigate how different coping strategies can have an analgesic effect during dressing changes of patients suffering from burns. Method: A literature review with a systematic approach. The result is based on 17 scientific articles and one licentiate dissertation. Result: Distraction, relaxation and manageability emerged as the central findings at the various coping strategies. Depending on what strategy the patient uses vary the emphasis between the findings. Conclusion: Pain intensity, activation and manageability were key factors that can affect copingabilities and thus pain relief. In order to help patients cope with their situation in an adequate manner, it is important for nurses to become aware of the importance of these factors.

A burn injury is a disastrous trauma and can have very wide ranging impacts, including individual, family, and social. Burns patients generally have a long period of hospital stay whose accurate prediction can not only facilitate allocations of scarce medical resources but also help clinicians to counsel patients and relatives at an early stage of care. Besides prediction accuracy, prediction timing of length of hospital stay (LOS) for burn patients is also critical. Early prediction has profound effects on more efficient and effective medical resource allocations and better patient care and management. Hence, the objective of this study is to apply a backpropagation neural network (BPNN) for predicting length of hospital stay (LOS) for burn patients at early stages of care. Specifically, we defined two early-prediction timing, including admission and initial treatment stages. Prediction timing at the admission stage is to predict a burn patient¡¦s LOS when the patient is admitted into the Burns Unit. Prediction at the initial treatment stage refers to the timing right after the first surgery for burn wound excision and skin graft is performed (typically within 72 hours of injury if the patient¡¦s condition allows). Experimentally, we evaluated the prediction accuracy of these two stages, using that achieved at the post-treatment stage (referring to the timing when all surgeries for burn wound excision and skin graft are performed) as benchmarks. The evaluation results showed that prediction LOS at the admission and the initial treatment stages could attain an accuracy of 50.37% and 57.22%, respectively. Compared to the accuracy of 62.13% achieved by the post-treatment stage, the performance reached by the initial treatment stage would consider satisfactory.

Finley Peter Dunn, a reporter and editor, started a syndicated newspaper column in 1893, and Robert Louis Burns, a Presbyterian Minister, started one in 1966. Why were they both remembered a humorists? Was Burns influenced by Dunne's work? Why did they use Ethnic Humor in their columns? What impact did their columns have on their readers? I found that both writers fit the criteria of literary journalists. They used humor in their writing to make their readers laugh, but also to make their points. Dunne wanted to sell newspapers, and Burns wanted to make people forget their cares. Dooley, the bartender in Dunne's column, was Burns' nickname. Presidents, governors, and your next door neighbor read the columns, which accurately mirrored the pulse of the nation and our human frailties. / Thesis (M.A.)--Wichita State University, College of Liberal Arts and Sciences, the Elliott School of Communication

No description available.

Elbow contractures in burn survivors lead to difficulties in their ability to perform meaningful occupations. Interventions focus on improving movement at the elbow while considering social and psychological factors in the individual's environmental context. The purpose of the review was to determine the methodological quality of research evaluating splinting and serial casting to improve elbow contractures and resulting functional limitations. A comprehensive search strategy uncovered 10 research studies. Standardized critical appraisal tools and protocols were used to analyze the research. Although some methodological issues were identified, the findings were positive. Strengths and weaknesses of the research were delineated to support and guide the use of serial casting and splinting. A body of research was found to warrant consideration of social and psychological factors. Conclusion. There is preliminary quality of evidence to support the use of splinting and serial casting and important considerations for future research. / Rehabilitation Science - Occupational Therapy

This study aimed to model the trajectories of life satisfaction as influenced by functional impairment and family satisfaction over a five-year period following spinal cord injury, severe burns, and lower-extremity fractures. Marital status and injury type were included to estimate predicted life satisfaction over the five-year period post-injury. Measures: Six-hundred sixty-two participants completed the Functional Independence Measure, Family Satisfaction Scale, and Life Satisfaction Inventory at 12, 24, 48, and 60 months post-injury. Results: Family satisfaction was a consistent predictor of life satisfaction across models. Consistent with past research (Resch et al., 2009), functional impairment was significantly predictive of life satisfaction. Conclusions: Individuals predicted to be most at risk were those individuals with severe burns, who were divorced or separated, with low family satisfaction, and/or high functional impairment.

Thesis (M.A.)--University of Hawaii at Manoa, 2007 / Pacific Islands Studies