1/19. Virtual reality as an adjunctive pain control during burn wound care in adolescent patients.For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The first was a 16-year-old male with a deep flash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the first session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17-year-old male with 33.5% total body surface area deep flash burns on his face, neck, back, arms, hands and legs. He had difficulty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the 'real world', allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/19. New approach for dose reconstruction: application to one case of localized irradiation with radiological burns.When localized accidental irradiation occurs, it is necessary to determine the extent to which tissues and vital organs have been damaged, mainly in the vicinity of the source. At present, biological markers cannot be used to estimate the heterogeneity of the dose distribution. An alternative is to map the absorbed dose in the different regions of the body. Using a Monte Carlo calculation code, it is possible to simulate the accident while taking into account the specific morphology of the irradiated individual and his environment, as well as the source characteristics. The calculated values are matched to the clinical signs of the lesion, particularly around the rim of the radiation-induced necrosis. This technique was applied successfully on two patients who presented very severe lesions due to acute localized irradiation after an accident that occurred at Lilo (georgia) in 1996-1997; only the most demonstrative case is presented here.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/19. Longstanding pigmentary changes in paediatric scalds dressed with a non-adherent siliconised dressing.The non-adherent siliconised dressing Mepitel is excellent for burns, especially in children. It provides a moist wound environment, promotes wound healing and is easy and relatively painless to use. However, surgeons should be aware that in black children its use has been associated with pigmentation abnormalities.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/19. music therapy for assistance with pain and anxiety management in burn treatment.The management of pain is one of the primary issues in burn care. Pain is not only a physiologic experience, but a psychological one as well. With this in mind, the treatment of burned patients must incorporate a holistic view of pain management and healing. Cognitive, behavioral, and pharmacologic interventions all have a role in pain management. Studies, as well as clinical experience, have shown that musical intervention has been helpful in assisting patients with pain management in a variety of medical settings. Music is an element of normal life that can be easily adapted for the needs of individual patients and their current environment while providing a means for self expression and for normalizing the environment. This article examines the rationale for using music therapy with burned patients, describes several protocols that have been adapted to meet the specific needs of burned patients, and summarizes our preliminary findings, which demonstrate significant response to music therapy protocols employed on our patients.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
5/19. The use of silicon gel for treating children's burn scars in saudi arabia: a case study.This case study is presented to illustrate the effectiveness of silicon gel as an important option in burn scar treatment and to provide treatment guidelines that address cultural, clinical and patient compliance issues in saudi arabia. The case study involves an 18-month-old child whose burn scar was treated for a period of 15 months with silicon gel. The Vancouver Burn Scar Scale assessment (Baryza and Baryza, 1995), used to track progress across the duration of treatment, reflected an improvement in the scar as the composite score changed from 9 to 2. Strategies for problem solving and addressing needs unique to the environment of saudi arabia were also developed over the treatment period. The findings of this case study indicate that silicon gel may be a superior treatment option under certain circumstances. Further research with a wider sample is indicated, given the high incidence of childhood burn injuries in saudi arabia.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/19. Use of a modified tilt table for preambulation strength training as an adjunct to burn rehabilitation: a case series.Because of the system-wide complications that arise with prolonged bed rest, early mobilization plays a critical role in the recovery process, especially in the patient with significant burn injury. Unfortunately, early mobilization of patients with severe burns can be a difficult and uncontrolled task and often requires several people to lift a patient to a standing position. This article describes the use of a modified tilt table that allows patients to perform a weight-bearing exercise, such as an inclined squat, in a gravity-reduced environment. Use of the modified tilt table may offer a more suitable therapeutic option when treating critically ill patients by providing a safe and controlled transition from bed rest to ambulation. Perhaps most importantly, the table appears to provide psychological benefits by empowering the patient to take more of an active role during the early stage of recovery.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/19. water-friendly virtual reality pain control during wound care.Recent research suggests that entering an immersive virtual environment can serve as a powerful nonpharmacologic analgesic for severe burn pain. The present case study describes an attempt to use water-friendly virtual reality (VR) technology with a burn patient undergoing wound care in a hydrotherapy tub. The patient was a 40-year-old male with 19% total body surface area deep flame/flash burns to his legs, neck, back, and buttocks. The virtual reality treatment decreased the patient's sensory and affective pain ratings and decreased the amount of time spent thinking about his pain during wound care. We believe that VR analgesia works by drawing attention away from the wound care, leaving less attention available to process incoming pain signals. The water-friendly VR helmet dramatically increases the number of patients with severe burns that could potentially be treated with VR (see http://www.vrpain.com).- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/19. The role of Acticoat with nanocrystalline silver in the management of burns.silver is an effective antimicrobial agent, but older silver-containing formulations are rapidly inactivated by the wound environment, requiring frequent replenishment. These older formulations may also be pro-inflammatory and may delay healing. Acticoat (Smith & Nephew, Hull, UK) is a relatively new form of silver antimicrobial barrier dressing which helps avoid the problems of earlier agents. It has rapid and sustained bactericidal activity, and because of this may reduce inflammation and promote healing. Despite extensive testing and clinical experience, no evidence has emerged of resistance or cytotoxicity to nanocrystalline silver. This article collects together a number of presentations that were given at the 2003 European burns association Meeting on the use of Acticoat in the management of burns.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/19. Patterns of burn adjustment.For many years, burn professionals have attempted to assess the outcomes of different types of burn injury and the factors that are related to good patterns of coping with the aftermath of thermal injury. Most writers have attempted to use objective criteria such as return to work or preexisting psychologic problems (e.g., alcoholism) in determining the success of rehabilitation, but much controversy over the forms of assessment persists. It is agreed that antisocial personality, organic brain syndromes, and lack of social support all undermine good recovery for patients with burns. The authors have attempted to look at the subjective side of the patient's adjustment by providing representative examples of several types of burn adjustment in terms of personality features, all of which would tend to complement other approaches. The use of denial, the ways in which hostility is managed by the patient, and how he or she uses key persons in the environment are examined. The cognitive, emotional (affective), and behavioral styles of patients are examined as part of this pilot study of cluster patterns or types of adjustment.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/19. heat stroke in an incubator: an immunohistochemical study in a fatal case.The authors report the unique case of an 8-day-old infant succumbing to heat stroke caused by an abnormal increase of the environmental temperature in an incubator. At postmortem examination, second-degree burns were detected, and macroscopic and microscopic findings were typical for a heat-related death. An immunohistochemical study was performed. At the same time, a detailed examination of the incubator was conducted, revealing a malfunctioning of the temperature and relative humidity control system. We suggest that the diagnosis of heat stroke has to be confirmed on the basis of a detailed postmortem examination and a complete immunohistochemical investigation of heat shock proteins, molecules produced acutely in response to heat stress.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
| | Next -> |