Biomedical subjects
Heather Cleland
Publications and source records attributed to Heather Cleland.
Nursing the minor thermal burn wound.
Explore the source record for details and available documents.
Adult domiciliary oxygen therapy. Position statement of the Thoracic Society of Australia and New Zealand.
Explore the source record for details and available documents.
Exfoliative dermatitis, fever and acute renal failure in a 60% burns patient.
Explore the source record for details and available documents.
The hospital costs of treating necrotizing fasciitis.
BACKGROUND: Management of necrotizing fasciitis places significant demands upon hospital and medical resources. A successful management usually requires extensive surgical intervention and an adjunct hyperbaric oxygen treatment. The cost impact on the health care system has not been well characterized. We have, therefore, analysed the cost of treating this disease at an Australian tertiary referral hospital with extensive case experience and well-developed financial costing systems and have compared this with the current casemix-based government funding arrangements applying in Victoria, Australia. METHODS: Data was extracted from the medical records of 92 sequential patients treated by the Alfred Hospital (Melbourne, Australia) during the four financial years 2000-04. Clinical costing data and government funding data was provided by the hospital's Finance Departments. RESULTS: The total Alfred Hospital in-patient costs for treating the patients was $5,935,545 with a mean cost per patient of $64,517 (range, $1025 to $514,889). The total casemix-based funding allocation derived from treating these patients was calculated at $3,208,664 with the per patient mean $34,887 (range, $1331 to $387,168). This analysis does not include allowance for non-Alfred Hospital costs such as those incurred by the ambulance service, referring hospitals, for rehabilitation or as a result of the burden of residual disability. CONCLUSIONS: This study has confirmed that a significant economic burden is involved in treating necrotizing fasciitis. There is a substantial difference between the hospital costs and government funding for treating these patients in the Australian setting.
Burns (minor thermal).
Explore the source record for details and available documents.
Surgical approach to the accessory nerve in the posterior triangle of the neck.
Explore the source record for details and available documents.
Minor thermal burns.
Explore the source record for details and available documents.
Too much vacuum-assisted closure.
There has been an explosion in the use of the vacuum-assisted closure device since 1997. Selectively and judiciously used, it is a valuable tool. However, we are concerned by the expanding list of 'indications' for its use. Prolonged applications, frequently several weeks, at the expense of early surgical reconstruction, might compromise the outcome in selected cases. We report four cases that illustrate this problem and stress the importance of timely surgical reconstruction utilizing the range of reconstructive techniques available as well as vacuum-assisted closure dressing.
How relevant and useful is the Cochrane Library as a resource for evidence in burn care, practice, and management?
The Cochrane Library, in particular, the Cochrane Database of Systematic Reviews (CDSR), is a compilation of reviews that have collated and assessed all the available clinical research on a particular topic into a summary about its safety and effectiveness. We conducted a study of the CDSR to evaluate the relevance of this database to burns care. Using prespecified criteria, two reviewers independently screened 4041 titles from Issue 3, 2005, of CDSR for possible relevance to burns care. Agreement regarding relevance to was resolved by discussion. Screening of the 4041 titles identified 78 titles as being potentially (unclear) or clearly (clear and directly related) relevant to burns care. Independent scoring of the 78 titles indicated that 9 were directly relevant to burns care and 28 were indirectly relevant to burns care. The remaining 43 reviews were deemed not relevant. The majority of relevant titles in the CDSR were produced by three Cochrane Review Groups. These included five reviews from Injuries, three from Wounds, and one from Pain, Palliative and Supportive Care. In summary, approximately 37, or just less than 1%, of the CDSR, Issue 3, 2005, completed reviews or protocols had some relevance to burns care and management. Increased burn clinician involvement in the Cochrane Library would help to increase the number of reviews conducted on questions relevant to burns care and would enhance the value of this evidence based medicine resource.
Fluid resuscitation in major burns.
BACKGROUND: The Parkland formula is established as the "gold standard" for initial fluid resuscitation for major burns. The purpose of this study was to review our fluid resuscitation practice for major burns to determine whether anecdotal observations of significant variations from the Parkland formula were wide spread and whether any difference could be used as a basis for a revision of fluid resuscitation in major burns. METHODS: A retrospective review of 127 presentations to The Alfred Burns Unit with total body surface area (TBSA) affected > or =15% was conducted. A retrospective review of the resuscitation data from these patients was compared with the Parkland formula as well as other studies. RESULTS: A total of 49 patients with complete data on fluid administration and uncomplicated burns were included in the analysis. Significantly larger volumes of fluid (5.58 mL/kg per %TBSA) were given to these patients in the first 24 h than predicted by the Parkland formula. Mean arterial pressure, pulse rate and urine output were at satisfactory levels. Clinically evident complications from fluid administration were minimal. Mortality was similar to that in other centres. CONCLUSION: Fluid resuscitation volumes significantly higher than those predicted by the Parkland formula were given, without adverse consequences. This retrospective review supports a prospective, multicentre, randomized, controlled study comparing this study with the Parkland formula, resulting in a better guide to initial fluid resuscitation in major burns.