PubMed Health⌕ Search

Biomedical subjects

M L Bowden

Publications and source records attributed to M L Bowden.

16 recordsLinked to original sources
PubMed1995

Diagnostic use of microsatellite instability in hereditary non-polyposis colorectal cancer.

50 families with a history of colorectal cancer were divided according to whether criteria for hereditary non-polyposis colorectal cancer (HNPCC) were fulfilled totally (A, n = 19) or partly (B, n = 31) and stratified by the demonstration that at least half the cancers tested per family were positive for DNA replication errors (RER+). Accepted clinical and pathological characteristics of HNPCC were found to cluster within 12 A/RER+ families in which the mean number of affected individuals per family was 10.1. Reliance upon clinical data alone may result in over-diagnosis of HNPCC, in small families who just meet the minimum criteria, whereas underdiagnosis is rare. The criteria could be refined by inclusion of RER status.

Adult↗
PubMed1994

Impact of social work on recidivism and non-medical complaints in the emergency department.

Recidivism among patients treated in the hospital Emergency Department (ED) is a significant factor in resource depletion. This study substantiates the efficacy of social work intervention in the ED using recidivism as an outcome measure. Data was collected on all patients seen by social work during the first 12 months of social work services to the ED between the hours of 3:00 p.m. and 11:30 p.m. The greatest decline in recidivism occurred where social work used a proactive intervention strategy as opposed to a more support oriented intervention.

Adult↗
PubMed1991

A review of the reconstructive surgery needs of 3167 survivors of burn injury.

A retrospective review of all patients admitted for acute care over the past 15 years was undertaken to identify readmission for reconstructive surgery. Of 3167 survivors 629 or 19.9 per cent were readmitted for at least one reconstructive procedure. Those patients requiring readmission for reconstructive surgery were younger and had larger total body surface burns compared to the group that were not readmitted for reconstructive surgery. The percentage of patients now being readmitted for reconstructive surgery is decreasing significantly and covers all size burns. The most common area of reconstruction, by frequency, involved the hand and wrist, arm and forearm, face, and neck. These data indicate that the goal of reducing the incidence of burn scar contractures in this patient population is being achieved. However, further work needs to be done to reduce the frequency of reconstructive surgery and to identify those variables which predispose patients to burn scar contractures which are amenable to intervention.

Acute Disease↗
PubMed1990

Rehabilitation of burned patients with bilateral above-knee amputations.

Bilateral above the knee amputations occur rarely in the seriously burned population. In a 6-month interval, two patients were treated in our Burn Center whose trauma necessitated bilateral above-knee amputations. This led us to review our experience with such cases. A review of 5018 patients treated over a 28-year period identified six patients over a 20-year period who had bilateral above-knee amputations, four of whom survived. These patients were found to have large and deep burns, concomitant injuries and a number of complications. Recovery was time consuming and costly. Physical therapists were challenged to create adaptations of traditional methods to meet the rehabilitation needs of these patients. The patients who survived remain wheelchair bound and unemployed, but are socially active, appear relatively well adjusted and report themselves satisfied with their lives. During a period of time when technological advances in medicine are ensuring survival of victims of massive trauma, questions are raised concerning the advisability of resuscitation. Knowledge gained in the treatment of these patients who are both burned and have had bilateral above-knee amputations can be reassuring to care providers with limited experience with such massive injury.

Adult↗
PubMed1989

Survival of an infant with massive thermal injury: a case report.

Survival of infants with greater than 80 per cent body surface area burns has not been well documented. Survival of a 4-month-old infant with 80 per cent full skin thickness flame injury is reported. Data from the National Burn Information Exchange showed that there were 2266 infants under 8 months of age treated for burns in reporting hospitals. Only four children of the 2266 were treated for full skin thickness thermal injury covering more than 80 per cent TBSA and none survived except for the child reported here. It was felt that early aggressive excision of the burn eschar was an important factor leading to the survival of this infant. Complex rehabilitation issues related to developmental issues as well as physical and psychosocial needs were identified and addressed throughout her time in hospital by a multidisciplinary team to ensure the best possible quality of life.

Burns↗
PubMed1989

Breathing management: a simple stress and pain reduction strategy for use on a pediatric service.

A review of the pediatric literature on pain and stress reducing strategies is followed by a description of a breathing management and relaxation technique. Its use as a pain coping method is illustrated by two cases on a pediatric service. The positive responses of stress affected patients suggests that this approach can be effective in reducing feelings of panic and anxiety as a reaction to pain and the anticipation of pain.

Adaptation, Psychological↗
PubMed1989

Factors influencing return to employment after a burn injury.

Return-to-work data were prospectively obtained from 155 adult burn patients who were employed before their injuries. Average time from burn to return to work was 63 days, and average time from discharge to return to work was 42 days. Size and depth of burn, occurrence of hand burns, age of the patient, and type of job significantly influenced return to work and return to work time. These data were compared to previous reports from this burn center and other burn centers, and it was concluded that return to work time is becoming shorter. More information must be scientifically gathered in order to determine all factors which influence return to work time. Researchers should direct their attention to those factors that are amenable to intervention from the burn team.

Adolescent↗
PubMed1988

The elderly, disabled and handicapped adult burned through abuse and neglect.

A retrospective review of 1152 acute burns treated at the University of Michigan Burn Center during the past 5.5 years identified 26 adult patients in whom abuse and neglect was suspected. These patients, 12 females and 14 males, had an average age of 42 years and average total body area burn (TBA) of 18 per cent. Eight of these cases were in situations in which the question of inflicted injury was raised and 18 were in situations of neglect and/or improper supervision. Seven (27 per cent) died from their injury. All of these adults were either very old, mentally impaired, and/or physically handicapped. Twenty-three were burned in health care facilities or institutions. Adult abuse in the elderly, handicapped and disabled population is similar to that found in child abuse and includes characteristic burn patterns, a story that does not fit the injury, and a delay in seeking medical care. An increased awareness of the problem is necessary for improved diagnosis and management of these patients.

Adult↗
PubMed1982

Psychosocial dwarfism: identification, intervention and planning.

Psychosocial Dwarfism, a syndrome caused by deprivation, emotional stress and/or neglect, occurs in both infants and children. The identification of children who are delayed because of such stress can be difficult. This article reviews historical and observational diagnostic clues including typical family interactional patterns and attitudes. Diagnosis of PSD is made by a demonstration of change, generally one that occurs upon removal of the child from the family environment. This removal is frequently the beginning of the intervention process, the goal of which is the reversal of physical and psychological delays, the elimination of bizarre behaviors, and the completion of catch-up growth and stabilization of normal growth. Too little is known about successful treatment methods in cases of PSD. The success of interventions is validated by change and can only be determined over long-term follow-up. There is a great need for research and it is important that all health care workers become aware of this challenging disorder.

Adolescent↗
PubMed1981

Social support and post-burn adjustment.

Interviews were conducted with 314 persons who had sustained burns and were treated at a major burn center between 1956 and 1976. The interviews covered standard socioeconomic data and post-burn life patterns including the number of weeks lost to employment or education. The data indicate that social support is both directly and indirectly related to patients' post-burn adjustment. Measures of social support from family, friends, and peers were significantly related to several subjectively assessed outcomes, such as life satisfaction, self-esteem and participation in social and recreational activities. There was also evidence that social support moderates the rehabilitation process independent of the severity of the burn injury. The findings tend to challenge the commonly held belief that psychosocial rehabilitation needs are monotonically related to the severity of the injury.

Adolescent↗
PubMed1980

Self-esteem of severely burned patients.

As a part of a retrospective rehabilitation study conducted in 1977, 320 persons treated at a major burn center between 1956 and 1976 were interviewed by professional survey research interviewers using a specially developed 519-item questionnaire that included standard socioeconomic data along with information about the person's life pattern subsequent to the burn. In addition, several complex dimensions of personality were measured through multiple indicators rather than by single items. According to the midpoint of the scale of Coopersmith's Self-Esteem Inventory, 85% of the respondents had adequate to high self-esteem. Although the size of the burn and part of the body burned did not seem to significantly affect self-esteem, age when burned and time since burn did. Disfigured females had significantly lower self-esteem than disfigured males. Social support, life satisfaction, involvement in social and recreational activities and employment were found to influence the group as a whole. Respondents with low self-esteem spent twice as many days in bed and missed considerably more days of work in the year prior to the study than did those with moderate or high self-esteem. The findings in this study indicate with some certainty that the majority of burned people make a successful adjustment following even large and disfiguring injuries and that successful rehabilitation is long-term and episodic in nature.

Adult↗
PubMedDate not supplied

A survey of burn hydrotherapy in the United States.

One hundred burn care facilities in the United States were surveyed to determine the present use of hydrotherapy in burn care. It was found that 92% of the burn units that were polled practice this treatment in some form. There was no consensus as to how the procedure is carried out, how long it takes, how often it is done, or who does it. Most burn facilities that were contacted use a disinfectant solution for hydrotherapy, and the procedure is carried out once a day for 30 minutes or less. In most of these facilities, nurses perform the procedure. Although immersion therapy continues to play an important role in most burn care facilities, spray or shower techniques are also incorporated into many programs.

Burn Units↗
PubMedDate not supplied

Impact of an inpatient rehabilitation facility on functional outcome and length of stay of burn survivors.

This study reviewed the use of an inpatient rehabilitation unit for burn survivors. We hypothesized that adult burn patients admitted earlier to inpatient rehabilitation have an equal or better functional outcome than those remaining in acute burn center for rehabilitation care. Functional Independence Measure (FIM) data were prospectively collected on our burn center admissions dating January 2002 to August 2003. National rehabilitation data were acquired from eRehabData and burn literature. A total of 217 adult patients survived until hospital discharge, with 21 (9.7%) discharged to inpatient rehabilitation (REHAB). REHAB had larger burn injuries, more inhalation injuries, higher incidence hand/foot burns, and longer length of stay (LOS). REHAB had lower FIM upon rehabilitation facility admission than national averages but greater FIM improvement during comparable rehabilitation LOS. Although our earlier rehabilitation admission strategy results in more frequent rehabilitation unit referrals, patients had shorter burn center LOS and greater FIM improvement compared with limited national burn patient functional outcome data currently available.

Activities of Daily Living↗
PubMedDate not supplied

Initiation of a quality assurance program for social work practice in a teaching hospital.

This first-stage paper describes the steps taken in implementing a quality assurance program. The rationale for writing social work protocols based on medical diagnosis or tasks rather than on psychosocial diagnosis is explained in detail. Protocols for adult rheumatoid arthritis, pediatric cancer, adult discharge planning, and adult nursing home placement are included to demonstrate the result of the medical diagnosis/task approach.

Adult↗