Biomedical subjects

R K Finley

Publications and source records attributed to R K Finley.

46 records · Page 3Linked to original sources

PubMedDate not supplied

Burn size estimate reliability: a study.

A study was undertaken to assess any differences between physicians' and nurses' estimates of burn size from drawings of 10 hypothetical patients with burns. Patient drawings were sent to the 199 burn facilities that are listed in the American Burn Association's Burn Care Resources in North America 1989-1990. The mailings were randomized between physicians and nurses. In order to have an even distribution, the cover letter asked the individual who received the forms to fill them out himself or herself rather than to pass them on to someone else. Forty-one nurses and 16 doctors (29%) returned the completed forms. The length of experience in burn care for the nurses averaged 9.3 years (range, 2 to 20 years), and the length of experience in burn care for the physicians averaged 14.7 years (range, 1 to 30 years [p = 0.01]). There were significant differences in the estimate of mean burn size between the physicians and nurses for only the two smallest drawings; in these cases, size may have been hard to translate from the patient to the drawing. There were four smaller burn charts (less than 20% body surface area), and in two (50%) of these, there were significant differences in the estimation of the burn size. For the six larger burn charts (greater than 20% body surface area), there were no differences in the size estimates. With regression analysis, no trend was noted that correlated the size estimates with the length of experience in burn care for either the physicians or the nurses. Additionally, the participants were asked to indicate which method of estimating burn size was used in their units. Thirty-five percent use the Rule of Nines, 33% use the Lund & Browder chart, 5.3% use Berkow's method, 3% use other methods, and 1.75% use a combination of the Lund & Browder chart and the Rule of Nines. Twenty-one percent failed to indicate any preferred method. Estimates of burn sizes with the use of standardized burn forms were consistently the same whether estimates were made by physicians or nurses. Sixty-eight percent of the respondents used the Rule of Nines or the Lund & Browder chart to estimate burn size, but 21% of the respondents failed to answer the question about which method is used in their units. In conclusion, there appears to be little variance in estimation of burn size as made by experienced burn nurses and physicians, and use of these estimates in a centralized data bank should be reliable.

Burn Units↗

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Positioning screen.

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Burns↗

PubMedDate not supplied

A comparison of the Tanner and Bioplasty skin mesher systems for maximal skin graft expansion.

Maximizing wound coverage of patients with burns who have meshed autografts is a primary intervention for wound closure. This study compared the Tanner and Bioplasty skin graft meshing systems for optimal skin graft expansion. Twenty patients for skin grafting were randomly assigned to either a Tanner or Bioplasty skin mesher group. Skin expansion ratios used with the Tanner group were 1.5:1 and 3:1, while Bioplasty ratios included 2:1 and 4:1. The patients' thighs were used exclusively as donor sites, and all grafts were harvested by the same surgeon. Expanded skin ratios were compared as to the difference in percent of predicted expansion outcome compared with the actual areas of the measured skin grafts. Comparing the differences of actual skin expansion with expected expansion, statistically significant results were found. When meshed skin grafts are used for wound closure, a 12.9% to 58.6% greater than anticipated area of donor skin should be harvested based on the expansion ratio selected.

Adult↗

PubMedDate not supplied

The effect of mechanical compression on chronic hand edema after burn injury: a preliminary report.

Chronic hand edema after wound healing is a troublesome condition to treat in patients with burns. Stagnant edema can cause fibrosis, which impedes rehabilitation and may lead to deformity. Although favorable results have been reported with mechanical compression used in acute injuries, no literature was found on the effects of compression for the treatment of chronic hand-burn edema. Five male patients with nine chronically edematous burned hands were subject to mechanical compression at 55 mm Hg pressure. A single-cell unit was used for a 30-minute treatment at 4:1 treatment ratio. Goniometric and volumetric hand measurements were recorded both before and after treatment. Although patients expressed a subjective feeling of improvement, no statistical difference was found in finger joint range of motion nor in hand volume when comparing pretreatment and posttreatment measurements. Many different treatment protocols exist in the literature and are discussed.

Adult↗

PubMedDate not supplied

Blood use in the burn unit: a possible role for erythropoietin.

Recently, several of our patients have raised questions concerning the safety of blood transfusions and especially the transmission of human immunodeficiency virus infection. We have noticed a growing reluctance of patients to receive blood transfusions. This prompted us to review the use of blood in our burn unit for 530 patients who were admitted from 1987 to 1989. Our traditional reasons for transfusion have been either an ongoing hemorrhage that leads to hypotension or a hematocrit of less than 30%. For these reasons 131 (24.7%) of the 530 patients reviewed required transfusions. The average number of units transfused in patients who received blood was 10 (range 1 to 69). Three hundred ninety-nine patients (75.3%) did not require transfusions. We undertook a prospective preliminary trial of recombinant erythropoietin in five patients who were admitted to our burn unit over a 2-month period to evaluate whether this agent could lessen the transfusion requirements. Because no definite value is given in the literature as to what level of hematocrit is most appropriate for transfusion, we chose a hematocrit of 20% as our new indication for transfusion. Inclusion into the trial required a total body surface area burn of over 10% that required at least one operation. Five patients met the inclusion criteria. Administration of erythropoietin was started on admission. According to our new criteria for transfusion none of the five patients receiving erythropoietin required the transfusion of blood or blood products. This study would suggest the need for both a prospective clinical trial of erythropoietin and further studies to better define the indications for transfusions in patients with burns.

Adult↗

PubMedDate not supplied

Micrografts. II: Evaluation of 25:1, 50:1, and 100:1 expansion skin grafts in the porcine model.

This study was undertaken to evaluate 25:1, 50:1, and 100:1 expansions of micronized skin grafts in a porcine model. Two full-thickness skin excisions (graft and control) were performed on each of 30 immature pigs (20 pounds). The pigs were divided into three groups of 10 animals each: group A, 25 cm2; group B, 50 cm2; and group C, 100 cm2. One square centimeter of the excised skin was thinned to produce a thick split-thickness skin graft. Four 90-degree passes were made through a skin mesher with the smooth side of the plastic mesh carrier to produce uniform pieces of skin. These pieces were applied to one area on each pig. Both the graft and control sites were covered with film. The film was removed on postoperative day 7, and excision sites were photographed on postoperative days 7, 10, 14, and 21. Healing was evaluated with a 12 x 12 inch digitizing pad to estimate the percent area healed. Healing was compared via analysis of variance, with percent area healed used as the dependent variable and treatment (control or graft) and postoperative day and expansion size used as the independent variables. No difference was found on postoperative day 7. On postoperative day 10, 25:1 grafts healed better than the 50:1 grafts, which were healed more than the 100:1 grafts. No difference was seen between 25:1 and 50:1 grafts on postoperative day 14; however, they were healed better than the 100:1 expansion grafts. No difference was seen between the graft sites on postoperative day 21.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

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A comparison of total body water analyses: bioelectric impedance analysis versus the tritiated water method.

Bioelectric impedance analysis (BIA) is used to measure the body composition and total body water of normal subjects. The purpose of this study was to determine if the hydration of patients with burns could be assessed by BIA. Assessments of total body water as determined by BIA and the tritiated water method were prospectively compared. The 2 analyses were performed 48 hours after admission for 5 patients with acute burns to determine the correlation of the 2 methods. The patients had a mean age of 36.4+/-14.7 years (range, 20-56 years), a mean burn size of 39.4%+/-15.9% of the body surface area (range, 23%-65%), and a mean full-thickness burn size of 27.7% of the body surface area. The total body water was measured on admission and again at 48 hours postburn. There is an excellent relationship between BIA and tritiated-water-method determinations of the total body water of patients with severe burns (r = 0.958). This correlation suggests that BIA provides an accurate measure of total body water, and so it is a reliable means of monitoring fluid resuscitation in patients with burns.

Adult↗

PubMedDate not supplied

Nutritional indicators of postburn bacteremic sepsis.

The potential of nutritional assessment parameters in predicting sepsis in burn patients was investigated. Sixty-two consecutive patients (mean age 41 years) with an average burn size of 19% were studied. Values were obtained on postburn day 10 for serum albumin, transferrin, nitrogen balance, total lymphocyte count, skin test reactivity, and percentage of ideal body weight. Parameters predictive of imminent septic episode included serum albumin less than 3.0 g/dl (p less than 0.001), total lymphocyte count less than 1500/mm3 (p less than 0.001), anergy (p less than 0.001), and serum transferrin less than 150 mg/dl (p less than 0.001). Nitrogen balance and percentage of ideal body weight were not found to contribute to group discrimination.

Adolescent↗

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Micrografts: the "super" expansion graft.

A novel technique for producing micronized skin grafts that was introduced in a paper presented at the 1990 ABA meeting was evaluated to quantify maximum expansion. Twenty Sprague-Dawley rats were divided into two groups representing 10:1 and 25:1 expanded micrograft ratios, respectively. Grafted sites in both groups were shown to heal better than those of the control group, and both grafted groups showed comparable healing at day 10.

Animals↗

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Comparison of the effect of passive exercise v static wrapping on finger range of motion in the burned hand.

A prospective study was undertaken to compare the use of passive exercise with that of static wrapping to increase finger flexion range of motion in burn patients. Six patients (four males and two females) with combined full- and partial-thickness dorsal hand burns were randomized to receive either treatment. Results showed that metacarpophalangeal (MCP) joint flexion improved an average of 7.46 degrees with passive exercise and 2.65 degrees with static wrapping. Proximal interphalangeal (PIP) joint flexion improved an average of 9.68 degrees with static wrapping and 4.28 degrees with passive exercise. The percentages of improvement in the MCP joint with passive exercise and static wrapping were 8.53% and 2.92%, respectively. In the PIP joint, the respective percentages were 3.69% and 8.09%. All differences were statistically significant at a P value of less than .001. It was concluded that in the rehabilitation of hands and/or fingers with recently healed burns, manual passive exercise is significantly better than static wrapping for increasing MCP joint flexion, while static wrapping is more effective for increasing PIP joint flexion.

Adult↗