Predictors of re-epithelialization in pediatric burn

INTRODUCTION An important treatment goal for burn wounds is to promote early wound closure. This study identifies factors associated with delayed re-epithelialization following pediatric burn. METHODS Data were collected from August 2011 to August 2012, at a pediatric tertiary burn center. A total of 106 burn wounds were analyzed from 77 participants aged 4-12 years. Percentage of wound re-epithelialization at each dressing change was calculated using Visitrak. Mixed effect regression analysis was performed to identify the demographic factors, wound and clinical characteristics associated with delayed re-epithelialization. RESULTS Burn depth determined by laser Doppler imaging, ethnicity, pain scores, total body surface area (TBSA), mechanism of injury and days taken to present to the burn center were significant predictors of delayed re-epithelialization, accounting for 69% of variance. Flame burns delayed re-epithelialization by 39% compared to all other mechanisms (p=0.003). When initial presentation to the burn center was on day 5, burns took an average of 42% longer to re-epithelialize, compared to those who presented on day 2 post burn (p<0.000). Re-epithelialization was delayed by 14% when pain scores were reported as 10 (on the FPS-R), compared to 4 on the first dressing change (p=0.015) for children who did not receive specialized preparation/distraction intervention. A larger TBSA was also a predictor of delayed re-epithelialization (p=0.030). Darker skin complexion re-epithelialized 25% faster than lighter skin complexion (p=0.001). CONCLUSIONS Burn depth, mechanism of injury and TBSA are always considered when developing the treatment and surgical management plan for patients with burns. This study identifies other factors influencing re-epithelialization, which can be controlled by the treating team, such as effective pain management and rapid referral to a specialized burn center, to achieve optimal outcomes.

Play and heal : randomized controlled trial of Ditto intervention efficacy on improving re-epithelialization in pediatric burns

BACKGROUND: The relationships between pain, stress and anxiety, and their effect on burn wound re-epithelialization have not been well explored to-date. The aim of this study was to investigate the effect of the Ditto (a hand-held electronic medical device providing procedural preparation and distraction) intervention on re-epithelialization rates in acute pediatric burns. METHODS/DESIGN: From August 2011 to August 2012, children (4-12 years) with an acute burn presenting to the Royal Children's Hospital, Brisbane, Australia fulfilled the study requirements and were randomized to [1] Ditto intervention or [2] standard practice. Burn re-epithelialization, pain intensity, anxiety and stress measures were obtained at every dressing change until complete wound re-epithelialization. RESULTS: One hundred and seventeen children were randomized and 75 children were analyzed (n=40 standard group; n=35 Ditto group). Inability to predict wound management resulted in 42 participants no longer meeting the eligibility criteria. Wounds in the Ditto intervention group re-epithelialized faster than the standard practice group (-2.14 days (CI: -4.38 to 0.10), p-value=0.061), and significantly faster when analyses were adjusted for mean burn depth (-2.26 days (CI: -4.48 to -0.04), p-value=0.046). Following procedural preparation at the first change of dressing, the Ditto group reported lower pain intensity scores (-0.64 (CI: -1.28, 0.01) p=0.052) and lower anxiety ratings (-1.79 (CI: -3.59, 0.01) p=0.051). At the second and third dressing removals average pain (FPS-R and FLACC) and anxiety scores (VAS-A) were at least one point lower when Ditto intervention was received. CONCLUSIONS: The Ditto procedural preparation and distraction device is a useful tool alongside pharmacological intervention to improve the rate of burn re-epithelialization and manage pain and anxiety during burn wound care procedures.

Constructing subjects and making experts : reading the politics of the psychotherapy novel

This paper examines the ideological and political basis of the practice of psychotherapy in contemporary culture. Psychotherapy is argued to be both inherently political and intimately concerned with the construction of subjectivity. These arguments are examined through interrogating the representation of psychotherapy in the works of Lindner ( The Fifty-Minute Hour , Bantam, New York, 1955) and particularly in Yalom's fictional text Lying on the Couch (HarperPerennial, New York, 1996). The implications within psychotherapy for representing normality, negotiating power, and locating and constructing subjectivity are highlighted through the critical treatment of these texts.

Response to re : putting vital stains in context

A response to: "Re: Putting vital stains in context" by Eric Papas & Lyndon Jones, published in the same issue of this journal. "There has been considerable discussion in recent times about the origins of solution-induced corneal staining (SICS) and I welcome this opportunity to further clarify some points raised in my paper1 in relation to certain issues highlighted by Drs Papas and Jones.2 Part of the difficulty in understanding these phenomena relates to the imprecise terminology used. For example, Drs Papas and Jones state ‘. . . SICS..."

Response to re : putting vital stains in context

A response to "Re: Putting vital stains in context" by Charles W McMonnies, published in the same issue of this journal. "I thank Professor McMonnies for his thoughtful comments,1 which rightly forcemeto more directly address the clinical ramifications of solution-induced corneal staining (SICS). I concur with his observation that determining whether the staining can be attributed to preservative-associated transient hyperfluorescence (PATH) or true pathology can be difficult in a typical clinical situation, perhaps requiring two visits in a single day. There is no easy answer to this dilemma..."

The Gothenburg Recommendations on Education for Sustainable Development

This document calls on governments, civil society and in particular educators to prioritize processes that develop and strengthen education for sustainable development (ESD). The world has changed since the UN World Summit on Sustainable Development in 2002. While there have been significant initiatives and progress has been made, the scale of effort is still overshadowed by the scope of the problem. For instance, human-induced climate change is creating a long-lasting ecological crisis with severe economic and social consequences. Recently the global economic crisis has drawn attention to the problem of borrowing from resources that do not exist. Poverty, conflict and social injustice remain critical issues on the global agenda. A renewed sense of commitment to the UN Decade of Education for Sustainable Development 2005-2014 is required. Formal, informal and non-formal education and learning processes for sustainability must be strengthened and prioritized. This document supports and builds on the concepts and values that are put forward within UNESCO’s International Implementation Scheme for Education for Sustainable Development and in the Earth Charter. The purpose of ESD is to reorient education in order to contribute to a sustainable future for the common good of present and future generations. ESD recognizes the interdependence of environmental, social and economic perspectives and the dependence of humanity on a healthy biosphere. Participation and involvement are necessary components of ESD, with an emphasis on empowerment and agency for active citizenship, human rights and societal change. Re-orientation is necessary at all levels and in all phases of education, and encompasses community learning, thus making ESD a wider process challenging the form and purpose of education itself.

Katarapko : Talking fish - making connections with the rivers of the Murray-Darling Basin

Once known as Crabb’s Creek, Katarapko Creek is a small anabranch of the Murray River, located between the towns of Berri and Loxton in the Riverland region of South Australia. Its 9 000 hectare grey clay floodplain is covered with blackbox, saltbush and lignum. The creek’s horseshoe lagoons, marshes and islands are the traditional lands of the Meru peoples. They fished the creek and surrounding waterways and hunted the wetlands. The ebb and flow of water guided their travels and featured in their stories. The Meru have seen their land and the river change...

Goulburn : Talking fish - making connections with the rivers of the Murray-Darling Basin

The Goulburn River’s cold, clear waters rush westward down from the steep hills and mountains of the Great Dividing Range toward Seymour. The river then turns northward and meanders through hills and plains until the river meets the Murray upstream of Echuca. These are the traditional lands of the Taungurung, Bangerang and Yorta Yorta peoples. However, the Goulburn River today is not the river the Taungurung, Bangerang and Yorta Yorta once knew and fished...

Upper Murrumbidgee : Talking fish - making connections with the rivers of the Murray-Darling Basin

The Upper Murrumbidgee cuts its way through the Snowy Mountains in south‐eastern New South Wales, snaking its way south, then turning north before dropping into the lowland and heading west to join the Murray downstream of Swan Hill. The Upper ‘Bidgee floodplain is only a couple of hundred metres wide, a stark contrast to the kilometres‐wide floodplains in other parts of the Murray‐ Darling Basin. When the floods come, they come up quickly and roar through the narrow valleys. These are the traditional lands of the Ngunnawal and Ngarigo peoples. They fished the river and surrounding waterways and hunted the wetlands. The seasonal rise and fall of the water guided their travels and featured in their stories. The Ngunnawal and Ngarigo people have seen their land and the river change...

Murray : Talking fish - making connections with the rivers of the Murray-Darling Basin

The Murray River is the boundary between NSW and Victoria. The river both defines boundaries and unites them with the waters that sustain townships, irrigation and the floodplain forests, including the 70 000ha of the iconic Barmah and Millewa Forest. The river and its floodplain are the traditional lands of the Yorta Yorta and Bangerang people. The Murray is a very different river to the one the Yorta Yorta and Bangerang peoples once knew and fished...

Darling and the Great Anabranch : Talking fish - making connections with the rivers of the Murray-Darling Basin

The Lower Darling River and Great Darling Anabranch are located in south west New South Wales. Muddy waters meander over the grey soil floodplains past red dunes, spiky saltbush and gnarled red gums. These are the traditional lands of the Paakintji people. But the land and the river are no longer what the Paakintji once knew and fished...

Upper Darling: Brewarrina to Bourke : Talking fish - making connections with the rivers of the Murray-Darling Basin

To say ‘Back o’ Bourke’ means ‘miles from anywhere’ to most Australians, however the Barwon and Darling Rivers that pass by the townships of Brewarrina and Bourke, respectively, are at the heart of the Murray‐Darling Basin. These are the traditional lands of the Ngiyampaa, Murawari and Yuwalaraay peoples (refer Aboriginal language groups in the Bringing back the fish section at the back of this booklet). They fished the river and surrounding waterways and hunted the wetlands. The Ngiyampaa, Murawari and Yuwalaraay people have seen their land and the rivers change...

Ovens : Talking fish - making connections with the rivers of the Murray-Darling Basin

The Ovens River rises in the Victorian Alps where it is linked to significant freshwater meadows and marshes. It flows past Harrietville, Bright, Myrtleford and Wangaratta where it is joined by the King River on its way to meet the Murray near the top of Lake Mulwala. These the traditional lands of the Bangerang people and their neighbours the Taungurung and Yorta Yorta peoples. They have fished the river and surrounding waterways and hunted the wetlands. The ebb and flow of water guided their travels and featured in their stories. The Bangerang, Taungurung and Yorta Yorta have seen their land and the river change...

The Coorong and Lower Lakes : Talking fish - making connections with the rivers of the Murray-Darling Basin

After gathering water from 23 river valleys, the Murray empties into Lakes Alexandrina and Albert before making its way to the Coorong and out the Murray Mouth to Encounter Bay in South Australia. The entire Murray‐Darling Basin is upstream. Everything that happens there affects what goes on here...

How small-sided and conditioned games enhance acquisition of movement and decision-making skills

This article summarizes research from an ecological dynamics program of work on team sports exemplifying how small-sided and conditioned games (SSCG) can enhance skill acquisition and decision-making processes during training. The data highlighted show how constraints of different SSCG can facilitate emergence of continuous interpersonal coordination tendencies during practice to benefit team game players.