Mr. Mattocks in the Character of Achilles : How I pant! How I burn for the fight.

Signatur des Originals: S 36/G00096

Sibling relationships in the family of a child with a burn injury

Purpose. Understanding siblings' experiences after a major childhood burn injury was the purpose of this mixed method, qualitative dominant study. The following research questions guided this project: How do siblings describe the impact of a major childhood burn injury experience? How do sibling relationship factors of warmth/closeness, relative status/power, conflict, and rivalry further clarify their relationship and their experience after a major burn injury? ^ Methods. A mixed method, qualitative dominant, design was implemented to understand the sibling experiences in a family with a child suffering from a major burn injury. Informants were selected from patients with childhood burn injuries attending the reconstructive clinic at a Gulf coast children's specialty hospital. The qualitative portion used the life story method, a narrative process, to portray the long-term impact on sibling relationships. A "case" represents a family unit and could be composed of one or multiple family members. Participants from 22 cases (N = 40 participants) were interviewed. Interviews were conducted in person and via telephone. The quantitative portion, or the embedded part of this mixed method design, used the Sibling Relationship Questionnaire Revised (SRQ-R) to conduct an additional structured interview and acquire scoring data. It was postulated that the SRQ-R would provide another perspective on the sibling experience and expand the qualitative data analysis. Thematic analysis was implemented on the qualitative interview data including the qualitative data from the interviews structured on the SRQ-R. Additionally, scores on the SRQ-R were tabulated to further describe the cases. ^ Results. The overall thematic pattern for the sibling relationship in families having a child with a major burn injury was that of normalization. Areas of normalization as well as the process of adjustment were the major themes. Areas of normalization were found in play and other activities, in school and work, and in family relations with their siblings and their parents. The process of adjustment in the sibling relationship was described as varied, involved school and work re-entry, and might even change their life perspective. Further analysis included an examination of the cases in which more than one person were interviewed and completed the SRQ-R. Participants from five ( n = 11) of six cases (n = 14), scored above 3.0 on the five-point scale on the Warmth/Closeness construct, indicating they perceived the sibling relationship as close. Five participants scored high on the Conflict construct and four participants scored high on the Rivalry construct. Finally, Relative Status/Power was low or negative in the six cases (n = 13). ^ Conclusions/implications. These findings suggest the importance of returning to normalcy for many of the families and the significance of sibling relationships on the process. Some of these families were able to use this major life event in a positive way to promote normalization. ^

AN EPIDEMIOLOGIC DESCRIPTION AND ANALYSIS OF LOST WORKDAY OCCUPATIONAL BURN INJURIES

Background research consisted of a hospital case series of all adult burn patients (n = 162) admitted to John Sealy Hospital's burn unit from January 1978 to June 1979. Comparisons between occupationally and nonoccupationally burned adults demonstrated that occupationally burned adults were significantly more likely to have been active in the burn injury event and to have changed jobs during the prior year. They were significantly less likely to have physical or mental problems which contributed to sustaining the burn injury. Comparisons between occupational and nonoccupational burn injury events concluded that occupational burn injury events were significantly more likely to involve multiple sources of energy, sparks as the source of ignition and gases as the source of combustion. Other salient characteristics of occupational burn injuries indicated that subsequent research should focus upon lost workday occupational burns and other injuries sustained by blue-collar petrochemical workers employed in Galveston County, Texas.^ Subsequent research consisted of a historical cohort study of occupational injuries sustained in 1979 by a cohort of blue-collar petrochemical workers (n = 1771) who belonged to O.C.A.W. Local 4-449 in Texas City, Texas. Specific cohort injury rates included 15.08 occupational injuries per 100 person work-years, 11.98 lost workday occupational injuries per 100 person work-years, and 1.64 lost workday occupational burn injuries per 100 person work-years. Salient results from this study indicate that burn injuries are a very important type (in terms of both frequency and severity) of occupational injury sustained by blue-collar petrochemical workers, pipefitters are at greatest risk of lost workday injuries and lost workday burn injuries, company-specific experiences are comparable for lost workday occupational injuries, differences among company-specific nonlost workday occupational injury experiences may not be "safety-related", and minimal job-specific experience may not place employees at greater risk of lost workday burn injuries.^

An outbreak of Multi-Drug Resistant Acinetobacter in the burn intensive care unit of a large tertiary care center

Risk factors for Multi-Drug Resistant Acinetobacter (MDRA) acquisition were studied in patients in a burn intensive care unit (ICU) where there was an outbreak of MDRA. Forty cases were matched with eighty controls based on length of stay in the Burn ICU and statistical analysis was performed on data for several different variables. Matched analysis showed that mechanical ventilation, transport ventilation, number of intubations, number of bronchoscopy procedures, total body surface area burn, and prior Methicillin Resistant Staphylococcus aureus colonization were all significant risk factors for MDRA acquisition. ^ MDRA remains a significant threat to the burn population. Treatment for burn patients with MDRA is challenging as resistance to antibiotics continues to increase. This study underlined the need to closely monitor the most critically ill ventilated patients during an outbreak of MDRA as they are the most at risk for MDRA acquisition.^

Prediction of sepsis in the burn intensive care unit patient

Sepsis is a significant cause for multiple organ failure and death in the burn patient, yet identification in this population is confounded by chronic hypermetabolism and impaired immune function. The purpose of this study was twofold: 1) determine the ability of the systemic inflammatory response syndrome (SIRS) and American Burn Association (ABA) criteria to predict sepsis in the burn patient; and 2) develop a model representing the best combination of clinical predictors associated with sepsis in the same population. A retrospective, case-controlled, within-patient comparison of burn patients admitted to a single intensive care unit (ICU) was conducted for the period January 2005 to September 2010. Blood culture results were paired with clinical condition: "positive-sick"; "negative-sick", and "screening-not sick". Data were collected for the 72 hours prior to each blood culture. The most significant predictors were evaluated using logistic regression, Generalized Estimating Equations (GEE) and ROC area under the curve (AUC) analyses to assess model predictive ability. Bootstrapping methods were employed to evaluate potential model over-fitting. Fifty-nine subjects were included, representing 177 culture periods. SIRS criteria were not found to be associated with culture type, with an average of 98% of subjects meeting criteria in the 3 days prior. ABA sepsis criteria were significantly different among culture type only on the day prior (p = 0.004). The variables identified for the model included: heart rate>130 beats/min, mean blood pressure<60 mmHg, base deficit<-6 mEq/L, temperature>36°C, use of vasoactive medications, and glucose>150 mg/d1. The model was significant in predicting "positive culture-sick" and sepsis state, with AUC of 0.775 (p < 0.001) and 0.714 (p < .001), respectively; comparatively, the ABA criteria AUC was 0.619 (p = 0.028) and 0.597 (p = .035), respectively. SIRS criteria are not appropriate for identifying sepsis in the burn population. The ABA criteria perform better, but only for the day prior to positive blood culture results. The time period useful to diagnose sepsis using clinical criteria may be limited to 24 hours. A combination of predictors is superior to individual variable trends, yet algorithms or computer support will be necessary for the clinician to find such models useful. ^

Ian Logan, Reading Anselm´s “Proslogion": The history of Anselm´s argument and its significance today, Ashgate, Farnham, 2009; 220 p. ISBN 978-0-7546-6123-8.

Fil: Peretó Rivas, Rubén.

Henry Perowne y su realismo clínico : Variaciones sobre medicina y literatura en Sábado, de Ian McEwan

La tendencia a ver las cosas desde el punto de vista de la propia profesión, en lugar de tener una perspectiva más amplia, implica que la formación profesional a menudo resulte en una distorsión en la forma en que se percibe el mundo. En el caso de los médicos, estos tiene la función de "producir la verdad" acerca de la enfermedad y la salud, de modo que detentan un poder omnímodo. En Sábado, de Ian McEwan, vemos cómo la formación profesional puede tener una enorme influencia en la personalidad y cómo se puede hacer uso y abuso del poder que confiere ser médico. El Dr. Henry Perowne, protagonista de la novela, es incapaz de dejar el guardapolvo colgado cuando está fuera del hospital, lo que implica que su visión del mundo y sus relaciones interpersonales estén teñidas por una mirada médica que le impide interpretar a las situaciones y las personas que lo rodean desde un punto de vista más global y humano. Esta incapacidad para apartarse de su "realismo clínico" es también lo que entorpece su acercamiento a la literatura: estar siempre aferrado al mundo fáctico representa un obstáculo para apreciar y disfrutar de la ficción y la poesía

Ian Morris y Barry Powell (Eds.). A New Companion to Homer. Leiden-New York-Köln, Brill, 1997, XIII + 755 pp.

Fil: Zecchin de Fasano, Graciela Cristina. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

Ian Morris y Barry Powell (Eds.). A New Companion to Homer. Leiden-New York-Köln, Brill, 1997, XIII + 755 pp.

Fil: Zecchin de Fasano, Graciela Cristina. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

Henry Perowne y su realismo clínico : Variaciones sobre medicina y literatura en Sábado, de Ian McEwan

La tendencia a ver las cosas desde el punto de vista de la propia profesión, en lugar de tener una perspectiva más amplia, implica que la formación profesional a menudo resulte en una distorsión en la forma en que se percibe el mundo. En el caso de los médicos, estos tiene la función de "producir la verdad" acerca de la enfermedad y la salud, de modo que detentan un poder omnímodo. En Sábado, de Ian McEwan, vemos cómo la formación profesional puede tener una enorme influencia en la personalidad y cómo se puede hacer uso y abuso del poder que confiere ser médico. El Dr. Henry Perowne, protagonista de la novela, es incapaz de dejar el guardapolvo colgado cuando está fuera del hospital, lo que implica que su visión del mundo y sus relaciones interpersonales estén teñidas por una mirada médica que le impide interpretar a las situaciones y las personas que lo rodean desde un punto de vista más global y humano. Esta incapacidad para apartarse de su "realismo clínico" es también lo que entorpece su acercamiento a la literatura: estar siempre aferrado al mundo fáctico representa un obstáculo para apreciar y disfrutar de la ficción y la poesía

Henry Perowne y su realismo clínico : Variaciones sobre medicina y literatura en Sábado, de Ian McEwan

La tendencia a ver las cosas desde el punto de vista de la propia profesión, en lugar de tener una perspectiva más amplia, implica que la formación profesional a menudo resulte en una distorsión en la forma en que se percibe el mundo. En el caso de los médicos, estos tiene la función de "producir la verdad" acerca de la enfermedad y la salud, de modo que detentan un poder omnímodo. En Sábado, de Ian McEwan, vemos cómo la formación profesional puede tener una enorme influencia en la personalidad y cómo se puede hacer uso y abuso del poder que confiere ser médico. El Dr. Henry Perowne, protagonista de la novela, es incapaz de dejar el guardapolvo colgado cuando está fuera del hospital, lo que implica que su visión del mundo y sus relaciones interpersonales estén teñidas por una mirada médica que le impide interpretar a las situaciones y las personas que lo rodean desde un punto de vista más global y humano. Esta incapacidad para apartarse de su "realismo clínico" es también lo que entorpece su acercamiento a la literatura: estar siempre aferrado al mundo fáctico representa un obstáculo para apreciar y disfrutar de la ficción y la poesía