- Email: [email protected]
A study on the effectiveness of group counseling program for empowerment of burn patients
S30
Burns 3 5 S ( 2 0 0 9 ) S1–S47
high employee turnover. The present study sought to determine if individual traits
clinical management. We sought to identify patients’ priorities regarding burns
such as emotional intelligence and coping skills affect care providers’ satisfaction,
treatment received in hospital, as they may differ from those of their health care
success and longevity in the acute burn and surgical intensive care hospital setting.
professionals.
Methods: Participants (171) 65 males, 106 females with mean years of ser-
Methods: One hundred burns surgery patients were surveyed by questionnaire.
vice of 9 years (SD ± 8.8) in the Burn Center or Surgical ICU, who completed
Their priorities with regard to choice of hospital, consultant, operating surgeon
three self-report measures regarding burnout, emotional intelligence and cop-
and follow-up team were enquired about, in addition to their thoughts on operative
ing skills. Sample included Caucasian (70%), Hispanic (13%), Asian (5%), African
waiting times.
America (4%), Other (8%). Professional designation RN (57%) Physician (24%) PA
Results: Despite well documented reductions in waiting times, patients still
(10%) and Allied Health (9%). A full 90% reported working 30 plus hours per
regarded waiting time most important (62%), above proximity of hospital to home
week.
(35%) and choice of surgeon (23%). Patients understood the difference in urgency
Results: Analysis of results found a staistically significant relationship between
between emergency and elective surgery but still gave wide ranges in acceptable
higher emotional intelligence scores and less depersonaliztion of patients,
waiting times. Only 25% of elective patients referred could recall being given a
stronger coping skills and greater sense of personal accomplishment (p < .001).
choice of hospital, consultant or both.
Persons with low emotional intelligence scores were more likely to dis-
Conclusion: Although NHS modernisation concentrates on providing patient choice,
engage and experience emotional exhaustion and burnout (p < .001). Weak
patients prefer access to a good local hospital, continuity of care being more impor-
coping skills scores were also statistically significant in predicting burnout
tant than the choice of a specific consultant.
(p < .001).
doi:10.1016/j.burns.2009.06.120
Conclusion: This study suggests that medical personnel with higher levels of emotional intelligence (EI) and stronger coping skills are more likely to be satisfied with their work, more successful in dealing with patients and less likely to burnout on the job. The utilization of EI, burnout and coping skills measurements could aid in the development of special training for those employees who are most
THU087 Psychosocial screening and outcome measurement in paediatric burns services in the UK
vulnerable to disengaging and developing burnout thereby improving patient
S.L. Gaskell 1,∗ , S. Cooke 1 , R. Hodgetts 2 , J. Mason 3 1 Paediatric Burns Service, Manchester
care and boosting employee satisfaction and productivity. Moreover such tools should be strongly considered for screening during the hiring process of new
Children’s Hospitals, Manchester, United Kingdom 2 Paediatric Burns Service, Birmingham Children’s Hospital, Birmingham, United Kingdom 3 Paediatric Burns Service, Royal Victoria Infirmary, Newcastle-upon-Tyne,
personnel.
United Kingdom
doi:10.1016/j.burns.2009.06.118
Rationale: The British Burn Association Psychosocial Special Interest Group convened a small working party to review available psychosocial screening tools and
THU084 The effect of parental support on burn-injured children’s self-reported anxiety夽 R.B. Rimmer ∗ , C.R.C. Bay, R.R. Croteau, L. Hansen, K.N. Foster, D.M. Caruso Surgery, Arizona Burn Center, Phoenix, United States
outcome measures that could be piloted in paediatric burn services across the UK. Psychosocial screening tools can be administered around the time of a child’s admission to identify any pre-morbid psychosocial factors known to impact on treatment and/or recovery after a burn. Psychosocial outcome measures can be used to measure the key psychosocial domains shown to be important after a burn
Rationale: This study sought to assess anxiety levels in a large group of burn-injured
injury.
children and to determine how perceived parental support impacted their anxiety
Methods: The Working Party therefore made the following recommendations
level. The study provides for a better understanding of the prevalence of anxiety
(subsequently endorsed by the wider BBA Psychosocial Special Interest Group
in burn-injured children and reveals how parental support can impact their well-
membership): 1. Psychosocial screening tool: A wider pilot of a tool developed and
being.
piloted in Manchester be carried out. It is designed to be administered by nursing
Methods: The MASC-10: Multidimensional Anxiety Scale for Children, a well vali-
staff as part of the burns integrated care pathway and then reviewed by the psy-
dated survey, was administered to pediatric burn survivors in attendance at burn
chology service on a weekly basis (or more often if required). It has proven useful
camp. Parental consent was obtained and children participated voluntarily. They
in highlighting psychosocial need that support/intervention can then be directed
were asked to assess the level of support they received at home on a five point
towards. 2. Psychosocial outcome measures: A “pack” of measures to be completed
Likert scale ranging from “None” to “Too much.”
at particular time-points during inpatient and outpatient phases was identified.
Results: Participants included 181 children (54% male and 46% female), mean age
These cover the domains of: child well-being (PTSD; emotional and behavioural
was 13 years (SD ± 2.6) range of 6–18. Ethnicity was reported as Caucasian (40%),
well-being and quality of life; pain; appearance concerns) and parental/family
Hispanic (23%), African American (22%), Other (12%) with 76% reporting visible and
well-being.
24% hidden burn scars. Mean age at burn injury was 5.7 years (SD ± 4.8). Children
A number of burns services treating children across the UK agreed to pilot these
who reported support levels of “None” (8) mean score of 59 or “Too Much” (12)
tools and report back.
mean score of 58 had significantly higher anxiety scores (p = .004) than those who
Results: This paper presents the output of the Working Party and preliminary
reported “A Little” of 50, “Just Right” of 49 or “A Lot” of 50. A score of 50 is considered
findings from this pilot. It explores: (i) progress around the practicalities of imple-
average.
menting these recommendations; (ii) the information gathered on the profile of
Conclusion: This study revealed that a majority of participants felt that they were
the families of children that are being admitted to UK burn services; (iii) whether
receiving adequate parental support which resulted in an average “normed” anxi-
the screening tool is facilitating greater psychosocial care for families; and (iv)
ety score. As hypothesized, children reporting no support had a significantly higher
preliminary outcome data for this patient cohort.
anxiety level. However, those reporting too much support also had significantly
Conclusion: The paper concludes with lessons learned and recommendations for
higher scores. Parenting a burn-injured child can be a tremendous challenge.
future directions.
Guidelines designed to assist parents in determining appropriate and helpful sup-
doi:10.1016/j.burns.2009.06.121
port for their child, rather than a neglectful or overprotective approach, should be developed in order to help diminish children’s anxiety and to help parents be more effective. doi:10.1016/j.burns.2009.06.119
THU085 The preferences of patients with respect to their burns care夽 S. Al-Benna 1,∗ , Y. Al-Ajam 2 1 Burn Centre, BG University Hospital Bergmannsheil, Bochum, Germany 2 Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
THU088 A study on the effectiveness of group counseling program for empowerment of burn patients S. Hwang 1,∗ , G. Choi 1 , C. Seo 2 , K. Jang 2 1 Medical Social Work, South Korea 2 Rehabilitation Medicine, Hallym University Medical Center, Seoul, South Korea
Rationale: This program reinforces patients who had undergone acute burn treatment with self-management skills and provides interaction with other patients for support for better adjustment.
Rationale: Government reforms aiming to create a modern, responsive and per-
Methods: Hallym University Hangang Sacred Heart Hospital of Korea conducted
sonalised health service are based on patient choice. Patients are largely unaware
a short term comparative study of a single group pre–post-test design and pre-
of existing choices regarding location of treatment and they often lack the med-
test post-test design in the year 2006 (April 17 to May 8 on 4 patients and July
ical knowledge and confidence required to make informed decisions about their
12 to August 2 on 5 patients). Encouraged by the successful outcome of the 2006
Burns 3 5 S ( 2 0 0 9 ) S1–S47
S31
comparative study, the same study was conducted in 2009(January 16 to February
Methods: 80 deep dermal contact burns measuring 10 mm by 20 mm were cre-
6 on 5 patients). The 2009 study further reinforced the 2006 study. These 2 studies
ated on the back and flanks of anesthetized domestic pigs (25 kg) using a brass
initiated 120 min session a week for a month. Measurements and instrumentations
bar preheated in boiling water (100 ◦ C) for 30 s. The bar was applied using a
used for this study were: the Korean version of Burn Specific Health Scale-Brief
spring loaded device designed to control the amount of pressure applied to the
(Hyun-Gyun Son), Post-traumatic Stress Disorder Checklist, Manual for the State-
skin by the bar. Burns were randomized to 4 h topical application of Debrase
Trait Anxiety Inventory (Spielberger), Stress Inventory (Holmes & Rahe), and Self-
(n = 40) or its vehicle (n = 40) followed by daily topical application of a petrola-
Rating Depression Scale (Zung). However, the 2009 comparative study utilized 3
tum based antibiotic. Wounds were visualized and photographed daily. 4 mm full
additional inventories: Empowerment Outcome Assessment (Parsons), the Korean
thickness punch biopsies were obtained for histologic analysis using H&E stain-
version of the Satisfaction with Appearance Scale (Hyun-Gyun Son), and the Self-
ing by a board certified dermatopathologist masked to the burn therapy at 7, 11,
Rating Depression Scale (Grinker, Overall & Friedman). Then the 2 studies analyzed
13, and 15 days after injury. Primary outcome was percentage of burns that were
the data with the SPSS win 11.0 for Wilcoxon Matched-Pairs Signed-Ranks Test.
completely reepithelialized. Secondary outcomes were mean percentage reepithe-
Results: Comparing the results of patients before and after they had undergone
lialization and percentage of completely reepithelialized burns on microscopic
the program, the SPSS revealed a decrease in the Stress (Z = −1.384, p = .166), Anx-
analysis. A sample of 40 burns in each group had 80% power to detect a 20%
iety (Z = −1.155, p = .248) which is not a significant decrease; however, the PTSD
difference in the percentage of completely reepithelialized wounds (two-tailed,
(Z = −2.175, p = .030), revealed a significant decrease, the Quality of Life (Z = −1.993,
P < 0.05).
p = .046) revealed a significant increase, proving the efficacy of the program. The
Results: Percentage of completely reepithelialized burns was higher for Debrase
results of the 3 additional inventories of 2009 are: an increase in Empowerment
than control burns at days 11 (40.9% vs. 3.1%; P = 0.002), 13 (87.5% vs. 50%; P = 0.007)
from 80 to 81 (Z = −.271, p = .786) which is not a significant increase; Satisfaction
and 15 (97.5% vs. 77.5%, P = 0.018). Mean (SD) percentage reepithelialization of
with Appearance (Z = −.412, p = .680) which also is not a significant decrease; how-
Debrase treated burns at 7 days was higher than of control burns (47.6% (3.2) vs. 0%
ever Depression (Z = −2.032, p = .042) revealed a significant decrease, proving the
(0); P < 0.001). There was no evidence of any adverse events in normal skin adjacent
efficacy of the program.
to Debrase treated burns.
Conclusion: For more effective intervention in burn patients, we need to develop
Conclusion: Treatment of deep dermal porcine burns with a single topical applica-
various systematic programs considering individual characteristics and their envi-
tion of Debrase results in more rapid reepithelialization than treatment with its
ronment.
vehicle.
doi:10.1016/j.burns.2009.06.122
doi:10.1016/j.burns.2009.06.124
THU089
THU093
The effects of therapeutic music listening on the pain relief for the patients with
Rapid and selective enzymatic debridement of porcine comb-burns with bromelain
burn
derived debrase
S.
Hwang 1,∗ ,
G.
Choi 1 ,
S.
Choi 2 1 Medical Social Work, Hallym University Medical Center, South
Korea 2 Music Therapy, Graduate School of Social Education Myongji University, Seoul, South Korea
A. Singer 1,∗ , S. McClain 1 , B. Taira 1 , T. Lim 1 , R. Gurfinkel 2 , L. Rosenberg 2 1 Emergency Medicine, Stony Brook University Medical Center, New York, United States
2 Emergency
Medicine, Soroka Medical Center, Beer-Sheba, Israel
Rationale: Burn patients involve the thermal destruction of skin cells or the damage to the tissues of the body and in most cases, the patients suffer from severe pains
Rationale: Deep burns are characterized by the formation of an eschar which delays
after having a narrow escape from the death caused by hot water, an electric shock,
healing. Surgical excision cannot always differentiate between the viable tissue
a fire or, etc. The pain burn patients suffer from is considered as the worst pain
and the eschar. We evaluated the efficacy and selectivity of a novel enzymatic
among other pains caused by an external wound and they feel burning pain as well
bromelain based debriding agent, Debrase® .
as daily activities such as having treatment, taking meals, moving a body and, etc.
Methods: 16 burns were created on each dorsum of four domestic pigs (20–25 kg)
Music is effective ways to make the patients change their response to stress that can
using a brass comb with four rectangular prongs preheated in boiling water and
be caused by disease, reduce the painful memories and attentions of accidents, and
applied for 30 s, resulting in four rectangular 10 mm × 20 deep burns, separated
increase, maintain, and recover physical and mental health and plays an active role
by three 5 mm × 20 mm unburned interspaces. The burned keratin layer (blisters)
in improving mental and physical symptoms through psychological approaches
was removed and the burns were treated with a single, topical, Debrase® or con-
that can draw their interests and attentions.
trol vehicle application for 4 h followed by topical SSD. Outcomes—wounds were
Methods: 6 patients who had been hospitalized at Hangang Sacred Heart hospital
observed and full thickness biopsies were obtained at 4 and 48 h for tissue struc-
of South Korea specialized in burn injuries and were able to communicate though
ture and thickness, vascular thrombosis, and burn depth, both within the comb
sound messages from music treatment programs designed for reducing pains par-
burns and the unburned interspaces in between them. Data analysis—2 and
ticipated in this study and the study conducted for 30 min for 10 sessions from
t-tests.
March 25, 2008 to April 30, 2008. In this study, Visual Analogue Scale (VAS) was used
Results: A single 4 h topical application of Debrase® resulted in rapid and com-
to measure the levels of pain and patients physical responses and conversations
plete eschar dissolution of all the burns in which the keratin layer was removed.
for each session were reordered.
The remaining Debrase® treated wound bed was thinner (1.1 ± 0.7 mm) than in
Results: Significant differences were observed in self-measurement for the pain of
the control burns (2.1 ± 0.3 mm; difference 0.9 mm [95% CI 0.3–1.4]), and contained
the burn patients who participated in music treatment.
normal appearing collagen. The Debrase® treated wound bed was viable with no
Conclusion: From the results, a positive effect of music treatment in burn patients
injury to the normal surrounding skin or to the unburned interspaces between the
was proved and music treatment should be used to burn patients in a variety of
burns which represents the zone of stasis. In control burns the dermis contained
ways based on this study.
mostly denatured collagen with necrosis of the dermal appendages and blood vessels. At 48 h, Debrase® treated areas were found partially desiccated under the SSD
doi:10.1016/j.burns.2009.06.123
treatment with 2/3 of the unburned interspaces demonstrating partial thickness necrosis and full thickness necrosis in 1/3 of wounds. In contrast, full thickness
THU092
necrosis was noted in all control interspaces (P = 0.05).
Rapid enzymatic debridement of deep burns with debrase speeds reepithelializa-
Conclusion: In a porcine comb burn model a single 4-h topical application of
tion in swine
Debrase® resulted in rapid removal of the entire necrotic tissue with preservation
Singer 1,∗ ,
Taira 1 ,
Lim 1 ,
Andersen 1 ,
McClain 1 ,
Gurfinkel 2 ,
A. B. T. R. S. R. L. Rosenberg 3 1 Emergency Medicine, Stony Brook University Medical Center, New York, United States 2 Emergency Medicine, Soroka Medical Center, Israel 3 Emergency Medicine, Stony Brook University Medical Center, Beer-Sheba, Israel
Rationale: Reepithelialization of deep burns requires spontaneous or therapeutic removal of necrotic eschar. Debrase is a bromelain derived enzymatic preparation that results in rapid and selective debridement of human and animal burns. We hypothesized that rapid debridement of deep burns with Debrase would speed reepithelialization in a porcine model.
of all the unburned tissues. doi:10.1016/j.burns.2009.06.125
Burns 3 5 S ( 2 0 0 9 ) S1–S47
high employee turnover. The present study sought to determine if individual traits
clinical management. We sought to identify patients’ priorities regarding burns
such as emotional intelligence and coping skills affect care providers’ satisfaction,
treatment received in hospital, as they may differ from those of their health care
success and longevity in the acute burn and surgical intensive care hospital setting.
professionals.
Methods: Participants (171) 65 males, 106 females with mean years of ser-
Methods: One hundred burns surgery patients were surveyed by questionnaire.
vice of 9 years (SD ± 8.8) in the Burn Center or Surgical ICU, who completed
Their priorities with regard to choice of hospital, consultant, operating surgeon
three self-report measures regarding burnout, emotional intelligence and cop-
and follow-up team were enquired about, in addition to their thoughts on operative
ing skills. Sample included Caucasian (70%), Hispanic (13%), Asian (5%), African
waiting times.
America (4%), Other (8%). Professional designation RN (57%) Physician (24%) PA
Results: Despite well documented reductions in waiting times, patients still
(10%) and Allied Health (9%). A full 90% reported working 30 plus hours per
regarded waiting time most important (62%), above proximity of hospital to home
week.
(35%) and choice of surgeon (23%). Patients understood the difference in urgency
Results: Analysis of results found a staistically significant relationship between
between emergency and elective surgery but still gave wide ranges in acceptable
higher emotional intelligence scores and less depersonaliztion of patients,
waiting times. Only 25% of elective patients referred could recall being given a
stronger coping skills and greater sense of personal accomplishment (p < .001).
choice of hospital, consultant or both.
Persons with low emotional intelligence scores were more likely to dis-
Conclusion: Although NHS modernisation concentrates on providing patient choice,
engage and experience emotional exhaustion and burnout (p < .001). Weak
patients prefer access to a good local hospital, continuity of care being more impor-
coping skills scores were also statistically significant in predicting burnout
tant than the choice of a specific consultant.
(p < .001).
doi:10.1016/j.burns.2009.06.120
Conclusion: This study suggests that medical personnel with higher levels of emotional intelligence (EI) and stronger coping skills are more likely to be satisfied with their work, more successful in dealing with patients and less likely to burnout on the job. The utilization of EI, burnout and coping skills measurements could aid in the development of special training for those employees who are most
THU087 Psychosocial screening and outcome measurement in paediatric burns services in the UK
vulnerable to disengaging and developing burnout thereby improving patient
S.L. Gaskell 1,∗ , S. Cooke 1 , R. Hodgetts 2 , J. Mason 3 1 Paediatric Burns Service, Manchester
care and boosting employee satisfaction and productivity. Moreover such tools should be strongly considered for screening during the hiring process of new
Children’s Hospitals, Manchester, United Kingdom 2 Paediatric Burns Service, Birmingham Children’s Hospital, Birmingham, United Kingdom 3 Paediatric Burns Service, Royal Victoria Infirmary, Newcastle-upon-Tyne,
personnel.
United Kingdom
doi:10.1016/j.burns.2009.06.118
Rationale: The British Burn Association Psychosocial Special Interest Group convened a small working party to review available psychosocial screening tools and
THU084 The effect of parental support on burn-injured children’s self-reported anxiety夽 R.B. Rimmer ∗ , C.R.C. Bay, R.R. Croteau, L. Hansen, K.N. Foster, D.M. Caruso Surgery, Arizona Burn Center, Phoenix, United States
outcome measures that could be piloted in paediatric burn services across the UK. Psychosocial screening tools can be administered around the time of a child’s admission to identify any pre-morbid psychosocial factors known to impact on treatment and/or recovery after a burn. Psychosocial outcome measures can be used to measure the key psychosocial domains shown to be important after a burn
Rationale: This study sought to assess anxiety levels in a large group of burn-injured
injury.
children and to determine how perceived parental support impacted their anxiety
Methods: The Working Party therefore made the following recommendations
level. The study provides for a better understanding of the prevalence of anxiety
(subsequently endorsed by the wider BBA Psychosocial Special Interest Group
in burn-injured children and reveals how parental support can impact their well-
membership): 1. Psychosocial screening tool: A wider pilot of a tool developed and
being.
piloted in Manchester be carried out. It is designed to be administered by nursing
Methods: The MASC-10: Multidimensional Anxiety Scale for Children, a well vali-
staff as part of the burns integrated care pathway and then reviewed by the psy-
dated survey, was administered to pediatric burn survivors in attendance at burn
chology service on a weekly basis (or more often if required). It has proven useful
camp. Parental consent was obtained and children participated voluntarily. They
in highlighting psychosocial need that support/intervention can then be directed
were asked to assess the level of support they received at home on a five point
towards. 2. Psychosocial outcome measures: A “pack” of measures to be completed
Likert scale ranging from “None” to “Too much.”
at particular time-points during inpatient and outpatient phases was identified.
Results: Participants included 181 children (54% male and 46% female), mean age
These cover the domains of: child well-being (PTSD; emotional and behavioural
was 13 years (SD ± 2.6) range of 6–18. Ethnicity was reported as Caucasian (40%),
well-being and quality of life; pain; appearance concerns) and parental/family
Hispanic (23%), African American (22%), Other (12%) with 76% reporting visible and
well-being.
24% hidden burn scars. Mean age at burn injury was 5.7 years (SD ± 4.8). Children
A number of burns services treating children across the UK agreed to pilot these
who reported support levels of “None” (8) mean score of 59 or “Too Much” (12)
tools and report back.
mean score of 58 had significantly higher anxiety scores (p = .004) than those who
Results: This paper presents the output of the Working Party and preliminary
reported “A Little” of 50, “Just Right” of 49 or “A Lot” of 50. A score of 50 is considered
findings from this pilot. It explores: (i) progress around the practicalities of imple-
average.
menting these recommendations; (ii) the information gathered on the profile of
Conclusion: This study revealed that a majority of participants felt that they were
the families of children that are being admitted to UK burn services; (iii) whether
receiving adequate parental support which resulted in an average “normed” anxi-
the screening tool is facilitating greater psychosocial care for families; and (iv)
ety score. As hypothesized, children reporting no support had a significantly higher
preliminary outcome data for this patient cohort.
anxiety level. However, those reporting too much support also had significantly
Conclusion: The paper concludes with lessons learned and recommendations for
higher scores. Parenting a burn-injured child can be a tremendous challenge.
future directions.
Guidelines designed to assist parents in determining appropriate and helpful sup-
doi:10.1016/j.burns.2009.06.121
port for their child, rather than a neglectful or overprotective approach, should be developed in order to help diminish children’s anxiety and to help parents be more effective. doi:10.1016/j.burns.2009.06.119
THU085 The preferences of patients with respect to their burns care夽 S. Al-Benna 1,∗ , Y. Al-Ajam 2 1 Burn Centre, BG University Hospital Bergmannsheil, Bochum, Germany 2 Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
THU088 A study on the effectiveness of group counseling program for empowerment of burn patients S. Hwang 1,∗ , G. Choi 1 , C. Seo 2 , K. Jang 2 1 Medical Social Work, South Korea 2 Rehabilitation Medicine, Hallym University Medical Center, Seoul, South Korea
Rationale: This program reinforces patients who had undergone acute burn treatment with self-management skills and provides interaction with other patients for support for better adjustment.
Rationale: Government reforms aiming to create a modern, responsive and per-
Methods: Hallym University Hangang Sacred Heart Hospital of Korea conducted
sonalised health service are based on patient choice. Patients are largely unaware
a short term comparative study of a single group pre–post-test design and pre-
of existing choices regarding location of treatment and they often lack the med-
test post-test design in the year 2006 (April 17 to May 8 on 4 patients and July
ical knowledge and confidence required to make informed decisions about their
12 to August 2 on 5 patients). Encouraged by the successful outcome of the 2006
Burns 3 5 S ( 2 0 0 9 ) S1–S47
S31
comparative study, the same study was conducted in 2009(January 16 to February
Methods: 80 deep dermal contact burns measuring 10 mm by 20 mm were cre-
6 on 5 patients). The 2009 study further reinforced the 2006 study. These 2 studies
ated on the back and flanks of anesthetized domestic pigs (25 kg) using a brass
initiated 120 min session a week for a month. Measurements and instrumentations
bar preheated in boiling water (100 ◦ C) for 30 s. The bar was applied using a
used for this study were: the Korean version of Burn Specific Health Scale-Brief
spring loaded device designed to control the amount of pressure applied to the
(Hyun-Gyun Son), Post-traumatic Stress Disorder Checklist, Manual for the State-
skin by the bar. Burns were randomized to 4 h topical application of Debrase
Trait Anxiety Inventory (Spielberger), Stress Inventory (Holmes & Rahe), and Self-
(n = 40) or its vehicle (n = 40) followed by daily topical application of a petrola-
Rating Depression Scale (Zung). However, the 2009 comparative study utilized 3
tum based antibiotic. Wounds were visualized and photographed daily. 4 mm full
additional inventories: Empowerment Outcome Assessment (Parsons), the Korean
thickness punch biopsies were obtained for histologic analysis using H&E stain-
version of the Satisfaction with Appearance Scale (Hyun-Gyun Son), and the Self-
ing by a board certified dermatopathologist masked to the burn therapy at 7, 11,
Rating Depression Scale (Grinker, Overall & Friedman). Then the 2 studies analyzed
13, and 15 days after injury. Primary outcome was percentage of burns that were
the data with the SPSS win 11.0 for Wilcoxon Matched-Pairs Signed-Ranks Test.
completely reepithelialized. Secondary outcomes were mean percentage reepithe-
Results: Comparing the results of patients before and after they had undergone
lialization and percentage of completely reepithelialized burns on microscopic
the program, the SPSS revealed a decrease in the Stress (Z = −1.384, p = .166), Anx-
analysis. A sample of 40 burns in each group had 80% power to detect a 20%
iety (Z = −1.155, p = .248) which is not a significant decrease; however, the PTSD
difference in the percentage of completely reepithelialized wounds (two-tailed,
(Z = −2.175, p = .030), revealed a significant decrease, the Quality of Life (Z = −1.993,
P < 0.05).
p = .046) revealed a significant increase, proving the efficacy of the program. The
Results: Percentage of completely reepithelialized burns was higher for Debrase
results of the 3 additional inventories of 2009 are: an increase in Empowerment
than control burns at days 11 (40.9% vs. 3.1%; P = 0.002), 13 (87.5% vs. 50%; P = 0.007)
from 80 to 81 (Z = −.271, p = .786) which is not a significant increase; Satisfaction
and 15 (97.5% vs. 77.5%, P = 0.018). Mean (SD) percentage reepithelialization of
with Appearance (Z = −.412, p = .680) which also is not a significant decrease; how-
Debrase treated burns at 7 days was higher than of control burns (47.6% (3.2) vs. 0%
ever Depression (Z = −2.032, p = .042) revealed a significant decrease, proving the
(0); P < 0.001). There was no evidence of any adverse events in normal skin adjacent
efficacy of the program.
to Debrase treated burns.
Conclusion: For more effective intervention in burn patients, we need to develop
Conclusion: Treatment of deep dermal porcine burns with a single topical applica-
various systematic programs considering individual characteristics and their envi-
tion of Debrase results in more rapid reepithelialization than treatment with its
ronment.
vehicle.
doi:10.1016/j.burns.2009.06.122
doi:10.1016/j.burns.2009.06.124
THU089
THU093
The effects of therapeutic music listening on the pain relief for the patients with
Rapid and selective enzymatic debridement of porcine comb-burns with bromelain
burn
derived debrase
S.
Hwang 1,∗ ,
G.
Choi 1 ,
S.
Choi 2 1 Medical Social Work, Hallym University Medical Center, South
Korea 2 Music Therapy, Graduate School of Social Education Myongji University, Seoul, South Korea
A. Singer 1,∗ , S. McClain 1 , B. Taira 1 , T. Lim 1 , R. Gurfinkel 2 , L. Rosenberg 2 1 Emergency Medicine, Stony Brook University Medical Center, New York, United States
2 Emergency
Medicine, Soroka Medical Center, Beer-Sheba, Israel
Rationale: Burn patients involve the thermal destruction of skin cells or the damage to the tissues of the body and in most cases, the patients suffer from severe pains
Rationale: Deep burns are characterized by the formation of an eschar which delays
after having a narrow escape from the death caused by hot water, an electric shock,
healing. Surgical excision cannot always differentiate between the viable tissue
a fire or, etc. The pain burn patients suffer from is considered as the worst pain
and the eschar. We evaluated the efficacy and selectivity of a novel enzymatic
among other pains caused by an external wound and they feel burning pain as well
bromelain based debriding agent, Debrase® .
as daily activities such as having treatment, taking meals, moving a body and, etc.
Methods: 16 burns were created on each dorsum of four domestic pigs (20–25 kg)
Music is effective ways to make the patients change their response to stress that can
using a brass comb with four rectangular prongs preheated in boiling water and
be caused by disease, reduce the painful memories and attentions of accidents, and
applied for 30 s, resulting in four rectangular 10 mm × 20 deep burns, separated
increase, maintain, and recover physical and mental health and plays an active role
by three 5 mm × 20 mm unburned interspaces. The burned keratin layer (blisters)
in improving mental and physical symptoms through psychological approaches
was removed and the burns were treated with a single, topical, Debrase® or con-
that can draw their interests and attentions.
trol vehicle application for 4 h followed by topical SSD. Outcomes—wounds were
Methods: 6 patients who had been hospitalized at Hangang Sacred Heart hospital
observed and full thickness biopsies were obtained at 4 and 48 h for tissue struc-
of South Korea specialized in burn injuries and were able to communicate though
ture and thickness, vascular thrombosis, and burn depth, both within the comb
sound messages from music treatment programs designed for reducing pains par-
burns and the unburned interspaces in between them. Data analysis—2 and
ticipated in this study and the study conducted for 30 min for 10 sessions from
t-tests.
March 25, 2008 to April 30, 2008. In this study, Visual Analogue Scale (VAS) was used
Results: A single 4 h topical application of Debrase® resulted in rapid and com-
to measure the levels of pain and patients physical responses and conversations
plete eschar dissolution of all the burns in which the keratin layer was removed.
for each session were reordered.
The remaining Debrase® treated wound bed was thinner (1.1 ± 0.7 mm) than in
Results: Significant differences were observed in self-measurement for the pain of
the control burns (2.1 ± 0.3 mm; difference 0.9 mm [95% CI 0.3–1.4]), and contained
the burn patients who participated in music treatment.
normal appearing collagen. The Debrase® treated wound bed was viable with no
Conclusion: From the results, a positive effect of music treatment in burn patients
injury to the normal surrounding skin or to the unburned interspaces between the
was proved and music treatment should be used to burn patients in a variety of
burns which represents the zone of stasis. In control burns the dermis contained
ways based on this study.
mostly denatured collagen with necrosis of the dermal appendages and blood vessels. At 48 h, Debrase® treated areas were found partially desiccated under the SSD
doi:10.1016/j.burns.2009.06.123
treatment with 2/3 of the unburned interspaces demonstrating partial thickness necrosis and full thickness necrosis in 1/3 of wounds. In contrast, full thickness
THU092
necrosis was noted in all control interspaces (P = 0.05).
Rapid enzymatic debridement of deep burns with debrase speeds reepithelializa-
Conclusion: In a porcine comb burn model a single 4-h topical application of
tion in swine
Debrase® resulted in rapid removal of the entire necrotic tissue with preservation
Singer 1,∗ ,
Taira 1 ,
Lim 1 ,
Andersen 1 ,
McClain 1 ,
Gurfinkel 2 ,
A. B. T. R. S. R. L. Rosenberg 3 1 Emergency Medicine, Stony Brook University Medical Center, New York, United States 2 Emergency Medicine, Soroka Medical Center, Israel 3 Emergency Medicine, Stony Brook University Medical Center, Beer-Sheba, Israel
Rationale: Reepithelialization of deep burns requires spontaneous or therapeutic removal of necrotic eschar. Debrase is a bromelain derived enzymatic preparation that results in rapid and selective debridement of human and animal burns. We hypothesized that rapid debridement of deep burns with Debrase would speed reepithelialization in a porcine model.
of all the unburned tissues. doi:10.1016/j.burns.2009.06.125