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The effects of therapeutic music listening on the pain relief for the patients with burn
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
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