It is very difficult to give a precise definition of degrees of pain. This problem prompted a study to examine the extent of the correlation between pain as felt by the burn patient and pain as perceived by the attending nurse. Data were collected from 6 patients following various nursing procedures. It was found that, compared to the patients' evaluation, nurses overestimated pain in 34.5% of cases, underestimated it also in 34.5% of cases and assessed it accurately only in 3 1 % of cases. An analysis is also made of different categories of nurses, and the relative accuracy of their perception of the patients' pain. It is concluded that nurses must learn how to assess pain correctly.

lafrati N.S. Burn Care, 7: 413-416, 1986.

In an attempt to reduce escalating health costs, the United States government has introduced DRGs (diagnosis-related groups). The DRGs related to bum cases are divided into 4 groups according to percentage of body area burned and whether surgery is performed. The paper analyses the burn DRG criteria and the designated fiscal reimbursement. A number of reasons are given for the finding that the present DRGs are unrealistic.

Hunt J.L., Purdue G.F. Bums Care, 7: 417-421, 1986.

In large burns biological dressings can be life-saving because of their ability to decrease wound infection by achieving temporary wound closure until completion by autografting. However the difficulty of maintaining sterility presents'a variety of problems. In this study pigskin and amniotic membrane were made infection-resistant by in situ incorporation of silver sulphadiazine. Antibacterial efficacy was tested in mice in vitro and in vivo. It was found that the use of silver sulphadiazine-impregnated wound covers may prevent the premature loss of temporary skin grafts by controlling infection. The wound is thus better prepared for autografting.

Modak S., Fox P., Stanford J., Sampath L., Fox C.L., Jr. Bum Care, 7: 422-425, 1986.

ROLES AND FUNCTIONS OF OCCUPATIONAL THERAPY IN BURN CARE DELIVERY

The occupational therapist is - an essential member of the bum care team. Bum patients need assistance if they are to achieve an optimal level of independence and a good quality of life. It is the responsibility of the occupational therapist to provide, quality care, so that the patient recovering from bum injuries can return more rapidly to a functional life-style. Various aspects of the occupational therapist's activities are described.

Kohimann McGourty L. Burn Care, 7: 431-433, 1986.

"Camp Celebrate" is an annual weekend camping experience for burned children, which gives them the opportunity to learn, grow and succeed, satisfying their natural curious and adventurous interests. The children can forget and/or share feelings of being burned and the constant reminders of their burn scars. A detailed description is given of the children's activity during the weekend camp, which has now been held for a number of years.

Rosenstein D.L.W. Burn Care, 7: 434-436, 1986.

This study examines chemotaxis at several intervals after burn injuries of varied age to determine if the rate at which a chemotactic response develops is afTected by bum injury, with particular reference to the kinetics of polymorphonuclear neutrophil (PMN) chemotaxis to Staphylococcus aureus. In vivo chernotaxis was measured by tissue myeloperoxidase at varying intervals in rats with 30% BSA back bums which received several identical inocula of S. aureus 3, 6 and 10 days after injury. Maximal chemotactic response was delayed, and increased, 6 and 10 days post-burn. The delayed response appears to be another mechanism by which bum injury affects PMN chernotaxis.

Meyer A.A., Manktelow A., Trunkey D.D. Burn Care, 7: 465-468, 1986.

Experiments in the rat suggest that acute burn trauma produced by scalding water alters small intestinal nutrient absorption and DNA synthesis. The rats showed decreased small-intestine mucosal weight and altered small-intestine transport of nutrients in vitro. H-thymidine incorporation into intestinal DNA in vivo and intestinal thypidine kinase activity in vitro were decreased 18 hours post-bum. These alterations could affect delivery of nutrients by the gut to bum patients.

Car-ter E.A., Udal J.N., Kirkham S.E., Walker A. Bum Care, 7: 469-474, 1986.

11. EVIDENCE FOR THE PRODUCTION OF HEPATIC DYSFUNCTION IN THE RAT FOLLOWING ACUTE BURN INJURY

There is little information in the literature regarding the absorption of nutrients or the exclusion of bacteria and toxins by the gastrointestinal tract following thermal injury. An observation was therefore made in the rat of the effect of acute bum

trauma on plasma enzyme activities (glutamic oxaloacetictransaminase, glutamic pyruvic transaminase and 5'-nucleotidase) used in routine histological examinations. It was found that acute bum trauma in the rat was followed by hepatic dysfunction.

Carter E.A., Kirkham S.E., Udal J.N., Jung W., Walker W.A. Bum Care, 7: 475-478, 1986.

NORFLOXACIN AND SILVER-NORFLOXACIN AS TOPICAL ANTIMICROBIAL AGENTS: RESULTS OF IN VITRO SUSCEPTIBILITY TESTING AGAINST BACTERIA AND CANDIDA SP ISOLATED FROM BURN PATIENTS

The commonly used topical antimicrobial agents are not uniformly effective, and newer agents are continuously being developed and evaluated. One of these, Norfloxacin (a, quinoline carboxylic acid compound), was formulated in a topical cream base and tested for activity against a variety of bacteria and yeasts isolated from burn patients. Silver-Norfloxacin was also studied. Of all the bacterial isolates tested none was resistant to the action of the two topical agents. All Candida organisms assayed were susceptible to silver-Norfloxacin. The results show that Norfloxacin -containing topical formulations provide broad-spectrum antibacterial activity, and in particular that the silver salt formulations of Norfloxacin, with their full antibacterial spectrum of activity and their uniform anticandidal activity, have a good potential for development as broadly active anti-infective agents for use in the therapy of bum patients.

Holder 1.A., Knoll C.A., Wesselman J. Bum Care, 7: 479-483, 1986.

Experiments showed that the use of citnetidine did not have any beneficial effect in a fluid-resuscitated inhalation injury rabbit model. No thanges were seen in oedema formulation when cimetidine was administered either before or just after the initial smoke inhalation treatment.

Stewart R.J., Yamaguchi K T., Santibanez A.S., Matsubara G. Bum Care, 7: 484-487, 1986.

A study was made of 72 bum patients with fungal sepsis. All were treated with intravenous amphotericin (0.5 mg/kg body weight/day), immediate wound debridement, and early wound closure. Nearly a third of the patients died. A retrospective multiple regression analysis was made of 62 variables in order to ascertain specific factors associated with fungal sepsis and their relationship to survival.

Pensler J.M., Herndon DX, Ptak H., Bonds E, Rutan T.C., Desai M.H., Abston S.

Bum Care, 7: 488-491, 1986.

Endotracheal intubation is recommended in the presence of upper airway obstruction secondary to face and oropharyngeal oedema caused by a face or neck burn, and the decision whether to prolong this technique or to perform tracheostomy is not an easy one. The choice must be individualized and based on the clinical condition of each single patient -tracheostomy must not be performed arbitrarily after a certain number of days. There is no general agreement about when to perform tracheostomy. A retrospective study of 320 cases describes pretracheostomy airway management and the indications, morbidity and mortality associated with tracheostomy.

Hunt J.L., Purdue G.F., Gunning T. Bum Care, 7: 492-495, 1986.

A pilot research study was carried out in order to survey the prevalence of psychological problems arising among a population of burned patients during the rehabilitative phase beginning around the time of discharge from hospital, and also to ascertain some of the reasons for poor post-burn outcome, in particular those related to pre-burn personality and psychopathology, as well as circumstances surrounding the bum. Five main conclusions were drawn: a) depression and anxiety are high immediately post-bum,, but reduce in time; b) post-traumatic stress disorder is common; c) neuroticism, trait anxiety and hypochondriasis are personality factors that may affect ,post-bum psychosocial outcome; d) the presence of compensation issues is associated with post-bum psychological difficulties; c) pre-burn psychiatric morbidity is associated with poor post-burn psychosocial adjustment.

Tucker P. Burns, 13: 7-14, 1987.

In order to study the haematopoietic changes that occur following burning, a mouse model was established, in which the animal's spleen was removed, as it had been found in a previous study that the murine spleen contributed to haematopoiesis, a phenomenon not found in humans. The model simulates the haematopoietic events seen in burned humans: anaemia and granUlocytosis. The splenectomized mouse model could be useful in studies designed to alter haematopoiesis following burning and to observe the effect these events have on wound healing and survival.

Wallner S.F., Vautrin R., Katz J. Bums, 13: 15-21, 1987.

The application of lasers in medicine has demonstrated their power of coagulation, thus showing their effect on blood vessels. An investigation was made of this effect on endothellum of the e response o e lung through stimulation of the brain surface in rats by two different types of laser: C02 and NdYag. After NdYag laser application to the rat brain surface, concentration changes were observed in some components of the renin-angiotensinaldosterone system and lung plasminogen activator. These changes were similar to those observed in cutaneous burn and haemorrhagic hypotension. The same changes were not observed following C02 laser application.

Brizio-Molteni L., Quigley M., Cerullo N.H., Molteni A. Burns, 13: 22-25, 1987.

L., Fitzsimons J., Solliday

BIOCHEMICAL INVESTIGATIONS AFTER BURNING INJURY: COMPLEMENT SYSTEM, PRO7 ANTIPROTEASE BALANCE AND ACUTE-PHASE REACTANTS

A prospective biochemical study in 17 burned patients showed complete complement activation in vivo independent of the extent of the burned surface area, a significant protease/antiprotease imbalance, especially in major burned patients, and a delayed but persisting 'acute phase response'.

Faymonville M.E., Micheels J., Bodson L., Jacquemin R, Lamy

M., Adam A_ Duchateau J. Bums, 13: 26-33, 1987.

A study was carried out of the effects of using extracorporeal membrane oxygenation (ECMO) in supporting sheep which have received lethal pulmonary smoke injury. The animals were systemically heparinized and placed on a venovenous perfusion circuit, remaining on partial venovenous bypass until 96 h post-bum. All animals in the treatment group survived, while the control group, which received the inhalation injury alone, had a 100 per cent mortality. A third group of animals, which received inhalation injury with systemic heparinization but not ECMO, had a 66 per cent mortality at 96 h. These results suggest that partial venovenous ECMO may be a useful form of adjunctive treatment in severe inhalation injury, which is known to constitute the most frequent cause of death in burn patients, accounting for 20-80 per cent of overall mortality.

Brown M., Traber D.L., Herndon D.N., Oldham K.T., Traber L.D. Burns, 13: 34-38, 1987.