Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units.
The study had a comparative retrospective design using combined methodology of instrument appraisal and thematic analysis. Three investigators appraised guidelines from burn units in Denmark (DK), Sweden (SE), New Zealand (NZ), and USA using the AGREE Instrument (Appraisal of Guidelines for Research & Evaluation), version II, and identified core themes in the guidelines.
The overall scores expressing quality in six domains of the AGREE instrument were variable at 22% (DK), 44% (SE), 100% (NZ), and 78% (USA). The guidelines from NZ and USA were highly recommended, the Swedish was recommended, whereas the Danish was not recommended. The identified core themes were: continuous pain, procedural pain, postoperative pain, pain assessment, anxiety, and non-pharmacological interventions.
The study demonstrated variability in quality, transparency, and core content in clinical guidelines on pain management in burn patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn patients in the clinic, to unify guideline construction, and to enable interdepartmental comparison of treatment and outcomes.
This is the third in a series of five papers about the use of computing technology in general practitioner (GP) practices in Denmark and New Zealand. This paper looks at the environments within which electronic medical records (EMRs) operate, including their functionality and the extent to which electronic communications are used to send and receive clinical information. It also introduces the notion of a longitudinal electronic health record (versus an EMR).
The perimeter of the basement membrane (Pbm) of an airway viewed in cross section is used as a marker of airway size because in normal lungs it is relatively constant, despite variations in airway smooth muscle (ASM) shortening and airway collapse. In vitro studies (McParland BE, Pare PD, Johnson PR, Armour CL, Black JL. J Appl Physiol 97: 556-563, 2004; Noble PB, Sharma A, McFawn PK, Mitchell HW. J Appl Physiol 99: 2061-2066, 2005) have suggested that differential stretch of the Pbm between asthmatic and nonasthmatic airways fixed in inflation may occur and lead to an overestimation of ASM thickness in asthma. The relationships between the Pbm and the area of ASM were compared in transverse sections of airways from cases of fatal asthma (F) and from nonasthmatic control (C) cases where the lung tissue had been fixed inflated (Fi; Ci) or uninflated (Fu; Cu). When all available airways were used, the regression slopes were increased in Fu and Cu, compared with Fi and Ci, and increased in Fu and Fi, compared with Cu and Ci, suggesting effects of both inflation and asthma group, respectively. When analyses were limited to airway sizes that were available for all groups (Pbm
This chapter reviews the data on occurrence of cancers that are potentially caused by alcohol drinking (cancers of the upper gastrointestinal and respiratory tracts, and liver cancer) in relation to social class. In order to assess the role of alcohol drinking in the observed social class gradients of these cancers, we have particularly looked for consistency in the gradients of different alcohol-related cancers, and used lung cancer occurrence to judge the role of tobacco smoking, which is the major other determinant of these diseases. Additional data on levels of alcohol drinking and on the occurrence of other alcohol-related morbidity are brought into the discussion where available. A role of alcohol drinking in the observed negative social class gradients for alcohol-related cancers is very likely in men in France, Italy and New Zealand. Evidence that is less strong, but is suggestive of a role of alcohol drinking, is seen for men in Brazil, Switzerland, the United Kingdom and Denmark. Although a role of alcohol drinking is likely or possible in certain populations, other factors may contribute as well, most notably tobacco smoking and dietary habits. Additional data on the frequency of complications after surgical procedures in alcohol drinkers are reviewed briefly.
We evaluated three established statistical models for automated 'early warnings' of disease outbreaks; counted data Poisson CuSums (used in New Zealand), the England and Wales model (used in England and Wales) and SPOTv2 (used in Australia). In the evaluation we used national Swedish notification data from 1992 to 2003 on campylobacteriosis, hepatitis A and tularemia. The average sensitivity and positive predictive value for CuSums were 71 and 53%, for the England and Wales model 87 and 82% and for SPOTv2 95 and 49% respectively. The England and Wales model and the SPOTv2 model were superior to CuSums in our setting. Although, it was more difficult to rank the former two, we recommend the SPOTv2 model over the England and Wales model, mainly because of a better sensitivity. However, the impact of previous outbreaks on baseline levels was less in the England and Wales model. The CuSums model did not adjust for previous outbreaks.
School-based dental clinics, when well-managed, can bring good quality care to children where they normally congregate, thus avoiding many of the problems found where children must be taken to private offices out of school hours. Both capital and running expenses for primary care can be substantially reduced. Utilization figures for school-based dental services now reach 98 per cent of eligible children in New Zealand, where dental nurses do simple operative dentistry including cavity preparation and fillings. Australia, where a modified New Zealand plan has been expanding for about 12 years, is moving rapidly to attain similar utilization. In Sweden, 95 per cent of the school-age population is reported to receive school-managed dental service through a government program. In the United States, however, it is commonly reported that less than one-half the school-age population receives good periodic dental care.
OBJECTIVES: To examine the extent of international differences in children's exposure to traffic as pedestrians or bicyclists. DESIGN: Children's travel patterns were surveyed using a parent-child administered questionnaire. Children were sampled via primary schools, using a probability cluster sampling design. SETTING: Six cities in five countries: Melbourne and Perth (Australia), Montreal (Canada), Auckland (New Zealand), Umeå (Sweden), and Baltimore (USA). SUBJECTS: Children aged 6 and 9 years. MAIN OUTCOME MEASURES: Modes of travel on the school-home journey, total daily time spent walking, and the average daily number of roads crossed. MAIN FINDINGS: Responses were obtained from the parents of 13423 children. There are distinct patterns of children's travel in the six cities studied. Children's travel in the three Australasian cities, Melbourne, Perth and Auckland, is characterised by high car use, low levels of bicycling, and a steep decline in walking with increasing car ownership. In these cities, over a third of the children sampled spent less than five minutes walking per day. In Montreal, walking and public transport were the most common modes of travel. In Umeå, walking and bicycling predominated, with very low use of motorised transport. In comparison with children in the Australasian and North American cities, children in Umeå spend more time walking, with 87% of children walking for more than five minutes per day. CONCLUSIONS: There are large international differences in the extent to which children walk and cycle. These findings would suggest that differences in 'exposure to risk' may be an important contributor to international differences in pedestrian injury rates. There are also substantial differences in pedestrian exposure to risk by levels of car ownership-differences that may explain socioeconomic differentials in pedestrian injury rates.