Because of their extensive wounds, burn patients are chronically exposed to inflammatory mediators. Thus, burn patients, by definition, already have "systemic inflammatory response syndrome." Current definitions for sepsis and infection have many criteria (fever, tachycardia, tachypnea, leukocytosis) that are routinely found in patients with extensive burns, making these current definitions less applicable to the burn population. Experts in burn care and research, all members of the American Burn Association, were asked to review the literature and prepare a potential definition on one topic related to sepsis or infection in burn patients. On January 20, 2007, the participants met in Tucson, Arizona to develop consensus for these definitions. After review of the definitions, a summary of the proceedings was prepared. The goal of the consensus conference was to develop and publish standardized definitions for sepsis and infection-related diagnoses in the burn population. Standardized definitions will improve the capability of performing more meaningful multicenter trials among burn centers.
This study assessed the extent to which the presence of a young developmentally disabled or nondisabled male child affected adaptation and family roles for both mothers and fathers. Developmental child assessments, in-home ratings of parenting, and maternal and paternal self-assessments and interviews were included. Marital adjustment, disruptions in family life, and observed parenting of the child (but not depression) varied with disability status of child. Mothers in both groups reported more depressive symptoms and family disruptions than fathers. Fathers of disabled children assumed less responsibility than comparison fathers for child care, even in mother-employed families. Decreased father involvement in child care was specific to the disabled child, not to siblings, and was related to severity of the child's atypical behaviors. Expressive support from one's spouse was the best predictor of quality of parenting observed in the home for both mothers and fathers of disabled and nondisabled sons. Disharmony between current and "appropriate" spousal support was a significant negative predictor of perceived and observed parental adaptation. The concept of harmonic responsiveness was proposed to explain how proffered support must be tuned to the perceived needs and expectations of one's spouse for it to be effective.In spite of increasing interest in family relationships, few studies have focused on social determinants of adaptive personal, marital, or parental responses to the home care of young children with diagnosed disabilities (Friedrich, Wilturner, &
This literature review focuses on the stresses families experience and the support factors needed to help them cope with their handicapped children. Stress often appears to increase with the age of the handicapped child, and it is also based on the daily care-giving demands of the child. Other general factors affecting stress are low family income, divorce, separation, and so forth. The father often plays a limited role in these families even when present. Both formal and informal social support networks are important to these families, often more so than professional support, which has been uneven. Families need to be treated as having individual needs that require individual solutions, even as their handicapped children. Investigators and practitioners are encouraged to continue their focus on the family as a legitimate unit of study and treatment.
This study confirms that transanal ICG angiography is feasible and provides imaging of mucosal and anastomotic blood flow. The technique warrants further study in a larger group of patients to assess its ability to identify defects in tissue perfusion that may lead to anastomotic breakdown.
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