Evaluation of the "Early" Use of Albumin in Children with Extensive Burns: A Randomized Controlled Trial.

OBJECTIVE: To compare early versus delayed albumin resuscitation in children with burns in terms of clinical outcome and response. DESIGN: Randomized controlled trial. SETTING: Burn center at a tertiary care teaching hospital. PATIENTS: Forty-six children aged 1-12 years with burns greater than 15-45% total body surface area admitted within 12 hours of burn injury. INTERVENTIONS: Fluid resuscitation was based on the Parkland formula (3 mL/kg/% total body surface area), adjusted according to urine output. Patients received 5% albumin solution between 8 and 12 hours post burn in the intervention group (n = 23) and 24 hours post burn in the control group (n = 23). Both groups were assessed for reduction in crystalloid fluid infusion during resuscitation, development of fluid creep, and length of hospital stay. MEASUREMENTS AND MAIN RESULTS: There was no difference between groups regarding age, weight, sex, % total body surface area, cause of burn, or severity scores. The median crystalloid fluid volume required during the first 3 days post burn was lower in the intervention than in the control group (2.04 vs 3.05 mL/kg/% total body surface area; p = 0.025 on day 1; 1.2 vs 1.71 mL/kg/% total body surface area; p = 0.002 on day 2; and 0.82 vs 1.3 mL/kg/% total body surface area; p = 0.002 on day 3). The median urine output showed no difference between intervention and control groups (2.1 vs 2.0 mL/kg/hr; p = 0.152 on day 1; 2.58 vs 2.54 mL/kg/hr; p = 0.482 on day 2; and 2.9 vs 3.0 mL/kg/hr; p = 0.093 on day 3). Fluid creep was observed in 13 controls (56.5%) and in one patient (4.3%) in the intervention group. The median length of hospital stay was 18 days (range, 15-21 d) for controls and 14 days (range, 10-17 d) in the intervention group (p = 0.004). CONCLUSIONS: Early albumin infusion in children with burns greater than 15-45% total body surface area reduced the need for crystalloid fluid infusion during resuscitation. Significantly fewer cases of fluid creep and shorter hospital stay were also observed in this group of patients.

Cross-Cultural and Psychometric Properties Assessment of the Exercise Self-Efficacy Scale in Individuals with Spinal Cord Injury.

INTRODUCTION: The Exercise Self-Efficacy scale (ESES) is a reliable measure, in the English language, of exercise self-efficacy in individuals with spinal cord injury. The aim of this study was to culturally adjust and validate the Exercise Self-Efficacy scale in the Portuguese language. MATERIAL AND METHODS: The Exercise Self-Efficacy scale was applied to 76 subjects, with three-month intervals (three applications in total). The reliability was appraised using the intra-class correlation coefficient and Bland-Altman methods, and the internal consistency was evaluated using Cronbach´s alpha. The Exercise Self-Efficacy scale was correlated with the domains of the Quality of life Questionnaire SF-36 and Functional Independence Measure and tested using the Spearman rho coefficient. RESULTS: The Exercise Self-Efficacy scale-Brazil presented good internal consistency (alpha 1 = 0.856; alpha 2 = 0.855; alpha 3 = 0.822) and high reliability in the test-retest (intra-class correlation coefficient = 0.97). There was a strong correlation between the Exercise Self-Efficacy scale-Brazil and the SF-36 only in the functional capacity domain (rho = 0.708). There were no changes in Exercise Self-Efficacy scale-Brazil scores between the three applications (p = 0.796). DISCUSSION: The validation of the Exercise Self-Efficacy scale questionnaire permits the assessor to use it reliably in Portuguese speaking countries, since it is the first instrument measuring self-efficacy specifically during exercises in individuals with spinal cord injury. Furthermore, the questionnaire can be used as an instrument to verify the effectiveness of interventions that use exercise as an outcome. CONCLUSION: The results of the Brazilian version of the Exercise Self-Efficacy scale support its use as a reliable and valid measurement of exercise self-efficacy for this population.

Introdução: O instrumento Exercise Self-Efficacy scale (ESES) é fiável, na língua inglesa, para medir a autoeficácia em exercícios em indivíduos com lesão medular. O objetivo do estudo foi adaptar transculturalmente e validar a escala ESES para a língua Portuguesa. Material e Métodos: O Exercise Self-Efficacy scale foi aplicado três vezes em 76 indivíduos, a cada três meses. A fiabilidade foi avaliada pelo coeficiente de correlação intraclasse de Bland e Altman, e a consistência interna pelo alfa de Cronbach. O Exercise Self-Efficacy scale foi correlacionado com os domínios do Questionário de Qualidade de Vida SF-36 e da Medida de Independência Funcional e avaliado pelo rho de Spearman. Resultados: O Exercise Self-Efficacy scale-Brasil apresentou boa consistência interna (alpha 1 = 0,856; alpha 2 = 0,855 e alpha 3 = 0,822) e alta fiabilidade no teste-reteste (coeficiente de correlação intraclasse = 0,97). Houve correlação forte do Exercise Self-Efficacy scale-Brasil somente com o domínio Capacidade Funcional do SF-36 (rho = 0,708). Não houve mudança nas pontuações do Exercise Self-Efficacy scale-Brasil entre as três aplicações (p = 0,796). Discussão: A validação do Exercise Self-Efficacy scale permite que este seja utilizado nos países de língua portuguesa de forma fiável, pois representa o primeiro instrumento específico para o estudo da auto-eficácia em exercícios em indivíduos com lesão medular e, ainda, ser utilizado como instrumento para verificar a efetividade de intervenções que utilizem exercício como desfecho. Conclusão: A versão brasileira da Exercise Self-Efficacy scale é válida e fiável para avaliação da autoeficácia em exercícios para essa população.