当前位置:公众访问 >页面
简体中文 / English
1.Screening
1.Management for Progress
2.Inclusion Criteria

1. Patients with either II-degree debrided burn wound or donor site

3. Ages between 18~65 years old

Patients who replies "No" to any of the above questions will not enter the study

Doctor's signature

Date

yyyy-mm-dd

3.Exclusion Criteria

Patients who replies "Yes" to any of the above questions will not enter the study

Doctor's signature

Date

yyyy-mm-dd

2.Baseline
1.Management for Progress
2.General Information

Other diseases

If yes, please describe

History of allergic disease

If yes, please describe

If yes, please describe

If yes, please describe

Date of birth

yyyy-mm-dd

Pulse rate

次/分

Respiratory rate

次/分

Systolic pressure (SP)

mmHg

Diastolic pressure (DP)

mmHg

Education level

Marital status

Grouping

Name of Drug

Route of Administration

Dosage per Day

Start Date

End Date

Doctor's signature

Date

yyyy-mm-dd

3.Physical Examination

Wound Surface Area

cm2

Wound Location

Wound Type

Signs and Symptoms

Wound Bed (erythema)

Wound Bed (exudation)

Wound Bed (bleeding)

4.Lab Investigations

Uric acid

μmol/L

Creatinine

μmol/L

Urea nitrogen

mmol/L

Serum albumin

g/L

Serum bilirubin

μmol/L

AST

U/L

ALT

U/L

Urine protein

g/L (或定性)

Urine red cell

个/μL (或定性)

Urine WBC

个/μL (或定性)

PLT

X10*9/L

Hb

g/L

RBC

X10^12/L

WBC

X10*9/L

Date of test

Routine Blood Test

Routine Urinalysis

Date of examination

yyyy-mm-dd

Date of test

yyyy-mm-dd

Liver Function Test

Date of test

yyyy-mm-dd

Renal Function Test

3.In the process of the treatment
1.Treatment Record
4.At the end of the treatment
1.Management for Progress
5.SOPs
1.Treatment SOP
6.Research team
1.Institutions
7.Design, Methods
1.Calculations of sample size