bluuebunny/crossref_metadata_2025 huggingface dataset:
612 Assessing the Impact of Burns on Children Aged 5–18 Years: A Narrative Review of Health Outcomes Literature
Authors: Austen Amelia , Hou Carina , Patel Khushbu , Brady Keri , Grant Gabrielle G , Schneider Jeffrey C , Kazis Lewis , Ryan Colleen M
Published: March 2020

Introduction

Burn injuries can have major long-term effects on the health and quality of life for children and adolescents. This study narratively reviewed the health outcomes literature focusing on the impact of burn injury for children aged 5–18.

Methods

Literature targeting pediatric outcomes was reviewed to identify the effects of burns on children aged 5–18 (n=16). Inclusion criteria included studies that focused on the impact of burns on health and quality of life and were age-appropriate for this population. Articles were identified via PubMed, Web of Science, and manual reference checks. Data collected included the outcomes and health domains assessed in each article and the findings of the effects of the burn injury on those specific outcomes. The Preschool LIBRE Conceptual Model served as a ‘domains framework’ to guide the identification of outcomes and health domains.

Results

Long-term burn-specific outcomes and broad health domains identified were physical functioning (n=9), psychological functioning (n=12), social functioning (n=4), symptoms (n=8), and family (n=7). Some studies exclusively focused on one domain whereas others assessed two domains or more. Subdomains such as upper extremity functioning and functional independence were addressed in the physical functioning domain. Psychological functioning outcomes included subdomains such as emotional health and behavioral problems. Social functioning outcomes evaluated subdomains such as problems with peers and social participation. The symptoms domain addressed post-burn pain and itch. Family outcomes subdomains such as parental satisfaction with appearance and general family functioning were identified.

Conclusions

Burn-specific outcomes and health domains assessing the effects of burns on children aged 5–18 were identified among 16 studies. There is a need for a comprehensive assessment tool that more precisely measures the impact of burn injury across these domains. This work will inform the development of the School-Aged Life Impact Burn Recovery Evaluation (LIBRE) Computer Adaptive Test (CAT) Profile – a new outcome metric for children and adolescents with burns.

Applicability of Research to Practice

This review is relevant to researchers and clinicians assessing health outcomes and measuring burn recovery in children aged 5–18.
623 The Benefits of Burn Awareness Week in a Large Metro Area Hospital
Authors: Johnston Jennine M , Abbott Sarah B , Montelongo Sandra , Huzar Todd F
Published: March 2020

Introduction

According to the American Burn Association, Burn Awareness Week is an annual event that provides an “opportunity for organizations to mobilize burn, fire and life safety educators to unite in sharing a common burn awareness and prevention message in our communities.” In 2018, due to alarming data indicating that a high volume of our children’s burn admissions was a result of scald burns, we recognized the need to participate in our first Burn Awareness Week and involve our community stakeholders.

Methods

Analysis of our data from the 2017 trauma registry determined that 61% of pediatric burn admits were scald burns and most were < 6 years old. Geo-mapping identified at risk areas by ethnicity and zip-codes. Our Burn Awareness Week messaging was designed based on this information. We predominantly targeted English and Spanish speaking families with the goal of increasing awareness of the prevalence and prevention of scald burns and evidence-based first aid treatment. Most materials created were bilingual and included an interactive burn awareness quiz with rewards, firefighter coloring books, bilingual first aid magnets, and t-shirts displaying the scald awareness message, “Hot Liquids Burn Like Fire.” Bilingual story board testimonials of real patients were displayed. Multimedia platforms provided public service announcements in English and Spanish.

Results

More than 1500 people attended the booth during the 5-day event. We designed and implemented our first Burn Awareness Week with participation from community stake-holders. A post-event survey identified that the interactive burn awareness quiz, first aid magnets, t-shirts, and story boards were most effective in delivering our message and well-received by the community. This event served as a catalyst to continue burn awareness and education with clinics and interdepartmental units. In addition, a community hospital requested our materials and information. During our event, one of our community stakeholders successfully secured a proclamation for Burn Awareness Week from our state Governor.

Conclusions

Burn Awareness Week enabled our institution and our community to get involved in addressing an identified pressing public health issue. We created a template for our future participation in Burn Awareness Week based on generated data that allows us to target demographic locations with specific burn related issues within our community.

Applicability of Research to Practice

Scald burns is the most common burn injury in young children admitted at our hospital. A collaborative event between our hospital and community stake-holders provided burn awareness and prevention education to our community to help reduce such injuries in the future.
635 Compression Garments with Silicone Improve Hypertrophic Scars Compared to Compression Garments Alone: A Retrospective Study
Authors: Hartman Brett , Robertson Karen , Spera Leigh J , Hinton Michael
Published: March 2020

Introduction

The management of hypertrophic scars is one of the major challenges facing healthcare providers in the treatment of burn patients. Two of the mainstay noninvasive clinical practices for hypertrophic scars is the utilization of pressure garments and garments with Silicone gel sheeting. Here, we present a comparison of the effectiveness of compression garments alone and garments with silicone in the treatment of a large pediatric patient population with hypertrophic scars.

Methods

A retrospective study was performed to compare the effectiveness of compression garments with silicone versus compression garments without silicone in the treatment of pediatric hypertrophic scars. Included in this study were patients who received at least 12 months of follow-up treatment with silicone or non-silicone compression garments between 2013 and 2018. Modified Vancouver Scar Scale (VSS) scores were analyzed 1, 3, 6, 9, and 12 months post-injury/surgery for each scar. Descriptive statistics and t tests were used to summarize and compare the total VSS scores between the two groups. In addition, descriptive and ANOVA statistics were performed to compare the effectiveness of silicone compression treatment for scars located on different regions of the body.

Results

In total, the compression garment with silicone group included 99 scars of 70 different patients and the non-silicone group included 28 scars of 19 different patients. Before-after total VSS scores for silicone group decreased from 4.11 (SD, 1.522) to 1.47 (SD, 1.268) compared to a decrease from 3.27 (SD, 1.117) to 1.80 (SD, 1.380) for compression group after 12 months of treatment (P< 0.05). ANOVA analysis revealed no statistically significant difference between silicone’s effectiveness on scars located in different regions of the body based on total VSS score after 12 months of treatment (F(4, 99)=1.47, p< 0.05).

Conclusions

Compression garments with silicone are more effective in treating hypertrophic scars than garments without silicone. The effectiveness of silicone is independent of the scar location assuming sufficient contact and coverage.

Applicability of Research to Practice

This retrospective study supports the use Silicone compression garments for hypertrophic scars in pediatric patients and is completely applicable to medical practice.
652 Topical Delivery of Fidgetin-Like 2 siRNA to Enhance Cell Migration for Burn Wound Healing in a Swine Model
Authors: Kowalczewski Christine , Michelle Holik , Larson David A , Shaffer Lucy , Christy Robert J
Published: March 2020

Introduction

Donor site skin is a precious commodity for burn wounds and graft-sparing procedures are critical for larger total body surface area burns. Currently, large ratio skin grafts have been found to preserve donor skin but at the expense of delayed reepithelialization and increased scar formation at the recipient site. In this study, we propose to utilize a topical gene therapy treatment as an adjunct to higher meshing ratio (4:1) split thickness skin grafts (mSTSG) to improve re-epithelialization and reduce donor skin requirements. Administration of small interfering RNA (siRNA) to suppress the expression of one microtubule regulatory protein, Fidgetin-Like 2 (FL2), has been shown to increase cell migration rate both in vitro and in vivo. We hypothesize that topical application of nanoparticle (NP) encapsulated FL2 siRNA will increase cell migration resulting in expedited reepithelialization in large mesh ratio mSTSG in a full-thickness porcine burn model. A pilot study was conducted to down-select siRNA dose by measuring the rate of reepithelialization of full-thickness grafted burns.

Methods

Ten full-thickness (FT) 5x5cm burn wounds were created on the dorsum of anesthetized Yorkshire pigs. Four days later, the wounds were surgically debrided to a bleeding wound bed and grafted using a 4:1 mSTSG. Treatments groups (n= 2 per pig) consisted of vehicle control (PBS), scrambled sequence NP siRNA (non-targeting siRNA; negative control), and either 5, 10, or 20uM concentration of NP FL2 siRNA were applied topically to the mSTSG. Rechecks were performed twice a week for four week during which time digital images, non-invasive measurements, punch biopsies were acquired, and treatment was reapplied. Quantitative measurements include rate of reepithelialization and laser speckle imaging. Histopathology was assessed by a blinded pathologist.

Results

All wounds reepithelialized within 28 days post-grafting without infection. There was a positive trend with increasing concentration of NP FL2 siRNA on the burn wound healing. LSI data showed no statistical differences to vehicle control. Pathology analysis is ongoing.

Conclusions

Topical application of NP FL2 siRNA did increase the rate of reepithelialization of large ratio mSTSG treated full-thickness injuries. Additional pilot animals are currently ongoing to down-select siRNA dose for future studies comparing the experimental treatment to the current clinical gold standard 1:1.5 mesh ratio.

Applicability of Research to Practice

A topical gene therapy treatment combined with a higher meshing ratio to improve current treatment modalities by increasing reepithelialization and decreasing multiple donor site harvesting.
653 Capillary Suction Device-a Novel Approach to Negative Pressure Wound Therapy
Authors: Babcock George F , Chatterjee Ranjit , Riddle Tara
Published: March 2020

Introduction

Negative Pressure Wound Therapy (NPWT) is a well-established procedure used for non-healing wounds including burn wounds. In NPWT, a special sealed dressing of large cell foam (>400 µm) or gauze is connected to a pump. The sealed dressing acts as a conduit to pressure transfer and aids in the passive flow of fluid. Most commonly, negative pressures between -10 and -125 millimeters of mercury (mm Hg) are used. The mechanism of healing is unknown but maybe due to removal of the exudate and bacteria, and the stimulation of tissue repair through micro deformation. Reticulated foams with micron-size open cells (100 to 5µm) exerts capillary suction between 10 and 60 mm of Hg with a multilayered foam dressing. The negative pressures produced are within the range of suction by mechanical pumps. Therefore, the long-term goal our research is to examine effectiveness of Capillary Suction Devices (CSD) as a topical device in both preventing and healing complicated wounds, burn and donor site wounds. Our hypothesis is that CSD is an effective, safe and lower cost alternative to vacuum-assisted NPWT.

Methods

Yorkshire pigs received 4 surgical posterior excision wounds, measuring 2 in. by 2 in. The wounds were covered with a NPWT dressing (110 mm Hg negative pressure by a pump), CSD with capillary suctions of 30 mm Hg (CSD-30) and 60+ mm Hg (CSD-60), and a conventional gauze dressing. The wounds were measured on 2 day and then every 4 to 5 days until wounds closed. We also measured and compared the total fluids collected with each dressing.

Results

By post-wound day 20, the wounds treated with CSD-60 and NPWT were 100% closed while the wounds treated with CSD-30 and gauze were 65 and 45%, respectively. This indicated comparable wound closure efficacies for CSD-60 and NPWT. The CSD-30 product was superior to gauze, but less efficacious than the tested NPWT protocol. The average total fluid uptake measured in grams dry weight were similar for CSD-60 and NPWT, 36 and 38g., respectively while the values were 24g for CSD-30 and 12g for gauze. However, the maximum fluid uptake observed at day 2 indicated that CSD-60 and CSD 30, 24 and 14g respectively, were superior to NPWT and gauze 12 and 7g respectively.

Conclusions

This data indicates comparable wound closure efficacies for CSD-60 capillary suction and NPWT. The CSD product with 30 mmHg suction was superior to gauze, but less efficacious than NPWT or CSD-60 protocol. The study results provide impetus for further research on the use of high suction CSD for replacement of pump mediated NPWT and the moderate suction CSD for preventing progression of high-risk wounds to an ulcerous stage.

Applicability of Research to Practice

This small study suggests that CSD maybe alternative in to NPWT. CSD provides a significant cost and weight advantage to the patient, as well is allowing for increased mobility.
662 Clinical Outcomes from Prospective Randomized Trials on the Proportion of Carbohydrates versus Fat in Enteral Nutrition for Burn Patients
Authors: Shields Beth A , Pruskowski Kaitlin A , Aden James K , Basel Anthony , Britton Garrett W , Cancio Leopoldo C
Published: March 2020

Introduction

Multiple organizations have developed guidelines for nutritional support following burn trauma. These guidelines are based on low levels of evidence and largely on expert opinion. We sought to compile randomized controlled trials (RCTs) evaluating clinical outcomes from carbohydrate versus fat in enteral nutrition (EN) for burn patients and then analyze outcomes via meta-analysis and compare these outcomes to current available guidelines.

Methods

We performed a literature search to identify RCTs evaluating outcomes of burn patients with different proportions of carbohydrate versus fat interventions. Meta-analyses were conducted on outcomes reported by more than one RCT with the DerSimonian and Laird random effects model. Statistical significance was established at α less than 0.05. Meta-analysis results were then evaluated alongside the available guidelines from American Society for Parenteral and Enteral Nutrition (ASPEN) and Society of Critical Care Medicine (SCCM), the European Society for Parenteral and Enteral Nutrition (ESPEN), and the International Society for Burn Injury (ISBI).

Results

We identified 3 studies meeting our inclusion criteria for RCTs. Meta-analysis showed lower fat, higher carbohydrate EN to be associated with lower incidence of pneumonia (p=0.0005) as well as a reduction in mortality (p=0.04). The ASPEN/SCCM and ISBI guidelines do not specifically address this topic. ESPEN recommends less than 60% carbohydrates and less than 35% fat. However, this is not in accordance with the 46–65% carbohydrate and 12–27% fat with favorable outcomes studied in the 3 identified RCTs.

Conclusions

As current guidelines are often not based on high levels of evidence, it was important to collect and evaluate all of the available RCTs. Our meta-analysis results of these RCTs demonstrated mortality benefits with lower fat, higher carbohydrate EN in burn patients. Additionally, we found lower rates of pneumonia with lower fat, higher carbohydrate EN.

Applicability of Research to Practice

Consideration should be made for 12–27% fat, 46–65% carbohydrate EN in burn patients; however, multicentered trials are required before strong recommendations can be made.
664 Risk Factors for the Development of Transaminitis in Pediatric Burn Patients Treated with Oxandrolone
Authors: Pape Kate , Zavala Sarah , Gayed Rita , Reger Melissa , Jones Kendrea , Kiracofe Brittany
Published: March 2020

Introduction

Oxandrolone is an anabolic steroid that is the standard of care for burn patients experiencing hypermetabolism. Previous studies have demonstrated the benefits of oxandrolone, including increased body mass and improved wound healing. One of the common side effects of oxandrolone is transaminitis, occurring in 5–15% of patients, but little is known about associated risk factors with the development of transaminitis. A recent multicenter study in adults found that younger age and those receiving concurrent intravenous vasopressors or amiodarone were more likely to develop transaminitis while on oxandrolone. The purpose of this study was to determine the incidence and identify risk factors for the development of transaminitis in pediatric burn patients receiving oxandrolone therapy.

Methods

This was a multicenter, retrospective risk factor analysis that included pediatric patients with thermal burn injury (total body surface area [TBSA] > 10%) who received oxandrolone over a 5-year time period. The primary outcome of the study was the development of transaminitis while on oxandrolone therapy, which was defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >100 mg/dL. Secondary outcomes included mortality, length of stay, and change from baseline ALT/AST.

Results

A total of 55 pediatric patients from 5 burn centers met inclusion criteria. Of those, 13 (23.6%) developed transaminitis, and the mean time to development of transaminitis was 17 days. Patients who developed transaminitis were older (12 vs 6.4 years, p = 0.01) and had a larger mean %TBSA (45.9 vs 34.1, p = 0.03). The odds of developing transaminitis increased by 23% for each 1 year increase in age (OR 1.23, CI 1.06–1.44). The use of other concurrent medications was not associated with an increased risk of developing transaminitis. Renal function and hepatic function was not associated with the development of transaminitis. There was no significant difference in length of stay and mortality.

Conclusions

Transaminitis occurred in 23.6% of our study population and was associated with patients who were older and had a larger mean %TBSA burn. Older pediatric patients with larger burns who are receiving oxandrolone should be closely monitored for the development of transaminitis.

Applicability of Research to Practice

Future research is needed to identify appropriate monitoring and management of transaminitis in oxandrolone-treated pediatric burn patients.
668 Early Enteral Nutrition in Geriatric Burn Patients: Is There a Benefit?
Authors: Castanon Lourdes , Hanna Kamil , Asmar Samer , Ditillo Michael F , Gries Lynn , Bible Letitia , Douglas Molly , Joseph Bellal
Published: March 2020

Introduction

Nutrition is a critical component of acute burn care and wound healing. There is no consensus over the appropriate timing of initiating enteral nutrition (EN) in geriatric burn patients. The aim of our study was to assess the impact of early EN on outcomes in geriatric burn patients. We hypothesized that early EN is associated with improved outcomes.

Methods

We performed a 2-year (2015–2016) analysis of the ACS-TQIP and included all older adult (age ≥65years) burn patients who received EN. Patients were stratified into two groups based on timing of initiation of EN: Early-EN (< 24 hrs) vs. Late-EN (≥ 24 hrs). We performed propensity score matching (1:2 ratio) to control for possible confounding variables including demographics, comorbidities, injury parameters, height and body weight. Outcome measures were in-hospital; complications, hospital and ICU length of stay, and mortality.

Results

A total of 593,818 trauma patients were analyzed, of which 447 patients were matched (Early-EN: 159 vs Late-EN: 318). Mean age was 44±22, 75% were males, and median ISS was 29 [26–36] and mean total body burn surface area (TBSA) was 15±5%. There was no significant difference between the two groups in terms of age (p=0.99), gender (p=0.60), race (p=0.91), ISS (p=0.43), GCS (p=0.85), TBSA (p=0.51), height (p=0.71), and weight (p=0.61). Overall, the complications rate was 40%, median hospital LOS was 25 [15–36] days, median ICU LOS was 15 [8–26] days and mortality rate was 16%. Patients in the early ED group had significantly lower rate of complications and mortality Table 1. At the same time, patients in the early group had lower hospital length of stay (23[12–36] vs. 26[16–38], p=0.013) and ICU length of stay (12[8–24] vs. 16[8–26], p=0.025).

Conclusions

In our propensity matched cohort of geriatric burn patients, early EN was associated with improvement in outcomes. The cumulative benefits observed may warrant incorporating early EN as part of intensive care protocols.

Applicability of Research to Practice

Geriatric patients are a special subset of the population that require additional considerations. Our research highlights the impact of early enteral nutrition on different in hospital outcomes. This is an area of constant debate, our study shows that early enteral nutrition in geriatric burn patients is associated with improved outcome. We found this applicable in most of our patients and thus it might warrant further incorporation in ICU burn protocols.
756 Homeless and Burned – A Retrospective Analysis of an Especially Challenged Patient Population
Authors: Chandramouli Mathangi A , Heffernan Jamie , Rabbitts Angela , Chang Philip
Published: March 2020

Introduction

The undomiciled burned patient presents more challenges to the burn team with regards to safe disposition. Discharge planning is complicated by the lack of a safe, clean environment to perform requisite wound care, thus prolonging hospital stays. The purpose of our study was to analyze the homeless patients admitted to a major urban burn center. This data would then better help identify trends and characteristics that could inform development of support services for this unfortunate population.

Methods

Demographic and clinical data from inpatients was collected from a single urban ABA verified burn center over a 3 year period between 1/2016 and 12/2018. Simple descriptive statistical analysis was performed.

Results

1985 patients were admitted over the 3 year period. 48 homeless patients were identified (2.4%). The average age of this population was 39.8±16.8 years (range 3 months to 63 years old). There were 5 children (10.4% of the homeless cohort) in this population (ranging from 3 months to 4 years of age). Only 2 homeless burn inpatients were greater than 60 years of age (2% of the homeless cohort).

There were 15 females (31%) and 33 males (69%).

The mean TBSA was 5.8±9.9%. The average length of hospital stay was 21.9±29 days. 27 of the 48 patients (56%) required operative treatment. The 3 most common etiologies of skin injury were flame burns (29%), scald burns (25%), and cold injury (19%). The vast number of patients (39 out of 48, 81%) were discharged back to “their previous condition” (i.e. homeless shelter or the streets). There was 1 mortality in this group.

Conclusions

Contrary to widespread assumptions about the homeless being overwhelmingly male and adult, a significant percentage of the homeless burn patients were female with a percentage of patients being pediatric as well. The length of stay was significantly longer for most patients given the relatively small average size of burn injury. Cold injury was more significant etiology in this population compared to the overall burn population.

Applicability of Research to Practice

This analysis of the undomiciled burn inpatient at a single urban burn center will help better describe this especially challenging population and help focus social support and discharge planning resources for this group.
776 A New Outcome Metric for Young Children with Burns: Item Pool Development for the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Computer Adaptive Test (CAT) Profile
Authors: Grant Gabrielle G , Brady Keri , Stoddard Frederick , Meyer Walter , Romanowski Kathleen S , Chang Philip , Painting Lynda E , Fowler Laura , Nelson Judith , Sheridan Robert , Warner Petra , Palmieri Tina L , Schneider Jeffrey C , Kazis Lewis , Ryan Colleen M
Published: March 2020

Introduction

The assessment of recovery from burn injury is critical to improving pediatric health. However, there is a lack of brief, burn-specific measures to assess preschool-aged burn survivors’ health outcomes. We developed items pools for a new, parent-reported computer adaptive test based assessment of preschool-aged children’s burn outcomes.

Methods

Initial item pools were informed by the Preschool LIBRE Conceptual Model based on the International Classification for Children (ICF) and the Burn Outcomes Questionnaires (BOQ 0–5) and generated from a review of existing instruments assessing health and developmental outcomes in children 1–5 years. Candidate items underwent a review process to bin items together based on the underlying construct they assessed. Items were then winnowed down and further refined based on clinical expert consensus meetings. The winnowing process focused on ensuring items assessed abilities and behaviors that could be reliably determined by parent report, were age-relevant, and focused on health and developmental concepts that are important in the assessment of children’s burn recovery. To ensure item quality, we conducted parent cognitive interviews. In final reviews, we standardized item recall periods, response options, verb tense, and literacy demands.

Results

A total of 9,509 items were identified and extracted. Four item pool domains were established: communication and language development (42 items), physical functioning (53 items), psychological functioning (56 items), and social functioning (37 items). The respective item pools aim to assess: children’s ability to receive meaning and produce language; children’s gross and fine motor abilities; children’s emotions and behavior (internalizing and externalizing behaviors, dysregulation, toileting, response to trauma and resilience); and children’s social participation and abilities. Recall period and response options were refined for consistency for all 188 final items.

Conclusions

Four item pools were developed assessing four domains 1) communication and language development, 2) physical functioning, 3) psychological functioning and 4) social functioning for preschool-aged children. The item pools are currently being field-tested for the calibration and validation of the Preschool LIBRE CAT Profile.

Applicability of Research to Practice

This work is relevant to researchers and practitioners evaluating the effects of burn injury on preschool-aged children’s health and developmental outcomes.
787 Burn Resuscitation Critical Reflective Practice
Authors: Schoonard Jennifer , Lee Jeanne , Strait Eli , Cabrera Jeremy , Garner Jen
Published: March 2020

Introduction

The Burn Resuscitation Critical Reflective Practice (CRP) was started as collaborative meetings to review 1st 48 hours of admission for burn resuscitations (resus) October 2018- July 2019. All multi- disciplinary teams were invited.

The problem identified was on average burn resus patients (>20% TBSA) were being over resuscitated in 1st 24 hours of admission.

The goals of the CRP were: 1) Decrease resus fluid in the 1st 24 hours; 2) Increase knowledge of the current fluid resus pathway; 3) Increase communication with interdisciplinary teams during the resus.

Methods

CRP initiated in October 2018. 6 CRPs were held October 2018- July 2019.The average ml/ KG/ TBSA prior to CRP from January 2017- September 2018 was 5.17ml/kg/TBSA (goal: < 4ml).

Chart reviews were done to gather data from each resus (i.e. urine output, fluids, labs, events). Discussions held with staff involved in the 1st 24 hours of resus regarding any communication/process issues.Patient data was presented & staff members present would discuss questions/ issues that came up during the resus.

Multi-disciplinary teams surveyed prior to CRP to assess comfort/competence with current resus pathway and communication. 46 surveys received prior to initiating CRP. After initiating CRP October 2018- July 2019, staff members that had attended >1 CRP were post-surveyed.

Results

January 2017- October 2018 average ml/ KG/ TBSA was 5.17ml/kg/TBSA. October 2018- July 2019 POST CRP implementation, the avg ml/ KG/ TBSA was 3.86 ml LR/ kg/ TBSA in 1st 24 hours of resus.

3 new practices were implemented 1) Decrease fluids by 200ml/hr (instead of 100) when UOP is >100/hr at least 2 hours into resus; 2) Double sign by 2 RNs required when calculating Parkland Formula; 3) Guideline created to guide communication between Burn RNs & trauma bay when burn resus arrives.

Post- survey data showed increase in comfort communicating with physicians regarding resus & increase in comfort/confidence in calculating Parkland Formula. 2 additional subjective questions were added onto the post- CRP survey.

Conclusions

Fluids given in the 1st 24 hours decreased from 5.17 to 3.86 average ml/ kg/ TBSA post- CRP. 3 new practices were implemented as discussed in results. Staff felt more comfortable communicating with team & calculating Parkland formula. Staff had positive responses on the post- survey.

Applicability of Research to Practice

The monthly CRPs are to be continued to discuss all burn resus patients received during the prior month. Allows team members to continue to modify practice as needed by what’s learned through each CRP to help better our patient outcomes and decrease overall resus fluids.
796 Use of a Synthetic Matrix Instead of Allograft for Temporizing a Major Burn
Authors: Burton Timothy , Wenta Samantha , Savetamal Alisa
Published: March 2020

Introduction

Cryopreserved cadaveric skin allograft is often used in our burn center as a temporary covering after burn excision. While allograft affords many benefits for the burn wound, it also often fails to engraft, particularly in large burns, thus requiring a return to the operating room for exchange. We report here our experience with using a synthetic dermal matrix in two patients with large burns. Using a synthetic dermal matrix has allowed the safe management of a large burn with decreased need to return to the operating room for allograft exchange.

Methods

A retrospective chart review was undertaken of two patients, who presented sequentially to the burn unit. Both patients were male, in their 30s, and otherwise healthy. Each had sustained 55% TBSA burns; the lower extremities of both were deeply injured (deep partial- and full-thickness). In each patient, the left leg was treated with the institution’s standard of excision, allografting, allograft exchange, and then split-thickness skin grafting. The right leg after excision was placed at least partially in a synthetic dermal matrix with a smaller area of allografting as needed. The time from application of the dermal matrix to delamination and split-thickness skin grafting of the right leg was noted.

Results

In patient #1, the time from matrix application to delamination and STSG was 31 days. In patient #2, it was 26 days (see Table 1). Patient #1 had 4446cm2 of matrix applied, while 2268cm2 were used in patient #2. For both of these patients, the right leg was largely left undisturbed during this time, while the left leg underwent allograft exchange and split-thickness skin grafting. Had these patients’ right legs required allograft exchange once weekly, the use of allograft (which is provided in 232cm2 packages) would have been much higher. Patient #1 would have required roughly 20 units of allograft every week for 5 weeks (100 units total). Patient #2, with half the area and a slightly quicker time to grafting, would have required 40 units in total. A substantial cost savings in allograft was realized by use of this matrix and does not include the operating room costs saved.

Conclusions

Application of a synthetic dermal matrix to a well-excised burn wound can allow for decreased use of allograft in large burns, where allograft is traditionally applied and exchanged as a temporizing measure. This can result in a significant decrease in product use, the operative time spent exchanging these allografts, and the patient blood loss that inevitably accompanies allograft exchange.

Applicability of Research to Practice

Synthetic dermal matrix can be safely and effectively used for coverage of large burns, with significant cost savings compared to use of cadaveric skin.
838 An Economical Alternative to Static Progressive Splinting of the Elbow
Authors: Siwy Katherine G
Published: March 2020

Introduction

A common musculoskeletal complication of burn trauma are elbow extension contractures which can have disabling effects on both daily living skills and leisure activities. One intervention which is used by Therapists to maximize active range of motion in these cases are static progressive splints. The benefit of static progressive is providing a continued gentle stretch, which is adjustable, to maximize length of connective tissues and improve joint pliability. These types of splint can be custom made or purchased commercially to the cost of the patient. Commercially provided static progressive splint are costly for the patient and are not efficient in capturing end range extension. Traditional static progressive splint patterns do not allow for the patient to provide the adjustable force rather, the therapist remodels the splint as range of motion gains are achieved. The “I” splint was created to allow for the patient to provide a static progressive low load adjustable force and range of motion while using the splint over the course of thirty minutes.

Methods

The splint is fabricated from therma plastic material. The standard anterior elbow extension splint pattern is made thought with a midline window. (Photo 1). When modeling the splint, the therapist positions the boarders of the splint higher than the upper extremity as this will act as the level arm for the adjustable force. Three straps are attached (photo 2). Distal at the wrist, proximal at the elbow and midline at the elbow. The elbow strap attached to the medial board, cups the posterior elbow and is fed inside the lateral board, then pulled up and over th boarder. This positioning transmits the upward force to gain extension. As the stretch decreases, the strap is pulled more tightly, allowing for increased elbow extension. The elbow comes up and through the window. Goal is for the patient to use 3 times per day for 30 minutes each session followed by exercise or functional activities which engage improved connective tissue length.

Results

There are many benefits from the use of the “I” splint pattern. The splint is able to be fabricated during 1 therapy session and be used immediately. The therapist only bills one orthotic charge and splint charge vs a costly rental and purchase price for the patient. The window design allows for greater adjustability of force able to capture fluctuations with stiffness and pain without fabricating another splint. The splint is lighter weight and easily portable.

Conclusions

The “I” splint design is a effective, efficient and economic intervention to treat elbow extension contractures.

Applicability of Research to Practice

Further research needs to be done to investigate range of motion gains and time to makes gains, effects on functional outcomes, cost benefits analysis with the “I” splint design for the patient and Health Care Systems.
843 A Study on Changes of Pancreatic Structure and Function After Severe Burns and Its Mechanism
Authors: Shen Chuanan , Li Dawei
Published: March 2020

Introduction

This research was to explore the changes of pancreatic structure and function after severe burns and its mechanism.

Methods

A scald model of rats with a 50% total body surface area was established. Rats were injected with bpv (hopic, 0.6 mg/kg) subcutaneously once daily post scald creation. Rats’ fasting blood glucose (FBG) and serum insulin concentration were measured to calculate the insulin resistance index at 72 h post injury. Western blot assay was used to measure the content of p-Akt and t-Akt in pancreatic tissue and observe Akt phosphorylation levels. Paraffin sections and electron microscopic sections of pancreatic tissue were prepared for observation under light and transmission electron microscopy. The number of insulin particles and insulin vacuoles attached to per 10 μm of the cell membrane in β cells were calculated.

Results

Scalds increased FBG and impaired glucose tolerance significantly in the rats. Bpv could reduce blood glucose and improve glucose tolerance remarkably. Western blot assay revealed that the activity of PI3k/Akt pathway in rats’ pancreas decreased after scalding, and bpv could up-regulate its activity. The number of insulin particles attached to to per 10 μm of the cell membrane in β cells was reduced, and the proportion of insulin vacuoles was increased, indicating that rats’ insulin secretion function was impaired. After treatment with bpv, rats’ insulin secretion function was improved.

Conclusions

The activity of PI3k/Akt pathway in scalded rats’ pancreas is reduced and the insulin secretion function is decreased. Improving the activity of PI3k/Akt pathway in rats’ pancreas may improve the insulin secretion function and restore physiological blood glucose levels during the early stage after scalding.

Applicability of Research to Practice

This research may be applicable in practice in the future to regulate the metabolism of burn patients.
Preoperative radiotherapy improves overall survival of pT4 pancreatic ductal adenocarcinoma patients after surgical resection
Authors: Xu Yaolin , Zhang Yueming , Wu Zizhen , Wang Dansong , Wu Wenchuan , Kuang Tiantao , Lou Wenhui
Published: March 2020

Objective

The aim of delivering radiotherapy for pancreatic ductal adenocarcinoma patients was to sterilize vessel margin, increase R0 resection rate and delay local progression. Whether preoperative radiotherapy could prolong overall survival of surgical candidates remained unknown.

Methods

Pancreatic ductal adenocarcinoma patients receiving radical resection from surveillance, epidemiology and end result database were enrolled. Propensity score matching was conducted to balance difference in baseline characteristics, and survival analyses were performed to compare overall survival between preoperative radiotherapy and upfront resection groups. Cox proportional hazard regression model and subgroup analyses were utilized to identify prognostic factors.

Results

A total of 11 665 and 597 pancreatic ductal adenocarcinoma patients receiving upfront resection and preoperative radiotherapy followed by resection from 2004 to 2016 were identified, respectively, while baseline characteristics were distinct between groups. After propensity score matching, preoperative radiotherapy was not associated with better overall survival (upfront resection vs preoperative radiotherapy, 26 vs 27 months). Subgroup analyses showed that preoperative radiotherapy was a protective factor in pT4 (hazard ratio = 0.64, 95% confidence interval: 0.47–0.88) but a negative predictor in pT1 (hazard ratio = 1.79, 95% confidence interval: 1.08–2.97) patient populations. Survival analyses showed that preoperative radiotherapy improved overall survival of patients with pT4 stage (upfront resection vs preoperative radiotherapy, 19 vs 25 months) and involvement of celiac axis, superior mesenteric artery and aorta (upfront resection vs preoperative radiotherapy, 20 vs 27 months), while preoperative radiotherapy was associated with worse overall survival in patients with pT1 tumor (upfront resection vs preoperative radiotherapy, 39 vs 24 months).

Conclusion

Preoperative radiotherapy could improve survival of resected pancreatic ductal adenocarcinoma patients with pT4 stage or with celiac axis, superior mesenteric artery and aorta invasion.
A fistulating incarcerated incisional hernia: a case report
Authors: Weledji Elroy P , Nana Theophile C
Published: March 2020

An incisional hernia is usually a defect in the scar of an abdominal surgery. The natural history is intestinal obstruction with the risk of strangulation. We report a case of a long-term conservative management of an incisional hernia with an abdominal corset. This resulted in fistulation from pressure necrosis that required an en-bloc excision of the incarcerated fistulating bowel with the hernia sac. The defect was managed using the Jenkin’s ‘mass closure’ technique with no recurrence of the hernia.
Greek Manuscripts in Alexandria
Authors: Houghton H A G , Monier Mina
Published: March 2020

Important manuscripts of the Greek New Testament and other early Christian writings are held by institutions in Alexandria. This report provides an update on the current location and identification of these documents, including the ‘Akhmim Fragment’ of the Gospel of Peter. It also gives preliminary information about four witnesses to the Greek New Testament which have now been added to the official register. These comprise a tenth-century catena manuscript of the Gospels (GA 2937) and three gospel lectionaries (GA L2477, L2478, and L2479).
Biofilm formation, adherence, and hydrophobicity of M. sympodialis, M. globosa, and M. slooffiae from clinical isolates and normal skinVirulence factors of M. sympodialis, M. globosa and M. slooffiae
Authors: Angiolella Letizia , Rojas Florencia , Mussin Javier , Greco Rosa , Sosa María de los Angeles , Zalazar Laura , Giusiano Gustavo
Published: March 2020

The genus Malassezia comprises a heterogeneous group of species that cause similar pathologies. Malassezia yeasts were considered as the most abundant skin eukaryotes of the total skin mycobiome. The ability of this fungus to colonize or infect is determined by complex interactions between the fungal cell and its virulence factors. This study aims to evaluate in vitro the hydrophobicity levels, the adherence capacity on a polystyrene surface and the ability to form biofilm of 19 isolates, including M. sympodialis, M. globosa, and M. slooffiae, from healthy subjects and from dermatological disorders. Cellular surface hydrophobicity levels were determined by two-phase system. The biofilm formation was determined by tetrazolium salt (XTT) reduction assay and by Scanning Electron Microscopy (SEM). Strain dependence was observed in all virulence factors studied. All isolates of M. sympodialis, M. globosa, and M. slooffiae demonstrated their ability to form biofilm at variable capacities. SEM observations confirmed a variable extracellular matrix after 48 hours of biofilm formation. All isolates of M. globosa were highly adherent and/or hydrophobic as well as biofilm producers. In contrast, M. slooffiae was the least biofilm producer. No significant differences between virulence factors were demonstrated for M. sympodialis, either as clinical isolate or as inhabitant of human microbiota. Results of this work together with the previous M. furfur research confirm that the most frequently Malassezia species isolated from normal subject's skin and patients with dermatosis, form biofilm with different capacities. The study of these virulence factors is important to highlight differences between Malassezia species and to determine their involvement in pathological processes.
The GOGREEN survey: the environmental dependence of the star-forming galaxy main sequence at 1.0 < z < 1.5
Authors: Old Lyndsay J , Balogh Michael L , van der Burg Remco F J , Biviano Andrea , Yee Howard K C , Pintos-Castro Irene , Webb Kristi , Muzzin Adam , Rudnick Gregory , Vulcani Benedetta , Poggianti Bianca , Cooper Michael , Zaritsky Dennis , Cerulo Pierluigi , Wilson Gillian , Chan Jeffrey C C , Lidman Chris , McGee Sean , Demarco Ricardo , Forrest Ben , De Lucia Gabriella , Gilbank David , Kukstas Egidijus , McCarthy Ian G , Jablonka Pascale , Nantais Julie , Noble Allison , Reeves Andrew M M , Shipley Heath
Published: March 2020

We present results on the environmental dependence of the star-forming galaxy main sequence in 11 galaxy cluster fields at 1.0 < z < 1.5 from the Gemini Observations of Galaxies in Rich Early Environments Survey (GOGREEN) survey. We use a homogeneously selected sample of field and cluster galaxies whose membership is derived from dynamical analysis. Using [$\rm{O{\small II}}$]-derived star formation rates (SFRs), we find that cluster galaxies have suppressed SFRs at fixed stellar mass in comparison to their field counterparts by a factor of 1.4 ± 0.1 (∼3.3σ) across the stellar mass range: 9.0 < log (M*/M⊙) < 11.2. We also find that this modest suppression in the cluster galaxy star-forming main sequence is mass and redshift dependent: the difference between cluster and field increases towards lower stellar masses and lower redshift. When comparing the distribution of cluster and field galaxy SFRs to the star-forming main sequence, we find an overall shift towards lower SFRs in the cluster population, and note the absence of a tail of high SFR galaxies as seen in the field. Given this observed suppression in the cluster galaxy star-forming main sequence, we explore the implications for several scenarios such as formation time differences between cluster and field galaxies, and environmentally induced star formation quenching and associated time-scales.
Observational estimate of the partial covering probability of quasar emission regions by distant H2 absorption clouds
Authors: Klimenko V V , Petitjean P , Ivanchik A V
Published: March 2020

We have searched high spectral resolution spectra of quasars known to exhibit high redshift (z > 1.7) intervening H2-bearing damped Lyman-α (DLA) systems for partial coverage of the quasar emission by intervening H2 clouds. Partial coverage manifests itself by the presence of non-zero residual flux in the core of saturated H2 absorption lines. The residual flux can be observed either only at the bottom of absorption lines redshifted on top of quasar emission lines, in which case part of the broad line region (BLR) is not covered, or in all absorption lines, in case some continuum source is not covered. Among 35 H2 absorption clouds in 14 quasar spectra obtained with the VLT-UVES or Keck-HIRES spectrographs, we detect partial coverage of the BLR for 13 clouds. This result suggests that the probability of partial coverage of the QSO BLR by a distant H2 absorption cloud is about 40 per cent. For four systems towards Q 0013−0029, Q 0405−4418, Q 0812+3208, and J 2100−0641, partial coverage is detected for the first time. We determine the theoretical probability of partial coverage of the BLR by a distant H2 cloud as a function of the ratio between the cloud and the BLR sizes. Using this model, we obtain an estimate of the characteristic BLR radius of $50^{+19}_{-23}\,\rm{light \,days}$. This is similar to the estimate of the BLR size obtained by reverberation-mapping analysis $({\sim}100\,\rm{light\, days})$.