bluuebunny/crossref_metadata_2025 huggingface dataset:
737 Treadmill Friction Hand Injuries in the Pediatric Patient
Authors: Abbas Paulette , Choe Mia , Ridelman Elika , Angst Beth A , Klein Justin D , Shanti Christina M
Published: March 2020

Introduction

Pediatric friction hand injuries are prevalent, likely due to the increasing presence of home exercise equipment. While friction injuries often appear deeper on initial assessment, not all are treated surgically during the acute phase. We sought to characterize our experience with outcomes based on acute (< 30 days) surgical intervention compared to delayed intervention.

Methods

Patients were queried from a single institution, verified pediatric burn center database. A retrospective chart review of pediatric patients (< 18 years) over a 5 year period was performed. Data collected included demographics, treatment methods (acute vs. delayed), dressing type, scar management, and follow-up. Outcomes included additional surgical and non-surgical adjuncts to treat the sequela of injury.

Results

Our institution treated 23 treadmill hand injuries over the 5-year period. There was a slight predominance of female (n=13, 57%) vs. male (n=10, 43%) patients. Median age at injury was 2 years (IQR 1–3). Thirteen patients (57%) sustained an injury equivalent to a second degree burn and ten (43%) to third degree. Injuries were initially treated with silvadene (n=14) and/or xeroform (n=21). Involvement of left and right hands were equally divided and all injuries involved the digits. The median number of digits involved was 2 (range 1–4). The most commonly injured digits were the middle and ring fingers (19 each). Average length of stay was 14 hours. All but one patient followed-up with a median number of 4 clinic visits. All of these patients were reported as healed at time of last follow-up. Median time to healing was 31.5 days (IQR 29 – 58).

Overall, 4 patients (17%) underwent acute surgical intervention with a median of 7 days from injury (IQR 1.75–13.5). Of these 4 patients, 2 (50%) required additional operations for scar management and 2 (50%) required non-surgical management. Of the 19 (83%) who did not undergo early surgical management, only 1 patient (6%) required a Z-plasty, 12 (63%) were managed with non-surgical intervention and 6 (31%) needed no further treatment after healing.

Conclusions

Pediatric friction hand injuries often affect multiple digits and lead to a median of 4 clinic visits. Our data suggest that early surgical intervention in this cohort did not minimize future surgical procedures or non-surgical management. Rather, delayed intervention appears to allow for fewer surgical procedures and similar non-surgical management. Larger studies are required to validate this finding; however, this data suggests that continued initial management with a combination of silvadene and xeroform may be a safe option.

Applicability of Research to Practice

Our study provides guidance in the evaluation and treatment of pediatric treadmill friction injury. This data supports delaying surgical interventions on these seemingly deep hand injuries.
761 Comparisons of Peer Supporters and Burn Patient’s Satisfaction with Peer Support Encounters
Authors: Henderson Tammy L , Joe Victor C
Published: March 2020

Introduction

Offering peer support to burn patients throughout the recovery process provides a sense of belonging and shared experiences that foster hope. Peer support connects survivors and their families and has been shown to have a positive impact for patients in inpatient and outpatient settings. Data is limited on the effects of providing support from both supporter and patient viewpoints, which setting is preferred, and if multiple visits are more beneficial than a single visit.

Methods

Satisfaction surveys were offered to all supporters and patients after each visit over an 11-year period (2007–17). Survey participation was voluntary and anonymous. Both supporter and patient surveys were scored on a 7-point Likert scale with five and six questions, respectively. Scores were compiled and reported as means with standard deviations. Comparisons were made between inpatient vs outpatient visits and single vs multiple visits. Data were analyzed by student’s t-test with significance defined as p < 0.5.

Results

There were 132 surveys collected from peer supporters (109 inpatient, 23 outpatient) and from 67 patients. Satisfaction for supporters and patients were consistently high in both settings (Table 1). Supporters’ desire to visit again were higher for the outpatient setting (p=0.03). There were no significant differences for supporters in single vs multiple inpatient visits. For patients, the lowest mean satisfaction score occurred in the single outpatient visit (5.77 ± 1.83). Comparing patients who had single vs multiple inpatient visits, mean scores for all questions except “questions answered” were higher for the latter though statistical significance was found only for “visit again” (p=0.01) and “good listener” (p=0.03).

Conclusions

Satisfaction overall is very high for peer support visits. However, burn patients preferred multiple visits in the inpatient setting while peer supporters preferred the outpatient setting.

Applicability of Research to Practice

More qualitative research is needed to explore why peer supporters may feel more comfortable in the outpatient setting and why patients appear to prefer multiple inpatient visits. Overall, patients are satisfied even with single visits from peer supporters.
770 Increasing Attendance in Parent Support Groups Through Creative Engagement
Authors: Stefan Julie , Magnuson Erica , Joe Victor C
Published: March 2020

Introduction

Engaging parents of pediatric burn survivors in support programs enhances children’s coping and self-esteem. A parent support group for pediatric burn survivors was created to address these issues, but participation was consistently low, with an average attendance of two. To increase attendance, the format of the program was modified to target the survivor as well as parental needs.

Methods

The program was created for burn survivors age 3 to 17 years and their parents. The pediatric module incorporated developmentally appropriate activities to engage pediatric burn survivors and siblings in therapeutic techniques to normalize their experience and provide expressive opportunities. Parents attended a parent support group, where facilitators encouraged expression of feelings connected to their child’s burn injury and developing strategies for supporting their child through daily life. The parent portion also fostered an opportunity for them to develop their own coping skills. A trained peer support volunteer attended the program to foster peer support. A survey gauging parental perception of their child’s coping and their own coping was developed and distributed to all parents at the end of the session.

Results

There were 29 attendees (11 adults and 18 children). Ten surveys were completed, but one was eliminated due to user error. The results were overwhelmingly positive and validated a need for parent support (see table). Most parent participants (78%) had never attended a burn survivor support program though all had previously attended survivor-related social events. All respondents indicated they wound attend this event again.

Conclusions

Engaging survivors and their families in recreational-based events appears to lead to higher attendance, as all participants had previously attended social events provided by the burn program. Parents may be more inclined to attend an event that focuses on their child’s needs rather than, or in addition to, their own. Additional programs are planned with a goal of quarterly meetings. Attendance and feedback will need to be tracked to corroborate the findings of this initial experience and foster the growth of a robust parental support program.

Applicability of Research to Practice

Providers of parent support groups need to be creative in developing formats that increase participation. Recreational activities alone do not foster coping skills and emotional support. Activities need to be created that support the psychosocial needs of pediatric burn survivors and their parents.
773 Do Physician Apparel, Posture and Familiarity Impact Adolescent Girls’ Engagement in Post-burn Medical Care?
Authors: Cartelli Lesia S , Sammons Ashley J , Stoycos Sarah A , Price Leigh Ann
Published: March 2020

Introduction

Pediatric burns require ongoing developmental adjustment to lifelong medical care. One well documented phenomenon, “white coat syndrome”, highlights the influence of physician status and medical settings on physiology, while data assessing patient perception of physician care highlights the importance of disarming power attributions by sitting at patient eye-level. The current qualitative report aimed to understand how adolescent patients engage with doctors and whether physician’s clothing, posture and white-coat influence willingness to engage.

Methods

As part of a 6-day therapeutic residential retreat for girls with burns, girls participated in three question-and-answer sessions with the retreat Medical Director, a burn reconstructive surgeon. In the first two sessions, the surgeon wore casual clothing and sat down in a circle with the girls. Session three, the surgeon wore a white coat and stood amongst the seated girls. Engagement with care was assessed via girls’ willingness to ask the surgeon medical care questions. Clinical quality assurance measures assessing nervousness and comfort with doctors were administered at baseline (T0) and post-second (T1) and third sessions (T2). Univariate t-tests were used to assess for mean differences across timepoints.

Results

Fifteen girls (range = 12–20 years old) attended and completed quality assurance questionnaires. Girls reported a significant reduction in nervousness from T1 (M = 2.70) to T2 (M = 1.60), t (9) = 2.54, p = .03, but no change from T0 to T1. Topics discussed included women’s health, scar revision for function vs aesthetic options and communication skills for conversing with medical professionals. Girls exhibited behavior consistent with increased comfort with the surgeon during the final session, as evidenced by spontaneous questions and candid discussion as the girls leapt from their chairs rolling up sleeves, pulling up pant legs and shifting their hair covering scars for a hands-on assessment.

Conclusions

Subtle shifts in physician apparel, posture and interaction may impact adolescent patient’s willingness to engage in their care via asking questions. Future research applying “white coat syndrome” theory to behavioral presentations and engagement with care may be warranted.

Applicability of Research to Practice

Future prospective quantitative research with a larger sample size may be warranted. Physicians treating adolescents who were burned as children may want to consider the formality of their clothes, white coat, stance and posture during initial encounters with patients in an attempt to increase patient comfort and engagement with care.
780 A Systematic Review and Meta-analysis of 30-day Readmission Rates Following Burns
Authors: Branski Ludwik , Tapking Christian , Hundeshagen Gabriel , Boson Alexis , Rontoyanni Victoria G , Kowalewski Karl-Friedrich , Kneser Ulrich , Hirche Christoph R
Published: March 2020

Introduction

Unplanned hospital readmissions in surgical areas account for high costs and have become an area of focus for health care providers and insurance companies. The aim of this systematic review is to identify the rate and common reasons for unplanned 30-day readmission following burns.

Methods

This study was performed following the PRISMA guidelines. Pubmed, Web of Science and CENTRAL databases were searched for publications without date or language restrictions. Extracted outcomes included 30-day readmission rate and reasons for readmission. Pooled 30-day readmission rate was estimated from weighted individual study estimates using random-effect models. Pooled estimates for risk factors are reported as odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of eight studies were included into qualitative analysis and six (four adults, two children) into quantitative analysis. The overall readmission rate was 7.4% (95% CI 4.1 - 10.7) in adults and 2.7% (95% CI 2.2 - 3.2) in children. Based on two studies in 112,312 adult burn patients, burn size greater than 20% total body surface area (TBSA) was not a significant predictor of readmission rate (OR 1.75, 95% CI 0.64 – 4.75; NS). The most common reasons were infection/sepsis, wound healing complications, and pain in both adults and children.

Conclusions

Unplanned readmissions following burns are generally low and appear more common in adults than in pediatric patients. However, only few studies are reporting on 30-day readmission rates following burns. Evidence is limited to support a significant association between greater burn size and higher readmission rates.

Applicability of Research to Practice

Since cost effectiveness and utilized hospital capacity are becoming an area of focus for improvement in health care, future studies should assess the risk factors of unplanned readmission following burns. Follow-up assessments and outpatient resources, even if not underlined by this data, could reduce readmission rates.
788 Improving Burn Camp Attendance: A Quality Improvement Study and Implications for Future Planning
Authors: Williford Desiree N , Tiani Alaina , Harrah Gabrielle N , Durkin Kristine , Leonard Linda , Hajduk Gina , Aballay Ariel , Duncan Christina
Published: March 2020

Introduction

Based on research showing the benefits of camp settings, our overnight, 5-day summer camp is designed to provide social support, acceptance, rehabilitation, and normative childhood experiences for our pediatric burn survivors (ages 7–17). Typical recreational activities (e.g., swimming, sports, crafts) and burn-specific programming (e.g., peer support discussions) are infused into camp. Despite this enriching opportunity, some individuals decide not to attend camp. The purpose of this quality improvement study was to better understand factors influencing decisions not to attend our summer camp and to identify strategies for overcoming these barriers to optimize attendance in the future.

Methods

Beginning in February 2019, we attempted to contact and interview 81 guardians of children who were eligible and invited to our summer camp but did not attend in 2017 and/or 2018. Attempts to contact were made via telephone by a trained burncamp staff member. Three attempts to contact were made per family unless otherwise reached. Our interview guide elicited reasons that led to their decision not to attend camp. Interviews were completed in approximately 30 minutes or less.

Results

Sixty-four contacts were unsuccessful, resulting in a 79% failure to contact rate. Only 17 individuals (21%) were successfully contacted. Thirteen caregivers (16%) completed the interview via telephone, while 4 (5%) refused to take part in the interview. Principal reasons for non-attendance included school attendance, parental beliefs about camp (e.g., child being away from home), other conflicting activities (e.g., other camps, vacations), and perceived lack of need for support (e.g., my child is doing well/does not need to go to a burn camp).

Conclusions

Despite the positive psychosocial outcomes observed among survivors who attend camp, large numbers of families and youth are not attending. While the purpose of the study was to explore factors influencing decisions not to attend camp, we also learned that it is important to address barriers to successfully contacting families. Challenges in planning the logistics of camp, specific strategies for engaging families over time, and ideas for addressing reported barriers to attendance (e.g., empowering well-adjusted survivors to attend to support others) will be discussed in this presentation.

Applicability of Research to Practice

Results from this quality improvement project have impacted camp planning and recruitment strategies. Findings may lead to increased enrollment rates and enhanced awareness of camp and its benefits.
794 Assessment of Nursing Knowledge and Preparedness for Nuclear Disaster
Authors: Grady Rich , Metivier Meghan , Prelack Kathrina , Ryan Colleen M
Published: March 2020

Introduction

In the event of nuclear incident, burn care teams are most likely to be called upon to respond. Yet, knowledge gaps exist related to nuclear disaster response. The primary objective of this study is to determine nurses’ baseline knowledge of preparedness for and treatment of victims of a nuclear event.

Methods

As part of a quality assurance initiative, we surveyed staff nurses in an acute pediatric burn facility to assess their knowledge of nuclear sources in the local area, preparedness for a nuclear event, and treatment of radiation exposure. Survey domains included a nursing self-assessment of knowledge base and comfort in treating victims of nuclear events, followed by questions assessing nursing knowledge of the proper response to nuclear fallout as well as treatment of symptoms to acute radiation exposure. Questions were provided in nominal category format (multiple choice, or true/false) and Likert scale. Data was summarized using frequencies and descriptive statistics.

Results

A total of 26 nurses responded to this survey. Their average number of years of experience in nursing was 22 years (range:1–43 years); 80% of participants had a baccalaureate degree or higher in nursing. Survey analysis revealed that 85% percent of participants reported not having had formal training in nuclear disaster response, and 65% reported being uncomfortable both in their knowledge base and their ability to provide care to patients with acute radiation exposure. Eighty percent reported not feeling able to treat victims of a major nuclear disaster. Only two nurses demonstrated a perfect score in questions related to response and treatment of radiation exposure. On average participants answered 68% of questions correctly. A large majority reported the need for more education.

Conclusions

A significant knowledge gap exists in proper response and treatment of nuclear disaster victims. Nurses in our facility report a lack of comfort in both their knowledge base and ability to treat these patients. Educational programming is needed and is being developed in our facility to improve competency and skill around nuclear disaster events.

Applicability of Research to Practice

Results of this survey will be used to develop educational programming in nuclear disaster response. A post education survey will be used to assess change in nursing knowledge and preparedness according to these initial findings.
802 Increasing Collaboration and Communication in Burn Resuscitations Through Education and Simulation
Authors: Castronovo Courtney , Smith David , Moynihan Holly
Published: March 2020

Introduction

Implementing the nurse driven burn resuscitation protocol on severely injured burn patients can often be intimidating to many nurses and there are many opportunities for mathematical errors.These errors have the potential to affect the patients’ fluid resuscitation and outcomes. Nurses often reported discomfort with navigating the protocol while stabilizing the patient.The aim of this inquiry was to see if offering and providing education to the intensive care unit (ICU) and emergency department (ED) nurses would increase their comfort levels initiating, and navigating our nurse driven modified parkland formula. Additionally, we hoped that by providing education to the ED nurses, this would lead to a smoother transition for patient hand-off by increasing collaboration among services.

Methods

Nurses were surveyed using a 5 point Likert Scale assessing comfort level prior to the education to obtain a baseline. Education was then implemented, and a follow up survey using the same scale was completed 3 months later to assess knowledge retention. Additionally, nurses were given similar practice questions as previously given in the simulation to assess application to practice.

Results

To date, we have had 14 nurses complete the education. Of those nurses, 2 were from the ED, and 14 were from the ICU. 57% of the nurses had less than 5 years of nursing experience. Of the respondents, there was a large increase noted in nurses comfort levels with accessing the burn admission resources, initiating the burn resuscitation protocol, and titrating the intravenous fluids based on hourly urine output based on the post survey results.

Conclusions

Continued education and evaluation is needed to determine if education sustains increased caregiver comfort levels, improves resuscitation outcomes, and enhances ED to ICU collaboration.

Applicability of Research to Practice

Research has shown that simulations for low volume, high acuity patient scenarios increase comfort levels of caregivers while enhancing collaboration, and communication. A study explored the effect of burn specific simulations on patient safety and nursing education. This study concluded that simulations had a profound effect on improving these two factors by practicing technical and communication skills (D’Asta, Homsi, Sforzi, Wilson, & Luca, 2019)

D’Asta, F., Homsi, J., Sforzi, I., Wilson, D., & Luca, M. D. (2019). “SIMBurns”: A high-fidelity simulation program in emergency burn management developed through international collaboration. Burns, 45(1), 120–127. doi: 10.1016/j.burns.2018.08.030
809 Culture Change in the Burn Unit: A Comprehensive Pressure Injury Reduction Strategy
Authors: Werthman Emily h
Published: March 2020

Introduction

In our regional burn center, which treats approximately 800 patients annually, the prevention of pressure injuries continues to challenge the burn team. The nursing team, in particular, was demoralized by a steady prevalence rate despite utilizing evidence based practice. A comprehensive pressure injury reduction plan was developed to provide new strategies to prevent pressure injuries and to provide real time data about the effectiveness of nursing interventions.

Methods

A team of physicians, nurses, nutritionists, pharmacists, physical and occupational therapists developed a plan to encourage all members of the team to become active participants in pressure injury prevention. The first method was the introduction of a weekly pressure injury survey for all burn patients. This survey ensures any emerging pressure injury is recorded and appropriate interventions taken. Secondly, a new pressure mapping device was installed in all ICU beds in the burn center. The pressure mapping device provides data to nurses during patient repositioning. This important data demonstrated to nurses, in real time, if their offloading was effective. Lastly, a weekly pressure injury analysis provided root cause analysis of any pressure injuries discovered in weekly surveys. As a result, nurses were provided real time feedback about the effectiveness of prevention techniques.

Results

Reporting of pressure injuries increased over 50% in the first year of the program. In addition, since the inception of the weekly prevalence surveys, the burn center has not not had a pressure injury progress past a stage two. The overall prevalence of pressure injuries has dropped each quarter,

Conclusions

Providing nurses with real time feedback in the form of real time full body pressure mapping, weekly prevalence and pressure injury analysis allows nurses to quickly change prevention techniques to better offload patients. While pressure injury rates have decreased, nurse involvement in pressure injury prevention has increased.

Applicability of Research to Practice

Pressure injuries continue to pose a significant challenge to burn patients. Given the continuing emergence of pressure injuries, nurses in our burn center were left demoralized and dissatisfied with their evidence based practice. Providing nurses with real time data to support the effectiveness of their prevention techniques has dramatically changed the culture in our burn center. Nurses are now able to view real time data about their practice through pressure mapping, weekly surveys and pressure injury cause analysis. As a result, nurses are more engaged in the important work of pressure injury prevention.
830 Voice Activated Tool: A Successful Assistance for Patients with Limited Hand Function
Authors: Thomas Mini , Chung David , de La Cruz Christopher
Published: March 2020

Introduction

Burn survivors require significant assistance in physical functions and independence during their recovery and rehabilitation phase. Amputation, splints, bulky dressings, and pain attribute to limited or lack of hand mobility. Voice activated tools (VAT) have rapidly grown in popularity including in healthcare. Prior to the implementation of this project, patients mostly depended on soft touch call lights which were suboptimal for most patients. We piloted VAT to assist in hand functions of patients with limited or lack of hand mobility.

Methods

The project was piloted in collaboration with IT, Occupational Therapy, Nursing, and patients’ family. IT enabled with uninterrupted source of wireless network connection in the patients’ room. Voice assistance was incorporated both through mobile phone and an added virtual assistant tool. Patients’ personal devices were used to promote utilization of stored information in the device. Occupational therapist assisted in mounting the device through a spring clamp and gooseneck cell phone holder to visualize the device screen. Speech therapists, nurses, and patient family helped in training the patient to voice appropriate commands. The patient utilized VAT for a wide variety of purposes including calling nurses, ordering hospital meals, phone calls, music, web browsing, and more. A survey was done to evaluate health care team’s opinion on VAT usage.

Results

Of the total burn team members, 34 (77%) staff responded to the survey including physicians, nurses, therapists, and nursing assistants. All survey responders reported VAT as a useful tool to be offered to all future patients with limited hand mobility. Majority (74%) of responders witnessed or participated in the successful use of VAT during the pilot period. Survey participants reported three reasons for the current soft touch call light system to be suboptimal: 1.Too sensitive, 2. Not all patients can use it 3.

Conclusions

Voice activated tool can be successfully utilized for assisting patients with limited hand mobility considering the current available tool is suboptimal. Adoption of a simple and popular technology of VAT can be easily incorporated in hospitals through collaboration of health care team.

Applicability of Research to Practice

Use of VAT could be successfully implemented for other hospital units including paralyzed patients, blind, and patients with orthopedic conditions or trauma to hands. Additionally, VAT could be incorporated in to rehabilitation and home training of patients with limited hand mobility. Further, VAT could be considered in the designing and planning of hospitals.
834 Early Ambulation Initiative Following LE Grafts in Comparison to Our Center’s Traditional Standard of Care: A Retrospective Data Review
Authors: LePage Lisa , Jeffreys Danielle T
Published: March 2020

Introduction

Our ambulation guideline following LE grafting is loosely defined as bedrest vs. lateral transfers only until POD#5. Patient’s mobility status is increased POD#5 with WB per physician discretion. A proposal was created to initiate mobility earlier than POD#5 for patients with LE grafts. Two of our three surgeons were in agreement with the early ambulation protocol. The third surgeon wished to follow the traditional ambulation practice guideline. This request was respected and made known to all staff for carryover. This afforded us the opportunity of a comparison group with our center’s traditional standard of care functioning as the control group.

Methods

The proposed early ambulation protocol was influenced by evidence-based practice guidelines as well as surgeon input. Criteria was based upon the location of grafting, graft crossing a joint, size of wound being grafted (< or = 400 cm), and general medical status of the patient. Our early ambulation protocol was established as follows: POD#1 Lateral transfers with involved LE elevated. POD#2 Dependent LE at edge of bed, WBAT short distance ambulation to chair or bathroom with AD. POD#3–4 Increase ambulation as tolerated, assess need for continued splinting, appropriateness of progressive ambulation, AROM exercises. POD# 4–5 Progress ambulation with AD as needed, stairs as needed for discharge, home exercise program. Our inclusion criteria consisted of patients of any age, LE burns with STSG not involving joints/involving joints with appropriate immobilization. Exclusion criteria consisted of fractures of involved LE, patients who were non-ambulatory at baseline, wounds >400 cm2, STSG to plantar aspect of foot, medically unstable patients, and surgeon discretion.

Results

Data reviewed over an eight month period of time yielded 27 patients who met our established criteria; 26 had no graft loss on the first dressing change. The patient with graft loss was attributed to graft placement directly over bone of the distal phalanx. Comparatively, no loss was noted in the control group with 10/10 patients ambulating on POD#5. Of note, early ambulation was granted for several patients with larger surface areas with no graft loss demonstrated, but were not included in this study.

Conclusions

In conclusion, 96% of patients demonstrated no graft loss with first dressing change following our early ambulation guideline. All patients who followed the traditional ambulation guideline demonstrated no graft loss on the first dressing change. Based on our findings, early mobility is not detrimental to graft integrity following specific established guidelines.

Applicability of Research to Practice

Our data supports early mobility of LE grafting up to 400 cm2 with 96% success rate. This may be supportive of further research with early mobility involving a larger surface area of LE STSG.
837 Clinical Experience Using Functional Outcome Measures in the Outpatient Burn Center
Authors: Boals Melissa , Curtis Lisa , Cochran Amalia , Bailey John Kevin , Coffey Rebecca
Published: March 2020

Introduction

For patients with severe burns, the emphasis has shifted from survival to maximizing functional outcomes. Outcome measures are tools that help establish a baseline status and monitor progression towards meaningful tasks such as activities of daily living (ADLs) and mobility (Staley et al. 1996). The goal of this retrospective study is to describe the use of functional outcome measures in burn patients in an outpatient setting using standardized measures.

Methods

A retrospective chart review of burn patients seen in the outpatient burn clinic between February 1, 2017 and May 31, 2019 was conducted. Only patients seen for burn injury, treated as outpatients, and with functional outcome measures recorded were included in the study. Pertinent demographic and clinical data were collected as well as outcome measures. All patients had grip strength dynamometry performed. Patients with upper extremity and lower extremity burns were administered the The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Lower Extremity Functional Scale (LEFS). Return to work data was also collected if the patient was employed at baseline.

Results

A total of 113 out patients were included in the analysis. Mean age was 43 years (20–88 years) with a mean TBSA of 6.1% (0.1 -67%). The mean number of OT and PT visits in the clinic were both 1.4. Initial grip strength measurements were obtained in 67 patients at a mean of post burn day (PBD) 33 and an average grip strength of 21.29 kg (right) and 26.8 kg (left). Follow up grip strength measurements were obtained in 45 patients on mean PBD 43 with right hand 49.98 kg and left hand of 51.28 kg. Initial QuickDASH was administered to 89 patients on PBD 47 with a mean percent disability of 48.72 (0–100). Second QuickDASH was given to 45 patients on PBD 68 with a mean percent disability score of 37.01 (0 – 95.45) - Initial LEFS was given to 77 patients mean PBD 61 with a mean % of maximal function score of 44%. Second LEFS was given to 40 patients mean PBD 71 with a mean % maximal function score of 58%. Mean return to work for the 46 patients who were employed was 53.6 days post burn.

Conclusions

Positive improvements were shown in grip strength and lower extremity function, but a decline in function was demonstrated for upper extremity function. This decline may be the result of a nearly 50% attrition rate on follow up QuickDASH measures due to discharge of highly functional individuals, meaning the remaining upper extremity burn patients had more severe injuries and dysfunction.

Applicability of Research to Practice

Ongoing research is needed to identify the best timing of outcome measures and how to best incorporate this information into burn treatment plans.
841 Fractional CO2 Laser Increases in Vitro Intradermal Delivery of Vitamins in Human Skin
Authors: Dabek Robert J , Bojovic Branko
Published: March 2020

Introduction

The morbidity associated with burn scar contractures remains high globally. Minimally invasive interventions with lasers are capable of decreasing morbidity through a process of scar rehabilitation. Laser interventions have the added benefit of increasing the intradermal delivery of topically applied drugs. Many substances, including vitamins with known roles in the integument, remain largely untested for their ability to potentiate the scar rehabilitation response seen in laser treated scars. Here we tested the ability of a fractional CO2 laser to increase the intradermal delivery of topically applied vitamins A and C.

Methods

Discarded healthy human skin from surgical procedures was collected. Skin was treated with fractional CO2 laser with a density of 3% and 5%, each at 2 different energy settings. A formulation of vitamin A and C was applied immediately to the laser treated skin as well as an untreated control. The skin was placed into a preservation device allowing diffusion of nutrients to the cells. Punch biopsies were taken at 6 hours and 48-hours after application of vitamins. Biopsies were analyzed using ELISA for vitamin content at 6 and 48-hours. Biopsies at 48-hours were analyzed using RT-PCR for RNA expression of several key regulators of wound healing.

Results

The CO2 laser was an effective tool to enhance the intradermal delivery of vitamins. Higher laser energies and densities offered an increase in vitamin content.

Conclusions

Treatment of skin with a fractional ablative CO2 laser is an effective modality for increasing intradermal delivery of topical vitamins A, C, and E. These results are promising in the search for optimal minimally invasive therapies to treat hypertrophic scars, as well as other dermatologic conditions.

Applicability of Research to Practice

The preliminary in vitro research has demonstrated the efficacy of fractional CO2 lasers to deliver vitamins intradermally. Further studies are underway to analyze the therapeutic effect of post-laser topical vitamin application on burn scars in the clinical setting.
852 A Novel Approach to Treating Minor Burn Scar Contractures in Children Using Laser Surgical Cuts
Authors: Zuccaro Jennifer , Lati Jamil J , Lazzarotto Lisa , Kelly Charis , Fish Joel
Published: March 2020

Introduction

Minor burn scar contractures can be successfully treated with conservative approaches including Carbon Dioxide (CO2) laser therapy. While previous research has mainly focused on using the CO2 laser in a fractional mode to create a stamped pattern of holes (Figure A), less is known about how altering this pattern may affect the overall outcome of the contracture. Given this knowledge gap, our research group sought to investigate a new laser technique in which a series of lines, referred to as “laser surgical cuts,” are created across the length of the scar (Figure B). Thus, the aim of this pilot study was to evaluate the effectiveness of using this novel, laser surgical cuts technique to treat minor burn scar contractures in pediatric patients.

Methods

This prospective pilot study was carried out in the outpatient setting at our pediatric hospital. Only patients that had a minor burn scar contracture that crossed a joint on their palm and/or digits and who had consented to receive treatment with laser therapy were eligible to participate. Prior to treatment, a trained occupational and/or physiotherapist assessed each participant’s contracture by examining at least one of the following characteristics depending on the contracture’s location and extent of involvement: 1) range of motion (ROM), 2) digit length, 3) hand-span. Treatment consisted of one session of laser therapy during which surgical cuts were created across the length of the contracture followed by casting for approximately one week. Following cast removal, the initial contracture assessment was repeated and pre-post measures were compared.

Results

Seven patients participated in this study. All injuries were the result of contact burns and the mean age at assessment was 5.1 years. Overall, patients with flexion contractures (n = 4) experienced a mean improvement in ROM by 22.5° (SD 14.4). Patients with discrepancies in digit length (n = 4) experienced a mean improvement of 9.4% (pre = 5.3 cm, SD 1.6; post = 5.8 cm, SD 1.6) while those with discrepancies in hand-span (n = 3) experienced a mean improvement of 13.7% (pre = 14.6 cm, SD 3.4, post = 16.6 cm, SD 3.0).

Conclusions

We have shown that using the CO2 laser to create surgical cuts can improve minor contractures in burn-injured children. Further, we hypothesize that improvements in ROM, digit length, and hand-span are the result of a decrease in the mechanical tension across the contracture following treatment. Based on the positive findings obtained from this pilot study, a larger study with long-term follow-up is needed to determine if treatment with laser surgical cuts is more effective than using traditional, fractional CO2 laser settings.

Applicability of Research to Practice

Ultimately, if this novel laser technique is proven to be highly effective, the need for future contracture release surgeries may be reduced.
866 Meeting the Challenge of Analgesia in a Pregnant Woman with Burn Injury Using Subanesthetic Ketamine: A Case Report
Authors: Hughes William , Roy Akshay , Hughes Liam P , West Lindsay A , Schwenk Eric , Hughes Michelle K , Viscusi Eugene R
Published: March 2020

Introduction

Burn injury is the fourth most common form of trauma worldwide, requiring unique management considerations and a collaborative approach to treatment. Thermal injuries sustained during pregnancy add considerably to case complexity. Overall, there is a low incidence of burns in gravid women living in developed countries, making management guidelines in this patient population scarce. Despite few data, it is recognized that early intervention and inter-disciplinary treatment are critical to optimize maternal and fetal outcomes. Thus, interventions including fluid resuscitation, excision and grafting, routine debridement and dressing changes, antibiotic administration, and early mobilization are the cornerstones of management. Effective pain management is crucial in allowing patients to tolerate these often-painful procedures, engage in rehabilitation, and to prevent pain-related morbidity.

Methods

The patient is a 34-year-old G5P3013 in her third trimester of pregnancy, who sustained partial and full thickness burns to 18% of total body surface area in a grease fire. She was brought to the ED approximately 2 hours post-injury by EMS. During her hospital stay, Acute Pain Management Service (APMS) was consulted for a comprehensive pain management plan. APMS recommendations included IV acetaminophen, hydromorphone PCA, gabapentin, and ketamine infusion with a reduced dose bolus for procedural analgesia. Risks and benefits of these medications were explained to patient and her family by the APMS, Maternal-Fetal Medicine, and the Burn team, stressing the importance of tolerating routine burn care to decrease morbidity. Although human data are limited, it was explained that low doses (as outlined in our regimen) present little fetal risk in animal models.

Results

The patient was discharged at hospital day 11 and seen for burn follow-up after 2 weeks post-discharge (35 weeks gestation) with returning color, no evidence of hypertrophy, and overall excellent wound healing. Patient reported no pain, and her pain regimen was discontinued. Patient demonstrated significant improvement in her injuries, and had a normal spontaneous vaginal delivery of a live born male 7 weeks post discharge, with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. Additionally, the patient brought her infant to the office visit and conveyed that the child was consistently reaching pediatric milestones.

Conclusions

Ketamine may be considered as an adjunct for procedural and background analgesia during the third trimester, as part of a multi-modal strategy in a short-term, monitored setting after a thorough and complete analysis of risks and benefits and careful patient selection.

Applicability of Research to Practice

Procedural pain management in a third-trimester burn patient.
Fibroadenoma containing lobular carcinoma in situ, an unusual finding in a normally benign mass
Authors: Brock Christie M , Harper Charles , Tyler Troy
Published: March 2020

This is the case of a 27-year-old female who underwent breast lumpectomy for fibroadenoma of the left breast. Pathologic evaluation of the specimen revealed lobular carcinoma in situ (LCIS) entirely confined to a large fibroadenoma without LCIS in the surrounding breast tissue.
Surgical resection for advanced bisphosphonate-related osteonecrosis of the jaw associated with fibrous dysplasia: a case report
Authors: Murase Yurika , Kishimoto Koji , Yoshida Shoko , Kunisada Yuki , Kadoya Koichi , Ibaragi Soichiro , Sasaki Akira
Published: March 2020

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an adverse drug reaction represented by destruction and/or death of bone. Fibrous dysplasia (FD) is a rare bony disorder characterised by abnormal fibro-osseous tissue that has lowered resistance to infection. Effective treatments for BRONJ that follows FD are unclear. Here, we report that advanced BRONJ associated with FD was successfully treated by surgical resection. A 69-year-old woman, whose left maxillary bone showed a ground glass appearance on computed tomography (CT) images, was taking alendronate. At 1 year after teeth within the abnormal bone were extracted, exposed bone was observed in the extraction sites and CT images revealed separated sequestrums. Under the clinical diagnosis of Stage 2 BRONJ with FD, we performed not only sequestrectomy but also a partial resection of the FD. Thereafter, the healing was uneventful without recurrence. In conclusion, our case suggests that surgical resection is useful for advanced BRONJ associated with FD.
X-ray, UV, and optical time delays in the bright Seyfert galaxy Ark 120 with co-ordinated Swift and ground-based observations
Authors: Lobban A P , Zola S , Pajdosz-Śmierciak U , Braito V , Nardini E , Bhatta G , Markowitz A , Bachev R , Carosati D , Caton D B , Damljanovic G , Dębski B , Haislip J B , Hu S M , Kouprianov V , Krzesiński J , Porquet D , Pozo Nuñez F , Reeves J , Reichart D E
Published: March 2020

We report on the results of a multiwavelength monitoring campaign of the bright, nearby Seyfert galaxy Ark 120, using a ∼50-d observing programme with Swift and a ∼4-month co-ordinated ground-based observing campaign, pre-dominantly using the Skynet Robotic Telescope Network. We find Ark 120 to be variable at all optical, UV, and X-ray wavelengths, with the variability observed to be well correlated between wavelength bands on short time-scales. We perform cross-correlation analysis across all available wavelength bands, detecting time delays between emission in the X-ray band and the Swift V, B, and UVW1 bands. In each case, we find that the longer wavelength emission is delayed with respect to the shorter wavelength emission. Within our measurement uncertainties, the time delays are consistent with the τ ∼ λ4/3 relation, as predicted by a disc reprocessing scenario. The measured lag centroids are τcent = 11.90 ± 7.33, 10.80 ± 4.08, and 10.60 ± 2.87 d between the X-ray and V, B, and UVW1 bands, respectively. These time delays are longer than those expected from standard accretion theory and, as such, Ark 120 may be another example of an active galaxy whose accretion disc appears to exist on a larger scale than predicted by the standard thin-disc model. Additionally, we detect further inter-band time delays: most notably between the ground-based I and B bands (τcent = 3.46 ± 0.86 d), and between both the Swift XRT and UVW1 bands and the I band (τcent = 12.34 ± 4.83 and 2.69 ± 2.05 d, respectively), highlighting the importance of co-ordinated ground-based optical observations.
CDK12: cellular functions and therapeutic potential of versatile player in cancer
Authors: Pilarova Kveta , Herudek Jan , Blazek Dalibor
Published: March 2020

Cyclin-dependent kinase 12 (CDK12) phosphorylates the C-terminal domain of RNA polymerase II and is needed for the optimal transcription elongation and translation of a subset of human protein-coding genes. The kinase has a pleiotropic effect on the maintenance of genome stability, and its inactivation in prostate and ovarian tumours results in focal tandem duplications, a CDK12-unique genome instability phenotype. CDK12 aberrations were found in many other malignancies and have the potential to be used as biomarkers for therapeutic intervention. Moreover, the inhibition of CDK12 emerges as a promising strategy for treatment in several types of cancers. In this review, we summarize mechanisms that CDK12 utilizes for the regulation of gene expression and discuss how the perturbation of CDK12-sensitive genes contributes to the disruption of cell cycle progression and the onset of genome instability. Furthermore, we describe tumour-suppressive and oncogenic functions of CDK12 and its potential as a biomarker and inhibition target in anti-tumour treatments.
Remineralization of enamel caries by an amelogenin-derived peptide and fluoride in vitro
Authors: Ding Longjiang , Han Sili , Wang Kun , Zheng Sainan , Zheng Wenyue , Peng Xiu , Niu Yumei , Li Wei , Zhang Linglin
Published: March 2020

Dental caries is one of the most common oral diseases in the world. This study was tantamount to investigate the combinatory effects of an amelogenin-derived peptide (called QP5) and fluoride on the remineralization of artificial enamel caries. The peptide QP5 was synthesized and characterized, and the binding capability of the peptide on hydroxyapatite (HA) and demineralized tooth enamel surface was analysed. Then, the mineralization function of the peptide and fluoride was studied through the spontaneous mineralization testing and remineralization on enamel caries in vitro. First, the novel peptide QP5 could bind on the hydroxyapatite and demineralized tooth enamel surfaces. Second, QP5 can transitorily stabilize the formation of amorphous calcium phosphate and direct the transformation into hydroxyapatite crystals alone and in combination with fluoride. In addition, compared to blocks treated by peptide QP5 alone or fluoride, the sample blocks showed significantly higher surface microhardness, lower mineral loss and shallower lesion depth after treatment with a combination of QP5 and fluoride at high or low concentrations. The peptide QP5 could control the crystallization of hydroxyapatite, and combinatory application of peptide QP5 and fluoride had a potential synergistic effect on the remineralization of enamel caries.