bluuebunny/crossref_metadata_2025 huggingface dataset:
595 Mapping the Literature of Burns and Ethics
Authors: DeRosa Antonio , Gibbons Linda , Stribling Judy C
Published: March 2020

Introduction

Burn clinicians commonly experience ethical dilemmas as a direct result of a patient’s burn injury, yet literature on ethics in burns are scarce. A bibliometric analysis of literature on burn patients and ethics is necessary to support decision-making of burn-injured patients and their families. By identifying core journals, analyzing cited references, categorizing journals into Zones, and estimating database coverage, the results of this study informs burn specialists of the most relevant journals related to discussions about ethical issues in treating burn patients.

Methods

This study examined references during a three-year period (2016–2018) from a sample core of journals using the mapping protocol from the Nursing and Allied Health Resources Section (NAHRS) of the Medical Library Association (MLA). Following the prescribed steps in the NAHRS protocol, the investigators polled experts from the burn unit in a U.S. urban academic medical center inquiring about resources they believe contain the highest amount of content related to burns and ethics.

Using the following search strategy, the investigators queried Scopus, a subscription-based discovery portal, to retrieve references from the source journals published during the years 2016–2018.

Results

Based on professional responses, analysis of journal impact factors from the Journal Citation Reports (JCR) provided by Clarivate Analytics and a search of burns and ethics articles in MEDLINE, three journals informed the source titles for this study: Burns, BMC Medical Ethics, and Journal of Medical Ethics. There were 225 cited references pulled from the bibliographies of source journal publications: 183 references were from journal articles; 99 of these published in Burns. The years 2009–2013 accounted for the highest number of references inclusive of all publication types (n=61), followed by 2014–2018 (n=52). According to Bradford’s Law of Scattering, the n for this study was 4.4 (49 journals in Zone 2 divided by the 11 journals in Zone 1). Each zone makes up approximately 33% of the total number of cited references in all journals.

Conclusions

Results of this mapping study reveal there is a need for further published research on burns and ethics. Advancing burn clinicians’ understanding of ethics and burns will improve the overall care of burn-injured patients and supports the clinician in meeting their own professional ethical obligations.

Applicability of Research to Practice

Directly applicable to practice.
600 Nursing Standard of Practice: Assessment & Assistance with Bedside Escharotomy
Authors: Adkinson Lyndsay , Theis Mary , Witmer Malorie
Published: March 2020

Introduction

An escharotomy is an emergent procedure to treat circumferential, full-thickness burns. If left untreated, distal ischemia, compartment syndrome, respiratory failure, tissue necrosis, or death may occur. This procedure involves an incision through areas of eschar to release pressure within the affected compartment. An escharotomy may be performed at the bedside under sterile conditions by an experienced provider with the assistance of the nursing staff. The assisting nurse must have knowledge of the technique, purpose, and associated complications of the procedure. Nursing responsibilities may include pre-/post-procedure care, assessment, assistance with required equipment, patient teaching, & documentation.

Methods

Extensive literature review was conducted to identify the existence of nursing standards of practice regarding assessment and assistance with bedside escharotomy. A 20-question survey was sent to burn center nursing staff to evaluate inconsistencies in nursing knowledge and practice during bedside escharotomy.

Results

Information gathered via literature review revealed no consensus among U.S. burn centers in nursing standard of practice for a bedside escharotomy. Survey results further demonstrated inconsistencies in nursing knowledge and practice. Notable results from the survey included variance in post-procedure assessments, provider presence and skill level, dressing intervention, & obtaining informed consent prior to procedure.

Conclusions

A procedure was developed to standardize nursing practice during bedside escharotomy. This procedure outlines required supplies and preparation of equipment, implementation of nursing assessment and assistance, special considerations & complications, patient teaching, and required documentation. Images were included in the procedure for reference. Nursing staff received education regarding the purpose and utilization of the procedure. The procedure is available electronically to all health system employees. Future plans include reevaluation of staff knowledge and utilization of the procedure.

Applicability of Research to Practice

Development of a standard bedside escharotomy nursing procedure has the potential to improve level of knowledge, consistency in practice, and patient outcomes. Continued utilization and evaluation of this standard of practice supports the need for a consensus among U.S. burn centers.
613 Thriving During Development of a Large, Advanced Burn and Wound Clinic - The Realization of Successful Change Management
Authors: Prestifilippo Kathleen M , Webb Emily , Mullins Robert F , Fagan Shawn , Hassan Zaheed , Homsombath Bounthavy , Craft-Coffman Beretta , Currington Cynthia , Whalen Meganjoy
Published: March 2020

Introduction

Our center had an existing advanced burn and wound clinic, established more than 10years ago. Over the past several years, the need for expansion has been evident and in the past year, this expansion has been realized and the clinic doubled in size. With growth of any kind comes change. Change in healthcare is most often met with resistance. A multidisciplinary approach to planning and building a new healthcare environment is crucial to its success.

Methods

Review of admission and turnover rates.

Results

Several variables can be attributed to this overall accomplishment:

Conclusions

Applicability of Research to Practice

Sharing experiences related to staffing and growth with other clinicians helps foster support and leads to development of newer and better ways to do everyday work in clinical settings.
631 Mobilization of Patient with Inhalation Burn Injury Requiring VV ECMO: A Case Study
Authors: Berenbaum Karina J , Gottlieb Lawrence , O’Connor Annemarie , Teele Megan , Esbrook Cheryl , Jessica Fortin , Song Tae H
Published: March 2020

Introduction

As extracorporeal membrane oxygenation (ECMO) becomes more popular, there is increasing evidence supporting the safety and feasibility of early physical and occupational therapy (PT, OT) and mobility with patients on ECMO. However, there is limited evidence to support mobilizing burn ECMO patients. This case discusses safety and feasibility and explains how to successfully mobilize a burn patient on ECMO.

Methods

The patient is a 56-year old male admitted after sustaining 16% total body surface area partial and full thickness burns to his face, neck, forearms, and hands following an explosion at work. He sustained an inhalational injury and was intubated upon admission. Progression of his inhalation injury led to respiratory failure despite maximal ventilatory support. To maintain appropriate oxygenation, he underwent placement of left femoral-left internal jugular veno-venous ECMO (VV-ECMO). The patient received PT and OT throughout his stay in the Burn ICU. After starting ECMO, the patient resumed therapy with a sitting restriction to < 45 degrees of left hip flexion. The critical care, burn, OT, PT, and cardiothoracic surgery teams discussed factors impacting his ability to participate in therapy, e.g., managing sedation to maximize wakefulness and titrating medications due to hypertension. Modifications to therapy treatments were made based on medical changes and the patient’s ability to participate. The patient was seen daily for mobilization by a PT, OT, nurse, and ECMO specialist team. Clinicians had extensive training and experience working with patients with acute mechanical circulatory support. Safety considerations were followed during all therapy sessions, including careful monitoring of ECMO flows, vitals signs, and securement of medical devices.

Results

While on ECMO for 11 days, the patient was engaged in daily therapy consisting of active exercise, bed mobility, transfers and standing balance activities. ECMO flows were maintained and no adverse events occurred during mobilization. From the first session on ECMO to day of discharge, the patient exhibited a 14-point increase in his Boston University Activity Measure for Post-Acute Care functional outcome score and progressed to ambulating 300 feet.

Conclusions

Burn patients on VV-ECMO with femoral cannulation can safely and effectively engage in therapy and early mobilization, which yield positive functional outcomes. A well-coordinated inter-disciplinary team and highly skilled staff is essential to provide safe and effective intervention.

Applicability of Research to Practice

Early mobilization of burn patients on ECMO is feasible and can ameliorate the effects of immobility. Burn therapists are an integral part of the inter-disciplinary team and should be trained to be skilled at providing care for patients on mechanical circulatory support.
643 The Use of Topical Exogenous Nutrient Supplementation to Improve Graft Take on an Avascular Wound Bed
Authors: Cooper Laura , Bohan Phillip Kemp , Carlsson Anders H , Chan Rodney K , Everett Tyler
Published: March 2020

Introduction

Skin graft survival relies on imbibition, inosculation, and revascularization from the wound bed. When a wound bed is poorly vascularized, as in the case of exposed fascia, tendon or bone, skin grafting may be delayed until the wound bed improves. We propose that topical nutrient supplementation may be able to increase take of skin grafts applied over an avascular wound bed.

Methods

Twenty full-thickness 5cm-diameter wounds were created on the dorsum of anesthetized swine and a dermal substitute (0.4mm, 0.8mm, 1.2mm, or 1.6mm thick) was placed on each wound. Negative pressure therapy with and without intermittent (3x per day) saline instillation was applied. Wounds were analyzed using a non-contact 3D camera at day 7 and day 14.

Results

Dermal substitutes of 0.8mm, 1.2mm, and 1.6mm thicknesses inhibited graft take significantly (p< 0.01, p=0.02, p< 0.01, respectively) for all wounds treated with wound vac alone. Addition of the normal saline instill showed a significant improvement in graft take (p=0.03) over wound vac alone for the wounds treated with the 0.8mm dermal substitute. Wounds covered with 1.2mm and 1.6mm dermal substitute continued to show significantly decreased graft take (p=0.03 and p=0.02, respectively). Wounds with 0.4mm dermal substitute showed similar graft take to control for both the wound vac and wound vac + instill treatments.

Conclusions

Dermal substitutes ≥0.8mm create a successful model of an avascular wound bed. Vac + instill treatment overcame the impedance of an avascular wound bed only for the 0.8mm dermal substitute thickness. This thickness of dermal substitute creates an ideal avascular wound bed model from which to conduct further studies incorporating topical nutrients instilled directly onto skin grafts placed onto avascular wound beds.

Applicability of Research to Practice

Single-stage skin grafting procedures onto avascular wound beds may become feasible with topical nutrient supplementation providing the environment to maintain graft survival until the wound bed is able to support the skin graft.
644 Enzymatic Debridement of Porcine Burn Wounds via a Novel Protease, SN514
Authors: Stone Randolph , Jockheck-Clark Angela R , Larson David A , Wall John , Michelle Holik , Shaffer Lucy , Natesan Shanmugasundaram , Tetens Shannon , Roche Eric , Shi Lei , Christy Robert J
Published: March 2020

Introduction

The future multi-domain battlefield will require prolonged care in theater with evacuation delays of up to seven days. This creates a great risk of infection by not removing any necrotic tissue from burns in a timely manner. Products that can provide non-surgical debridement (NSD) prior to definitive care are essential. The purpose of this study was to evaluate a novel protease (SN514) as a potential NSD agent on deep partial (DPT) and full thickness (FT) burn wounds in a pig and on discarded human skin.

Methods

On day -4, twenty DPT and FT 3 cm diameter burn wounds were created on the dorsum of 8 anesthetized Yorkshire pigs using appropriate pain control methods. Burns were treated daily from day 0 to day 4 with one of five treatment groups: 1) no treatment, 2) collagenase, 3) 0.5% SN514, 4) 1.0% SN514, or 5) hydrogel vehicle. The wounds were assessed every day, rinsed with 4% chlorohexidine and sterile water, digital and laser speckle images (LSI) were acquired, the treatments reapplied, and then rebandaged. Biopsy strips were harvested across the middle of wounds on day 3 or 4. Samples were paraffin embedded, sectioned, stained with H&E and Masson’s trichrome, and imaged. For the human skin cohort, an abdominoplasty sample was burned to create FT burns. Burned and unburned samples were treated daily with SN514 for up to 4 days.

Results

During the daily assessment, SN514 treated wounds appeared more debrided than controls. No bleeding, infection, inflammation, or redness were observed. LSI detected significant increases in the perfusion status of SN514 treated wounds for the DPT burns on day 4. Histological analysis indicated a greater debridement of the porcine burn wounds for SN514. Treatment of human burned tissue with SN514 resulted in an 80% weight reduction compared to untreated samples.

Conclusions

SN514 treatment removed significant amounts of necrotic tissue from DPT and FT burns. SN514 achieved this in the absence of blood loss, without harming adjacent normal skin, and may have potentiated the wounds to allow healing to begin. The observed increase in perfusion after treatments suggests that the wound bed was optimal for spontaneous healing or a temporary covering. Application of SN514 on the burned human tissue successfully debrided both the dermis and hypodermis.

Applicability of Research to Practice

The ultimate aim is to identify NSD products for prolonged care scenarios that are easy to use, safe, and may improve healing of burns without the need for surgical debridement.
660 Prevalence, Risk Factors, and Clinical Consequence of Enteral Feeding Intolerance in the Critically Ill: An Analysis of a Multicenter, Multi-year Database
Authors: Heyland Daren , Ortiz Luis A , Day Andrew G
Published: March 2020

Introduction

We aimed to determine the incidence of enteral feed intolerance (EFI), factors associated with intolerance, and to assess the influence of intolerance on key nutritional and clinical outcomes in critically ill patients.

Methods

We used data from The International Nutrition Survey database collected from 2007–2014. Included patients were mechanically ventilated critically ill adults who remained in the Intensive Care Unit for at least 72 hours and received some enteral nutrition during the first 12 days of their ICU stay. Data collected included nutritional prescription, adequacy, and clinical otucomes. We defined EFI as feeding is interrupted due to one of the following reasons: high gastric residual volumes (GRV), increased abdominal girth or abdominal distension, vomiting/emesis, diarrhea or subjective discomfort. Logistic regression controlling for covariates (year, region, sex, APACHE II score, admission type by primary diagnosis, BMI and baseline caloric and protein prescriptions) was used to determine risk factors for intolerance and its clinical significance.

Results

The current analysis included 15, 918 patients from 775 ICUs. Of these, 4, 036 (25.4%) had at least one episode of EFI. The rate rose from just below 1% on day 1 to a peak of 6% on day 4 and 5 and declined daily thereafter (See Figure). Factors predictive of EFI are shown in Table 1. Admission diagnosis was significantly predictive of EFI with patients with burn injuries showing the highest incidence. After controlling for the covariates,patients who had EFI received about 10% less EN adequacycompared to patients without of EFI (see Table 2). The mortality rate in EFI patients was 31% vs. 24% among patients who did not have EFI (OR=1.5 [95% CI, 1.4–1.6] p< 0.0001). Patients who had EFI had fewer ventilator free days, longer ICU lengths of stay, and longer time to discharge alive (all p< 0.0001) (See Table 2).

Conclusions

Intolerance occurs frequently during enteral nutrition in the critically ill and is associated with poorer nutritional and clinical outcomes. The identification, prevention, and optimal management in burn injured patients may improve nutrition delivery and clinical outcomes in this important “at risk” population.

Applicability of Research to Practice

To improve the nutrition therapy in burns patients.
669 The Validation of a Novel Outcome Measure in Severe Burns- the Persistent Organ Dysfunction (POD)+Death: Results from a Multicentre Evaluation
Authors: Heyland Daren , Stoppe Christian , Ortiz Luis A , Day Andrew G
Published: March 2020

Introduction

Very few burn care interventions have been rigorously evaluated with adequately powered randomized clinical trials (RCTs) focusing on long-term clinically relevant outcomes. There is a need to improve the efficiency of RCTs in burn care so that more definitive high quality RCTs can be completed with the available resources. Persistent Organ Dysfunction (POD) plus death is a novel endpoint that has been previously validated in general ICU patients. The objective of this study was to validate and demonstrate the utility of POD+death for clinical trials of burn patients.

Methods

We performed a secondary analysis of a dataset from a RCT of enteral glutamine (the RE-ENERGIZE Trial) involving 60 Intensive Care Units (ICUs) around the world. Enrolled patients were followed for 6 months documenting hospital and 6 months outcomes including quality of life. For the purposes of this analysis, we restricted inclusion to patients with >20% burn size. We define POD as requiring supportive technologies during critical illness and is present when a patient has ongoing requirement for vasopressors, dialysis, or mechanical ventilation at the outcome assessments time points. We evaluated the data for the prevalence of POD and its association with outcome. We hypothesized that patients alive with POD, compared to those alive without POD, would have worse clinical outcomes and that by combining POD+death, we would gain statistical efficiencies.

Results

Five hundred thirty-nine patients were involved in this analysis. At 28 days, 4.6% of patients were estimated to have circulatory failure, 6.3% had renal failure, 17.1% had respiratory failure, and 8.9% had died, for an overall prevalence of POD+death=27%. Of survivors at day 28, those with POD, compared to those without POD, had a higher mortality rate in the follow up period, had longer ICU and hospital stays, and a reduced quality of life on many of the domains at 6 months (see Tables). Using our observed 28 day rates, to achieve 80% power at a two-sided alpha=0.05 to determine a 25% RRR in mortality, we would require 2246 patient per group to detect a 25% RRR in mortality from 9% to 6.75%, but only 573 patients per group to detect a 25% RRR in mortality+POD from 27% to 20%

Conclusions

POD+death may be a valid composite outcome measure and compared to historically used endpoints, POD may reduce the sample size requirements of clinical trials of severe burns patients. Further validation in larger clinical trials is required.

Applicability of Research to Practice

To improve the efficiency of RCTs in burn settings.
708 Enteral Nutrition Initiation During Periods of Vasopressor Requirements and Elevated Lactate Levels
Authors: Shields Beth A , Pruskowski Kaitlin A , Williams Alicia M , Cancio Leopoldo C
Published: March 2020

Introduction

Nutrition is a core component of care for the critically ill burn patient. The Society for Critical Care Medicine recommends initiating enteral nutrition (EN) within 4–6 hours of injury for burn patients, while simultaneously recommending waiting until hemodynamic stability is achieved for critical care patients. The goal of this analysis was to evaluate tolerance of EN during periods of different pressor requirements and lactate levels.

Methods

We performed a retrospective evaluation on all burn patients admitted to our intensive care unit in 2018 who received EN. This performance improvement project was approved by our regulatory compliance division. Lactate levels and vasopressor use just prior to EN initiation, the highest EN rates and gastric residual volumes during the 24 hours after initiation, and ischemic bowel and aspiration after EN initiation were recorded. Significance was accepted at p< 0.05.

Results

EN was initiated at 30 ± 20 hours after admission in 58 patients with the following characteristics: 47 ± 19 years old, 29 ± 24% TBSA burn, 13 mechanical ventilator days (IQR: 5–30), 15% mortality. The highest EN rate reached was 100 ± 49 mL/hr during the first 24 hours after initiation. Lactate levels were 1.9 mmol/L at the time of EN initiation (IQR: 1.6–2.4 mmol/L), with a maximum of 4.9 mmol/L. Lactate levels did not have a significant correlation with gastric residual volumes (p=0.532). Most (59%) patients did not have vasopressor requirements, but 21% required vasopressin only, 2% required norepinephrine only, and 19% required a combination of vasopressin and norepinephrine. Those who received norepinephrine received 3.3 ± 1.7 mcg/min, with a maximum of 7 mcg/min. There was a significant difference in gastric residual volumes between patients who had no vasopressor requirements compared to those who required vasopressors [13 mL (IQR: 0–200 mL) vs. 240 mL (IQR: 21–430 mL), p=0.014)]; however, the number of patients with gastric residual volumes over 500 mL was not significantly different (3% vs. 17%, p=0.149).

When examining patients receiving vasopressin alone, there was a significant but weak correlation between vasopressin dose and gastric residual volumes (p=0.047, R2=0.339); however, when examining only patients receiving norepinephrine, there was no correlation between norepinephrine dose and gastric residual volumes (p=0.905, R2=0.002).

There was 1 episode of aspiration and 1 episode of ischemic bowel, both of which occurred 3 days after EN initiation. EN was initiated without vasopressors running and lactate levels were normal in both cases.

Conclusions

The majority of patients tolerated EN initiation with vasopressor dosing of norepinephrine up to 7 mcg/min and lactate up to 4.9 mmol/L.

Applicability of Research to Practice

We found no indication for holding EN for lactate levels under 5 mmol/L and norepinephrine under 8 mcg/min.
743 Keeping up with Dr. Google: When Are Patients Seeking First-aid Burn Resources?
Authors: Parizh David , Effendi Maleeh , Martin Thomas L
Published: March 2020

Introduction

Treating burns is a relatively common occurrence in American Emergency Departments occurring an estimated 486,000 times per year. In the digital era, patients feel increasingly empowered to seek out medical resources independently. The true number of people sustaining an injury and treating themselves at home or outside of the hospital setting is difficult to quantify. However, we can see when patients were searching for first-aid burn resources on the world’s most powerful and popular search engine - Google. We hypothesized that there would be a correlation between patient’s searching for burn care resources online and burn admissions.

Methods

We used Keywords Everywhere a browser add-on for Google Chrome to cross check various phrases and words that Americans might search for to find information on how to treat a burn. “Burn treatment” was found to be the most commonly searched phrase and this was verified using Google Trends. Google Trends dose not give raw search numbers. However, it expresses the search frequency for a term relative to how frequently that term was sought out during a specified time period. We pulled search data for each successive year back till 2006 the earliest year for which complete data was available. We were then able to overlay this data on a year to year basis and thus view when information about treating burns was the most sought out.

Results

A clear increase in the frequency of searches for burn treatment can be seen around the summer months, peaking in the week surrounding the 4th of July. Further data comparing this trend to burn admissions is forthcoming as data is being solicited.

Conclusions

Americans are searching for more resources regarding burn injuries in the summer months; and especially in the days surrounding the fourth of July. We are excited to correlate this data to burn admissions. If there is an inverse relationship between admissions during the summer months and number of inquiries made via Google for acute burn care, this may suggest that many of the burns are minor. Thus, being treated through our clinics or through third-party providers. Alternatively, the patients may be treating themselves using internet resources. If this proves to be the case, there may be an opportunity to enrich online resources for our patients.

Applicability of Research to Practice

Once the data processing is complete, there will be an indication if the number of people seeking out resources via Google Search Engine correlates with out burn admissions. If not, this may be an opportunity for improvement to enrich burn first-aid resources available online.
765 The Impact of Peer Support Group Programs on Psychosocial Outcomes for Burn Survivors & Caregivers: A Review of the Literature
Authors: Bello Mariel S , Stoycos Sarah A , Carrera Brenda T , Kurakazu Dawn , Briere John , Garner Warren L , Gillenwater Justin , Yenikomshian Haig A
Published: March 2020

Introduction

Providing peer support group programs for burn survivors and their caregivers is an integral part of facilitating short- and long-term psychosocial recovery. Despite this, there is a lack of availability and standardization of these groups, which is partly due to a paucity of literature on this subject. The purpose of this study is to review the literature of the various types of peer support groups programs and their subsequent impact on psychosocial outcomes for burn survivors and their families.

Methods

A systematic review of the literature utilizing PubMed, PsycINFO, and Medline, was conducted for articles published between 1990 and 2018. Searches used the AND function to identify articles that crossed both a burn term (burn patient OR burn survivor OR burn care OR burn recovery) and a support group-related term (support, peer participation, aftercare, burn camp, outpatient group, inpatient group, group training). Inclusion criteria were studies in English, human subjects, peer support group programs, and studies that assessed psychosocial outcomes.

Results

Twenty articles met our inclusion criteria (7 for outpatient groups, 3 for inpatient groups, 2 for combined inpatient/outpatient groups, and 8 for burn camps). For outpatient peer support programs, all articles (n=7) demonstrated improvements in psychosocial outcomes including life satisfaction, acceptance of self, and reduced levels of isolation. For inpatient programs, all articles (n=3) reported improvements in emotional processing, concerns from caregivers, and coping strategies. The 2 articles that examined combined inpatient/outpatient programs reported substantial declines in post-traumatic stress, depression, and anxiety. Interestingly, findings were inconsistent for burn camps, 5 articles reported improvements in self-esteem, social integration, and reduced anxiety and depression while 3 articles demonstrated no significant changes.

Conclusions

Peer support group programs in various settings improve psychosocial well-being for both patients and caregivers. Inpatient/outpatient regimens were consistently beneficial while burn camps had inconsistent findings.

Applicability of Research to Practice

Peer support group programs are necessary for effective burn survivor and caregiver healing, regardless of format. Our ABA-verified burn center is currently working on a study to determine optimal inpatient/outpatient regimens of peer support.
767 Growing up with Burn Injuries - Has the Experience Changed over Time?
Authors: Rimmer Ruth B , Bay Curt , Kalil Emile T , Chacon Daniel W , Milem Mik , Esker Mark , Duke Desiree C , Wise Dustin , Foster Kevin N
Published: March 2020

Introduction

Growing up with disfigurement and functional limitations resulting from childhood burns can be challenging. Initial stages of care involve painful surgeries/dressing changes, strenuous physical & occupational therapy, pressure garments and time away from family/school activities. Few studies have examined the voiced issues faced by youth while maturing with burns. This study’s purpose was to determine if experiences in the post-injury phase differed between currently burn-injured youth vs. young adults burned as children.

Methods

A prior study asked Child Burn Survivors (CBS -10–16 yrs.) and Young Adults (YAs -17-25yrs.) to answer the statement: “The hardest thing about being burned is…” The most common issues included: People Staring, Getting Unwanted Questions, Being Bullied, Remembering When I Was Burned, Having Additional Surgeries and My Scars. The current study asked participants to rate items on a 4-point scale from (1) Not at all to (4) Really a lot. The YAs were asked to consider issues they encountered maturing with burns.

Results

Child Survivors (CBS, n=147) mean age 13.4 years, male (n=46%) female (n=54%), and YA Survivors (YA, n = 81) male(n=39%) female (n=61%) mean age =19.1 yrs., and were predominately racial/ethnic minorities (CBS=67%; YA = 58%). No differences existed for age burned (CBS=6 yrs. vs. YA = 6.4 yrs.) hidden & visible scars (CBS=55% vs. YA=68%) and TBSA ≥ 50% (CBS=19% vs. YA =20%). Top mean scores for CBS’s included: Remembering the Burn (2.05) & Getting Unwanted Questions (2.0). The YA group’s top mean scores included Being Bullied (2.10) & People Staring (2.0). The CBS group reported that Getting Unwanted Questions was more problematic than the YA Group (p =003). YAs shared that Being Bullied was their biggest problem vs. CVS, significantly more so (p=.01).

Conclusions

Bullying appears to be less of a problem for current child burn survivors than those previously burned. The difference may be due to a recent emphasis placed on anti-bullying in US schools. Findings highlight an ongoing need to address the psycho/social issues related to burns. Teaching interventions like the Phoenix Society’s Rehearse Your Response can help youth address unwanted questions and staring. Providing children an opportunity to process the injury event may also improve their ability to cope with burn stressors.

Applicability of Research to Practice

This research has clinical implications as issues shared by participants can be addressed by burn healthcare providers and therapists. Results endorse the delivery of supportive strategies which complement surgical/medical treatment and should help improve their social interactions/quality of life.
768 Young Adults Burn Survivors - Key Challenges They Faced While Growing Up
Authors: Rimmer Ruth B , Bay Curt , Rutter Cindy , Chacon Daniel W , Wise Dustin , Duke Desiree C , Milem Mik , Foster Kevin N
Published: March 2020

Introduction

There is a paucity of research regarding the challenges faced by young adults (YA) who matured with burns. It is well documented that acute burn care is laden with painful surgeries/dressing changes, gruesome physical/occupational therapies, anxiety and time away from family & friends. However, the specific issues young adults burned as children find most challenging remain largely unknown. This study sought to provide YA survivors with an opportunity to describe the difficult issues they endured.

Methods

Burn surviving youth responded to the open-ended statement “The hardest thing about being burned is…” Seven themes were derived from their responses: People Staring at Me, Being Bullied, Remembering When I was Burned, Having Additional Surgeries, My Scars, Getting Questions About My Burns,& the Pain & Itching, Young adult survivors were asked to rate each item on a 4-point scale from (1) Not at all to (4) Really a lot.

Results

Participants were YA survivors (n=64) mean age 19.1 years, female (62%) male (38%), average age at burn of 6.4 yrs. Sixty-eight percent reported both visible & hidden scars; 25% had a TBSA > 50%. Sixty-six percent were minority race/ethnicity. More than half of respondents reported issues with My Scars (65%), Remembering the Burn (52%) and Pain & Itching (50%). People Staring and Bullying has been bothersome for over 70%, 72% reported Being Bullied and 71% noted People Staring. The highest 5 means among YA subgroups included: Participants with hand scars- Being Bullied (2.6), those with visible scars - My Scars (2.6). Those reporting both facial & hand scars endorsed People Staring (2.4), youth with a TBSA ≥ 50% - Being Bullied (2.4) and with visible scars - Remembering the Burn – (2.4). Girls were bothered significantly more by My Scars (p=.02). Youth with both facial & hand scars had greater issues with Pain/Itch (p=.03).

Conclusions

This study provides insight into problems encountered by maturing burn survivors and discloses the more challenging issues they endured. These data can assist burn centers, camps, and psychotherapists in discussing potential survivor issues and suggest interventions to help burn-injured youth respond to challenges. Special consideration should be given to girls, those with facial/hand scars, large TBSAs and visible scarring.

Applicability of Research to Practice

This research can help burn care professionals better understand the major difficulties burn-injured youth experience. Supportive strategies should be developed to augment surgical/medical treatment with constructive psycho/social interventions. Providing survivors with constructive coping strategies can help to improve their social interactions and quality of life.
782 Central Line Associated Blood Stream Infection Reduction Utilizing a Business Improvement Model: The Four Disciplines of Execution
Authors: Dale Elizabeth , Schmits Grace , Allard Karen
Published: March 2020

Introduction

In July of 2018, the Burn ICU had very high Central Line Associated Blood Stream Infection (CLABSI) rate, more than double national rates. Due to the high cost and mortality associated with CLABSI, the unit leadership initiated a quality improvement project to decrease CLABSI rates.

Methods

The process implemented is called the “Four Disciplines of Execution” (4DX) based on a book by Sean Covey. Those methods are as follows:

Results

The 4DX Process allowed identification of areas for all team members (MDs and RNs) to improve their practice. Over time, consistency of practice with lead measures became 100% and new lead measures had to be developed. CLABSI improvement rate exceeded expectations; in June the rate dropped to 2.29 infections per 1000 patient line days (only 1 CLABSI during intervention period).

Conclusions

This process allowed engagement of the whole team, allowed for MD and RN problem solving and accountability, and resulted in dramatic improvement in HAI rates in the Burn ICU.

Applicability of Research to Practice

This method was unique compared to typical healthcare improvement models. In addition to being effective, it helped improve overall morale and performance on the unit.
795 Factors Associated with Time to Initial Debridement in a Pediatric Burn Center
Authors: Giles Sheila , Wheeler Krista K , Fabia Renata , Lever Kimberly , Shi Junxin , Thakkar Rajan
Published: March 2020

Introduction

There is sparse literature addressing the time of initial burn debridement. The purpose of this study was to describe factors associated with time to initial debridement in one American Burn Association (ABA) verified pediatric burn center.

Methods

Quality improvement data was prospectively collected for pediatric burn patients admitted from July 2018 through June 2019. The data included sedation method, total body surface area (TBSA) burn, mechanism of injury, and time to burn wound debridement. Adverse outcomes were also recorded. Nonparametric methods were used to evaluate associations. Medians are presented with interquartile ranges (IQR).

Results

There were 137 patients included in this study. The median time to initial debridement was 261 minutes (IQR: 166–321). Most patients (80%) received conscious sedation for their first debridement. The median time to debridement was significantly lower for patients receiving sedation as opposed to those without sedation, 240 minutes (IQR: 163–308) vs 338 minutes (IQR: 257–442), p=0.0004. Patients with TBSA burn > 5% (n=46) also had a significant earlier time to debridement as compared with patients with smaller burns, 183 minutes (IQR: 150–277) vs 283 minutes (IQR: 197–360), p< 0.0001. There was a significant difference in time to initial debridement based on mechanism of injury, p=0.0213. The median time to debridement for flame burns was 173 minutes (IQR: 149–308) as compared with scald burns with a median of 247 (IQR: 157–298) and contact burns, median 286 (IQR: 197–389). There were no adverse outcomes observed during the study period.

Conclusions

In an ABA verified pediatric burn center, conscious sedation, larger TBSA burn, and flame burns appeared to contribute to earlier time to debridement, with no adverse outcomes. Further analysis are ongoing as to whether pain scores differed for these initial burn dressings and if conscious sedation had any effects on subsequent dressings.

Applicability of Research to Practice

This study adds to the sparse literature regarding time to initial debridement and identifies factors associated with an earlier time to debridement. This study also raises further opportunities for investigation regarding the relationship between initial sedated debridement procedures and pain scores during subsequent dressing changes.
804 Successful Implementation of Acupuncture for Hospitalized Burn Patients
Authors: Thomas Mini , Joe Victor C , Nunez Molly , Nourani Bobby , Chin Theresa L , Burton Kimberly , Rychlock Rachel , Li Sheng , Horie Mariko
Published: March 2020

Introduction

There is evidence that acupuncture is beneficial for burn patients, resulting in improved pain control, decreased stress, and improved wound healing. Nevertheless, a limited number of hospitals have adopted acupuncture for inpatients. The purpose of this project was to incorporate acupuncture as an adjunct modality for pain control and other symptomatology for inpatients on the burn service.

Methods

In April 2019, the hospital initiated acupuncture services for inpatients through the Integrative Health (IH) program and hired three licensed acupuncturists and a medical director. The burn team collaborated with IH to develop care delivery guidelines. Referral for acupuncture services are initiated with a consult transmitted by the burn team physician via the electronic medical record. Acupuncture services are provided Monday to Friday, 8 to 5 pm. Acupuncturists attend weekly inter-disciplinary team rounds to answer questions and discuss potential treatment indications. Traditional Chinese Medicine evaluation is performed, with history and physical, including tongue inspection and pulse assessment. After verbal consent, practitioners treat using either single-use filiform acupuncture needles or blunt needles. Following treatment, the patient is evaluated for pain and satisfaction. About 3–5 treatment sessions are offered weekly. An online survey was conducted to evaluate healthcare workers’ attitude towards acupuncture in the inpatient setting.

Results

Since April 2019, 20% of hospitalized patients on the burn service received acupuncture referral and the number of patients utilizing acupuncture is increasing. A total of 191 sessions were provided for 22 patients. Common reasons for patients not to receive treatment include lack of consent, unavailability due to other scheduled treatments, and lack of appropriate intact skin for needling. The attitude survey was completed by 166 health care workers including physicians, nurses, therapists, and social workers. Overwhelmingly positive opinions were reported as shown in the table.

Conclusions

The project demonstrated successful implementation of acupuncture as an adjunct therapeutic modality for the burn inpatient service. It was met with patient satisfaction and acceptance by the healthcare team. Plans are in process to mature the provision of acupuncture services and follow outcomes such as pain control, sleep, and stress.

Applicability of Research to Practice

Currently, acupuncture for hospitalized patients is not billed which may be a major barrier in promoting this therapy. However, increased patient satisfaction and symptom relief could potentially offset costs. Future studies should also examine potential impact on wound healing and length of stay of burn patients.
807 Implementation of an Evidence-based Wound Care Process at a Regional Burn Center Reduces Hospital Acquired Infections
Authors: Mullins Sydney , Bernardy Sarah , MacLachlan Marianne , Evans Maureen , Olszewski Anna , Kidd Kara N , Maroon Angela , Renteria-Turley Alessandra , Mattison Sarah , Barsun Alura , Sterling Leonard , Romanowski Kathleen S , Sen Soman , Palmieri Tina L , Greenhalgh David G
Published: March 2020

Introduction

Central line associated blood stream infection (CLABSI) rates in burn patients exceeds the national average. The purpose of this study was to determine if implementation of an evidence-based process for wound care and central line management reduce infections.

Methods

A protocol for central line and wound care was developed in conjunction with another burn center with lower CLABSI rates and a care bundle, based on colorectal surgical literature. The new protocol required hand to elbow washing prior to wound care, separating the dirty and clean steps of the wound care process, changing protective gear when going from dirty to clean and performing the Hospital Acquired Infection (HAI) bundle elements separate from wound care. CLABSI and Ventilator Associated Pneumonia (VAP) rates were then compared with the previous year.

Results

Following implementation of the new wound care guidelines, the number of CLABSIs declined from 10 in 2017 to 2 in 2018 and 1 so far in 2019 (through August 2019). The median number of CLABSIs per 1000 days was 0 (range of 0 to 11) before the bundle and 0 (range of 0 to 4.2) after implementation of the bundle. Using the Wilcox rank sum test, there was no significant difference (p=0.09) between the CLABSI rate per 1000 device days between the time period before the bundle implementation and after the bundle implementation, however this may be due to the small sample size. Although the CLABSI rate did not show a statistically significant decrease, the proportion of positive blood cultures decreased by 50% after implementation of the bundle. The number of VAPs declined from 8 in 2017 to 6 in 2018 and so far in 2019 no VAPs have been reported (through August 2019). There was no difference in device days between groups.

Conclusions

Creating a wound care process that clearly defines and separates clean and dirty steps, similar to colorectal surgical bundles in the reduction of Surgical Site Infection, reduced CLABSI and HAI rates in a clinically significant, if not statistically significant way in the Burn Intensive Care Unit. Further study is needed to increase the power of this study to possibly detect statistically significant differences.

Applicability of Research to Practice

Implementation of an evidence-based, standardized practice for wound care improved infection rates at one regional burn center. It would be beneficial for this process to be replicated at other centers to further test correlation with infection reduction.
813 Burn Care in the Patient’s Home: Development of a Secure HIPPA Compliant Process to Share Photographs with the Provider
Authors: Ayers Brittany , Johnston Mark , Mohr William J , Altamirano Heidi M
Published: March 2020

Introduction

Burn Telemedicine programs are shown to improve care, increase access to specialists, provide real-time education, and reduce rates of missed outpatient visits. Many occur in acute care facilities or outpatient clinics and conducted with video technology. This center has expanded the depth of options for the care team to include a Burn Telemedicine Store and Forward Program. This program is unique in that patients receive an outpatient burn visit from their home.

Methods

Photographs instead of video are uploaded into the patient’s electronic medical record. The provider reviews the photographs then conducts a phone visit to review the plan of care and recommendations.

This program is reserved for patients requiring outpatient evaluation and meet specific criteria including having technology available to upload photographs into the medical record, minor burns not requiring complex dressing changes, or burns located in areas needing range of motion evaluation.

Burn telemedicine coordinators assist patients in creating access to their electronic medical record prior to discharge or during their initial clinic visit. Training relating to lighting, camera angles, and number of photos to include is performed. Photographs are uploaded into the medical record within a prescribed timeframe. The phone visit is then scheduled and conducted between the patient and provider.

Results

Benefits of this program include flexibility for patients to receive follow up care from their home, increased access to burn specialists in areas where healthcare facilities are scarce, and the ability to speak to their providers to review the care plan. Additionally, this program is beneficial to providers who have flexibility to review photographs and formulate the plan within the electronic medical record for this subset of patients instead of having them travel to a busy outpatient burn clinic. The providers bill the patient’s insurance for the phone visit. Finally, this process is fully secure and HIPPA compliant.

Challenges have occurred within this program. The telemedicine coordinators have had to assist patients with limited experience with technology to upload photos into the electronic medical record which is time consuming and complex. In addition, some patients are not available during their scheduled phone visit time, resulting in additional time to reschedule their visits. Still this program has helped reduce the number of patients lost to follow up.

Conclusions

This program is a beneficial option for this subset of patients. Patients comment how much they appreciate the ability to do an outpatient appointment from their home.

Applicability of Research to Practice

This is applicable as it describes the benefits and challenges of developing a secure option for outpatient burn care. Outpatient visits directly into a patient’s home is unique and innovative.