bluuebunny/crossref_metadata_2025 huggingface dataset:
Minerals play key roles in driving prokaryotic and fungal communities in the surface sediments of the Qinghai-Tibetan lakes
Authors: Yang Jian , Jiang Hongchen , Sun Xiaoxi , Chen Junsong , Xie Zhanling , Dong Hailiang
Published: March 2020

There is limited knowledge of the relative influences of deterministic and stochastic processes on prokaryotic and fungal communities in lake sediments. In this study, we surveyed the prokaryotic and fungal community compositions and their influencing factors in 23 surface sediments from six lakes on the Qinghai-Tibetan Plateau (QTP) with the use of Illumina sequencing. The results showed the distribution of prokaryotic and fungal communities in the studied QTP lake sediments was shaped by different assembly processes, with prokaryotes primarily governed by variable selection and homogenizing dispersal (accounting for 57.9% and 37.3% of the observed variations) and fungi being mainly regulated by variable selection, non-dominant processes and homogenizing dispersal (38.3%, 43.7% and 13.7%, respectively). Regarding the variable selection, mineralogical variables played key roles in shaping prokaryotic and fungal community structures. Collectively, these findings expand current knowledge concerning the influences of deterministic (e.g. variable selection) and stochastic processes (e.g. homogenizing dispersal and non-dominant processes) on the prokaryotic and fungal distribution in the QTP lakes.
Quantitative analysis of serum-based IgG agalactosylation for tuberculosis auxiliary diagnosis
Authors: Liu Peng , Ren Shifang , Xie Yan , Liu Chuangang , Qin Wenjun , Zhou Yuanyuan , Zhang Mingxia , Yang Qianting , Chen Xin-chun , Liu Ting , Yao Qili , Xiao Zhen , Gu Jianxin , Zhang Xiao-Lian
Published: March 2020

Tuberculosis (TB) is the leading infectious cause of mortality worldwide, especially in developing countries. However, effective means for TB diagnosis, especially for bacillus-negative (Bn) TB laboratory diagnosis, are urgently needed. In the present study, serum IgG from each tuberculosis patients and healthy controls was purified using affinity chromatography. The samples were then analyzed using mass spectrometry (MS) and ultraperformance liquid chromatography (UPLC) methods. We quantitatively assessed the changes of serum IgG galactosylation in 567 human serum samples including 377 pulmonary TB patients and 190 healthy donors (HDs). We found significantly more agalactosylated (G0) vs monogalactosylated (G1) and digalactosylated (G2) N-glycans of IgG in TB patients, including smear-negative TB patients, than in HDs. The detection rate of TB diagnostic performance by MS for IgG–Gal ratio G0/(G1 + G2 × 2) is 90.48% for bacillus-positive (Bp) and 73.16% for Bn TB patients. Further, combination of MS method with other routine laboratory TB diagnostic methods significantly increased the detection rate to 91.01%–98.39%. Similar results were observed in Mycobacterium tuberculosis (M. tb) infection mouse models. The decrease in galactosylation of IgG in TB patients was also qualitatively confirmed using specific lectin blot assay. Using the above techniques, we can discriminate the content of IgG G0 with terminal N-acetylglucosamine and IgG–Gal ratio G0/(G1 + G2 × 2) between TB patients and HDs. Our data suggest that quantitative analysis of serum-based IgG–Gal ratio G0/(G1 + G2 × 2) could be used for TB auxiliary diagnosis with high effectiveness and feasibility and its combination with other routine laboratory TB diagnostic methods could remarkably improve the detection rate.
Vaccination With Moderate Coverage Eradicates Oncogenic Human Papillomaviruses If a Gender-Neutral Strategy Is Applied
Authors: Vänskä Simopekka , Luostarinen Tapio , Baussano Iacopo , Apter Dan , Eriksson Tiina , Natunen Kari , Nieminen Pekka , Paavonen Jorma , Pimenoff Ville N , Pukkala Eero , Söderlund-Strand Anna , Dubin Gary , Garnett Geoff , Dillner Joakim , Lehtinen Matti
Published: March 2020

Background

Human papillomavirus (HPV) vaccination of girls with very high (>90%) coverage has the potential to eradicate oncogenic HPVs, but such high coverage is hard to achieve. However, the herd effect (HE) depends both on the HPV type and the vaccination strategy.

Methods

We randomized 33 Finnish communities into gender-neutral HPV16/18 vaccination, girls-only HPV16/18 vaccination, and hepatitis B virus vaccination arms. In 2007–2010, 11 662 of 20 513 of 40 852 of 39 420 resident boys/girls from 1992 to 1995 birth cohorts consented. In 2010–2014, cervicovaginal samples from vaccinated and unvaccinated girls at age 18.5 years were typed for HPV6/11/16/18/31/33/35/39/45/51/52/56/58/59/66/68. Vaccine efficacy for vaccinated girls, HE for unvaccinated girls, and the protective effectiveness (PE) for all girls were estimated. We extended the community-randomized trial results about vaccination strategy with mathematical modeling to assess HPV eradication.

Results

The HE and PE estimates in the 1995 birth cohort for HPV18/31/33 were significant in the gender-neutral arm and 150% and 40% stronger than in the girls-only arm. Concordantly, HPV18/31/33 eradication was already predicted in adolescents/young adults in 20 years with 75% coverage of gender-neutral vaccination. With the 75% coverage, eventual HPV16 eradication was also predicted, but only with the gender-neutral strategy.

Conclusions

Gender-neutral vaccination is superior for eradication of oncogenic HPVs.
Theory on the Ground: Ethnography, Religio-Racial Study, and the Spiritual Work of Building Otherwise
Authors: McTighe Laura
Published: March 2020

“We should be able to live and thrive, not just survive.” With these words, the Black feminist leaders of Women With A Vision (WWAV) in New Orleans refuse the religious and racist terror of post-Hurricane Katrina recovery—and theorize beyond the lethal logics that set their organizing home ablaze in a still-uninvestigated arson attack. This article approaches WWAV’s gauntlet as “theory on the ground”: theory developed in the midst of lived struggle, which carries forward the enduring resistant visions of generations past, and grows them in and through the geographies of the present, towards new and more livable futures. Drawing inspiration from Judith Weisenfeld’s study of religio-racial movements in New World A-Coming, this ethnography moves on the ground and in step with my comrades at WWAV to show how the spiritual work of building otherwise can transform both what we write (the content and theory of our scholarship) and how we write it (the methods and ethics of its undertaking). Centering WWAV’s world-building theory, learning from it, moving with it: this is essential decolonial academic praxis, which comes from and flows through a commitment to ending white supremacy and being an accomplice to Black liberation. In offering “theory on the ground” as both a model and an intervention, this article shows how ethnographers of religion, as well as those who use our tools and our texts, might study differently to build our field and our world otherwise.
Characterization of Klebsiella pneumoniae isolates from a mother–child cohort in Madagascar
Authors: Rakotondrasoa Andriniaina , Passet Virginie , Herindrainy Perlinot , Garin Benoit , Kermorvant-Duchemin Elsa , Delarocque-Astagneau Elisabeth , Guillemot Didier , Huynh Bich-Tram , Brisse Sylvain , Collard Jean-Marc
Published: March 2020

Objectives

To define characteristics of Klebsiella pneumoniae isolated from carriage and infections in mothers and their neonates belonging to a paediatric cohort in Madagascar.

Methods

A total of 2000 mothers and their 2001 neonates were included. For each mother, vaginal and stool samples were collected at the birth. Additionally, upon suspicion of infection, samples were collected from suspected infected body sites in 121 neonates. Genomic sequences of all isolated K. pneumoniae were used for phylogenetic analyses and to investigate the genomic content of antimicrobial resistance genes, virulence genes and plasmid replicon types.

Results

Five percent (n = 101) of mothers were K. pneumoniae positive. Of 251 collected K. pneumoniae isolates, 102 (40.6%) were from mothers and 149 (59.3%) were from neonates. A total of 49 (19.5%; all from infants except 1) isolates were from infected body sites. MLST identified 108 different STs distributed over the six K. pneumoniae phylogroups Kp1 to Kp6. We found 65 (25.8%) ESBL producers and a total of 101 (40.2%) MDR isolates. The most common ESBL gene was blaCTX-M-15 (in 99.3% of isolates expressing ESBL). One isolate co-harboured blaCTX-M-15 and blaNDM-1 genes. Three isolates from infected body sites belonged to hypervirulent-associated ST23 (n = 1) and ST25 (n = 2). We observed two cases of mother-to-child transmission and sustained K. pneumoniae carriage was identified in 10 neonates, with identical isolates observed longitudinally over the course of 18 to 115 days.

Conclusions

This study revealed substantial genetic diversity and a high rate of antimicrobial resistance among K. pneumoniae isolated from both carriage and infections in Madagascar.
77 Functional Outcomes in Patients with Hand Burns Receiving Long Term Hand Therapy
Authors: Choi Katherine J , Pham Christopher H , Collier Zachary J , Carney John , Kurakazu Dawn , Yenikomshian Haig A , Gillenwater Justin
Published: March 2020

Introduction

Sparse data exists on functional outcomes of patients receiving outpatient therapy after admission with hand burns. The purpose of our study is to evaluate the effectiveness of long-term outpatient occupational therapy (OT) on hand joint range of motion (ROM), activities of daily living (ADL) status, and pain after burn injury.

Methods

All patients with hand burns admitted to a single ABA verified burn center from January 2015 to May 2016 with properly documented outpatient OT follow up were included. Demographics (TBSA, hand dominance, mechanism), interventions (time-to-surgery, procedures), and long-term outcomes (further procedures, pain, ROM, contractures, scars, ADL) were evaluated. The effect of patient demographics and interventions on outcomes were evaluated with descriptive statistics and multivariate logistic regression.

Results

Of 61 patients with hand burns, 43 were referred for outpatient therapy, but only 31% (n=19) consistently presented for follow up. Mean age was 37±14 years, 74% (n=14) were male, and mean TBSA was 12%±17. Surgical management was required in 63% (n=12), and the mean time-to-surgery was 16±37 days from injury. Contractures occurred in 16% (n=3), 11% (n=2) had hypertrophic scarring, and 21% (n=4) developed both contractures and hypertrophic scarring. Of these patients, 21% (n=4) required further surgical intervention, including 3 contracture releases and 1 triamcinolone injection.

Mean OT follow up was 16±14 weeks. As of the last OT note, 84% (n=16) had independent ADL function, 16% (n=3) required assistance, and none were poorly functioning. Likewise, 47% (n=9) had normal ROM, 53% (n=10) were within functional limits, and none had poor ROM. 79% (n=15) demonstrated improvement of ADL function, and 84% (n=16) had improvement of ROM. At OT intake, 68% (n=13) reported pain as a major limitation, but by end of therapy, only 21% (n=4) were limited by pain. Those with contractures or hypertrophic scars were 9.9 times less likely to have improvement in ADL status (p=.03, RR 9.9, CI 1.3–67).

Conclusions

Most patients referred for hand therapy after burn injury return to functional independence and have functional ROM.

Applicability of Research to Practice

Referral to and compliance with dedicated long-term hand therapy leads to improvements to ADL and ROM in patients admitted with hand burn injuries.
94 Bioimpedance Spectroscopy Is a Valid and Reliable Measure of Edema in Hand Burn Injury
Authors: Edwick Dale O , Hince Dana A , Rawlins Jeremy M , Wood Fiona M , Edgar Dale W
Published: March 2020

Introduction

The assessment of swelling following burn injury is complicated by the presence of wounds and dressings, particularly as the patient cohort experience significant pain, impaired movement, and may require medications that result in modified behavior. Further, traditional measures of volume, such as water displacement volumetry (WDV) or circumferential limb measures may pose increased infection risk and pain due to contact with open wounds. Clinically, edema is most often assessed by noting loss of skin creases, palpation of areas of visible swelling, and loss of function, as there remains a lack of sensitive objective measures for edema in patients with hand burn injury. Bioimpedance spectroscopy (BIS) is a measure of body composition that has been demonstrated by our group to be reliable for measuring whole body and limb edema during resuscitation, and to be sensitive to local edema changes within healing wounds. The aim of this study was to determine the reliability and validity of BIS as a measure of edema following hand burn injury.

Methods

One hundred patients presenting with hand burn injury were recruited to this trial. Repeated volume measures of the hand were recorded using a novel application of BIS, and repeated using WDV. The results were analysed using multi-level mixed effects regressions. The use of BIS electrodes on the dorsum of the middle finger at the DIP and MCPJ levels, and dorsum of the wrist and forearm have been previously described for measuring lymphedema.

Results

Paired repeated measures were obtained for 195 hands. Alternate electrode positions on the palm of the middle finger and hand, and volar wrist and forearm, and a combination of palmar hand / dorsal forearm were assessed. There was no evidence of a significant difference between these electrode configurations and the previously described dorsal hand / forearm configuration (position x distance interaction, p=0.608–0.802). Dorsal hand / volar forearm configuration was significantly different (position x distance interaction, p=0.006) from the standard electrode position described. Comparison with WDV demonstrated a strong correlation (r=0.79; limits of agreement 198-460mL; bias 329mL). Reliability of BIS was determined by ICC: 0.9978–0.9999 (CI 0.9967–0.9999).

Conclusions

Compared to WDV, BIS is a valid and reliable measure of edema following acute hand burn injury. This study also confirmed the interchangeability of multiple BIS electrode positions.

Applicability of Research to Practice

BIS offers a real time measure of fluid (change) within the extracellular space, and therefore edema in patients with hand burn injury, while minimizing the risk of infection and increased pain in burns patients. The interchangeability of electrode positions provides clinicians with a number of flexible options to accommodate locations of hand burn wounds, thus allowing between patient comparisons.
104 Comorbidity Does Not Predict Outcomes After Burn Injury in the Elderly
Authors: Bernal Isabel , Paine Rosemary , Carter Damien W , Falank Carolyne
Published: March 2020

Introduction

As the population ages; burn centers, especially those with a large rural catchment, will be expected to care for older adults with complex medical co-morbidities. Recent work has shown that %TBSA at which 50% of patients would be expected to die (LD50) for elderly patients is up to 20% lower than non-elderly patients. However, the factors contributing to mortality are unclear. We undertook this study to characterize our experience with elderly burn patients in our rural state and to understand how mortality is affected by comorbid disease.

Methods

We performed a retrospective review of all burn patients ≥50 years old admitted to our burn center over a 5 year period between January 2014 and December 2018. We collected demographic and injury data including %TBSA, mechanism, inhalation injury status, discharge disposition, length of stay as well as complications including pneumonia, kidney injury, wound infection and graft loss. We calculated the modified Baux score, Charlson Comorbidity Index (CCI) and overall mortality for each patient. The %TBSA and CCI were correlated with complications and mortality using the Pearson correlation coefficient analysis.

Results

There were 243 patients (35%) who met inclusion criteria out of total of 688 burn admissions during that period. The median age was 60 years (mean 62.2, range: 50–95) and 72.4% were male. The median TBSA was 4% (mean: 8.2%, range: 0.5% - 55%). We found weak correlations between CCI and both pneumonia (R=0.177, p=0.005) and mortality (R=0.1297, p=0.0434). There was also a weak correlation between %TBSA and pneumonia (R=0.3302, p < 0.001), kidney injury (R=0.205, p=0.001), wound infection (R=0.1295, p=0.045) and graft loss (R=0.2616, p< 0.001). Interestingly, in the subgroup with > 15% TBSA burns (n=35), there was no significant correlation with increased complications. For the entire cohort, the predicted mortality based on the mean modified Baux score was 16%. The actual observed mortality was 4.1%.

Conclusions

Our findings suggest that, in our center, CCI is not predictive of burn related complications or mortality and %TBSA is not predictive of complications or death. The observed to expected mortality ratio was remarkably low.

Applicability of Research to Practice

As we treat older burn patients, it is important to identify the individual patient factors and hospital specific burn care factors that may improve outcomes in the elderly population.
117 Light or Dark Pigmentation of Engineered Skin Substitutes Containing Melanocytes Protects Against UV-Induced DNA Damage in Vivo
Authors: Supp Dorothy M , Hahn Jennifer M , Lloyd Christopher M , Combs Kelly A , Swope Viki B , Abdel-Malek Zalfa , Boyce Steven T
Published: March 2020

Introduction

Engineered skin substitutes (ESS) were developed to meet the need for prompt wound closure in patients with large full thickness burns. ESS containing autologous fibroblasts and keratinocytes were shown to provide stable wound closure in burn patients, but are limited by hypopigmentation. DNA damage caused by ultraviolet (UV) radiation is a known risk factor for development of skin cancer. In normal human skin, epidermal melanocytes provide pigmentation, helping to shield skin from UV-induced DNA damage. The current study investigated inclusion of human melanocytes (hM) and their role in the response of ESS to UV light in vivo.

Methods

Primary cells were isolated from skin of healthy de-identified human donors with IRB approval. Three groups of ESS were prepared with fibroblasts and keratinocytes, +/- hM, and were grafted orthotopically to immunodeficient mice: ESS without hM; ESS with light skin-derived (Caucasian) hM (ESS+hML); and ESS with dark skin-derived (African American) hM (ESS+hMD). After 8 weeks in vivo, grafts were irradiated with 135 mJ/cm2 UV, and mice were euthanized after 2 or 24 hours; non-UV treated mice served as controls. Pigmentation and erythema were measured with a Mexameter. Melanocytes and cyclobutane pyrimidine dimers (CPDs) were quantified by immunostaining with anti-TYRP1 and anti-CPD antibodies, respectively, followed by image analysis (Nikon Elements). Statistical analyses (SigmaPlot) utilized t-test or one-way ANOVA; P< 0.05 was considered significant.

Results

At 8 weeks post-grafting, mean hM density in ESS+hML and ESS+hMD was not significantly different from normal human skin samples. Pigmentation (in Mexameter units) before UV irradiation was significantly different among groups (ESS+hMD > ESS+hML > ESS no hM). UV irradiation did not increase erythema in any group, but resulted in significantly increased pigmentation in ESS+hML and ESS+hMD at 2 hours, but not 24 hours, post-UV. CPDs, the most prevalent form of UV-induced DNA damage, were significantly elevated 24 hours post-UV in ESS without hM. DNA damage was significantly lower 24 hours post-UV in ESS+hML and ESS+hMD compared with ESS without hM. No differences in DNA damage were observed between ESS+hML and ESS+hMD.

Conclusions

Pigmentation of ESS+hML and ESS+hMD in vivo varied according to the skin phototype of the hM donor, with no difference in melanocyte density, which was similar to normal human skin. Inclusion of either light or dark hM decreased UV-induced DNA damage, suggesting that hM in ESS play a photoprotective role, as in normal human skin.

Applicability of Research to Practice

Protection against UV-induced DNA damage may reduce the risk of skin cancer in patients grafted with ESS containing melanocytes.
127 Does Socioeconomic Status Impact Opioid Requirements in Burn Injured Patients with Methamphetamine Abuse?
Authors: Tejiram Shawn , Solomon Eve A , Greenhalgh David G , Palmieri Tina L , Sen Soman , Romanowski Kathleen S
Published: March 2020

Introduction

Methamphetamine (MA) abuse among burn injured patients is associated with lower socioeconomic status, larger burn injuries, and longer lengths of stay. While overlap among MA and opioid abuse has risen, studies examining the impact of MA abuse and socioeconomic status on opioid requirements in burn injured patients remain limited. The aim of this work was to examine the impact of MA abuse and socioeconomic status on discharge opioid requirements in burn injured patients.

Methods

Records on burn injured patients admitted to an ABA verified burn center were retrospectively reviewed from January 2016 to December 2017. Demographics, burn size (TBSA), admission toxicity screening, discharge pain scores, length of stay (LOS), adjuvant pain medications, and opioid equivalents (OE) within 24 hours of discharge were reviewed. OEs were determined by conversion of narcotics to oral morphine equivalents. Patients were grouped into methamphetamine positive (MPOS) or negative groups (MNEG) for comparison purposes.

Results

Of 690 patients who met inclusion criteria, 451 admission toxicity screening exams were performed that identified 170 patients positive for methamphetamine abuse. MNEG patients had significantly higher OE (p=0.03) requirements than MPOS patients. No significant differences were noted between gender (p=0.22), TBSA (p=0.70), benzodiazepine use (p=0.87), or clonidine use (p = 0.88) between groups. MPOS patients were less likely to receive gabapentin (p=0.03). OE and OE/TBSA requirements correlated with discharge pain score (p < 0.001) and LOS (p < 0.001). A significantly higher level of poverty was seen in MPOS patients (p < 0.0001), but poverty itself was not a predictor of OE (p = 0.66), OE/TBSA (p = 0.90), pain score (p = 0.28), or LOS (0.49). Multivariate linear regression found MNEG status (p=0.003), TBSA (p< 0.0001), and pain score (p< 0.0001) were independently associated with OE.

Conclusions

Though lower socioeconomic status was seen more in patients with MA abuse, it was not associated with opioid use or pain scores. While it is generally believed that MPOS patients require more pain medication, this was not the case in our current study population. Additional work will be necessary to determine techniques to improve pain control.

Applicability of Research to Practice

Given the opioid crisis, it is critical to understand factors that determine pain medication usage in this patient population to decrease the use of narcotics while improving pain control.
503 Cardiac Arrhythmias and Dysfunction in Pediatric Burns
Authors: Wilmot Ivan , Chang Philip , Nelson Judith , Fowler Laura , Warner Petra
Published: March 2020

Introduction

Long term cardiac dysfunction and reversible cardiomyopathy can develop in large burns. In addition, cardiac arrhythmias can occur with any burn size. The incidence of cardiac arrhythmias and dysfunction in pediatric burns is unclear. Therefore, the objective of this prospective study was to evaluate the incidence of arrhythmias and cardiac dysfunction in pediatric burns and assess if early recognition improves clinical outcomes.

Methods

Pediatric burn patients ages 0 - 18 with TBSA injuries greater than 30% or those with cardiac dysfunction/ arrhythmia were enrolled after obtaining IRB approval. Exclusion criteria included pre-existing cardiac disease, desquamative skin disorders and electrical injury. For patients with burns greater than 30%, echocardiograms (Echo) were obtained on admission and then monthly. Echo exams were discontinued after three negative exams or upon discharge. All patients with arrhythmias had electrocardiograms (EKGs) and electrolyte panels obtained.

Results

Of the 130 acute burn patients admitted during 2017–2018, 10 patients were enrolled. The average age was 5 years (0.8 to 10 yrs), 70% were males and 90% sustained flame injuries. Average TBSA was 45% (24–70%) with average full thickness burns of 33% (0–67%). 20 Echos and 21 EKGs were obtained.

Only three patients experienced cardiac symptoms, reflecting an incidence rate of 2%. One patient had sustained bradycardia with EKG reading anterior wall myocardial infarction: however troponins, ECHO and clinical evaluation were not consistent with this reading. A severe medication side effect was found to be the inciting cause. Another patient demonstrated bradycardia with sleep, requiring no intervention. The final symptomatic patient, with a 25% TBSA burn, experienced four bradycardic arrests, caused by PEA arrest at the referring hospital after aspiration and receipt of multiple pain medications. Responding to epinephrine, the bradycardia resolved. Admission Echo demonstrated an ejection fraction of 25% with a normal EKG. Repeat ECHOs demonstrated full cardiac recovery.

The remaining patients did not exhibit any abnormalities on ECHO examinations aside from trivial tricuspid regurgitation. In addition, electrolytes panels did not demonstrate any findings contributing to cardiac arrhythmias.

Given these negative findings and the cost involved with ECHO examination, it was elected to discontinue the prospective study.

Conclusions

Although cardiac dysfunction and arrhythmias can impact patient care, the incidence of cardiac disease in pediatric burns is low. Elective Echos in large burns demonstrated no abnormal findings. Use of ECHOs is best performed with symptomatic disease.

Applicability of Research to Practice

Incidence of cardiac disease is low in pediatric burns. Use of echocardiograms are best used in patients with symptomatic disease.
540 Healthcare Resource Utilization and Costs of Care Among Pediatric Patients with Thermal Burns Undergoing Inpatient Autografting in a Managed Care Population
Authors: Teng Chia-Chen , Tan Hiangkiat
Published: March 2020

Introduction

Autograft is considered the standard of care for severe burns; however, data on the economic outcomes in the pediatric population are sparse. This study assessed the healthcare resource utilization (HCRU) and costs of care among pediatric patients undergoing autografting for thermal burns.

Methods

The HealthCore Integrated Research Database was used to identify patients < 18 years old with thermal burns receiving the first inpatient autograft between 1/1/2011 and 6/30/2016. The first admission date was assigned as the index date; 12-month pre- and 24-month post-index-date continuous enrollment were required. Patient demographics, clinical characteristics, HCRU, and total costs were assessed.

Results

Of 65 identified patients, mean age was 7.2 years (standard deviation, SD=5.19), 46.2% were < 6 years old, and 69.2% were male. The majority of burn sites were in upper limbs (64.6%) and lower limbs (52.3%), followed by trunk (41.5%) and eye, face, head, and neck (24.6%). Over 80.0% of patients had third or deep third degree burns; 60% had total body surface area (TBSA) < 10% of any degree burn, and only a few patients (≤ 10) had TBSA ≥ 30%. The mean total all-cause cost in the one-year pre-index period was $14,359 (SD=$27,393), and $9,274 (SD=$25,694) of that cost were burn-related. The average length of stay of the index hospitalization was 10.9 days (SD=10.72), with mean total cost of $94,652 (SD=$162,176). The first-year post-index mean total cost was $111,536 (SD=$174,616) and 93.5% (including index hospitalization) were burn-related. On average, the index hospitalization accounted for 84.9% of the first-year costs. The second-year mean total cost was $10,734 (SD=$40,185), with 5.9% burn-related. Very few (≤ 10) patients had a burn-related hospitalization in the first year after discharge from the index hospitalization, and none had any burn-related inpatient stay in the second year.

Conclusions

The first-year economic burden after burn injury in this pediatric population was substantial, driven by the initial hospitalization for those undergoing autografting. Burn-related HCRU and cost reduced considerably in the second year post-index.

Applicability of Research to Practice

This study provided insights on the economic burden of pediatric patients with thermal burns who underwent inpatient autografting. Although autograft is part of the standard of care for severe burns, healthy skin availability and morbidity associated with skin harvest for autograft are major concerns among this vulnerable population. Innovations in burn care are warranted to ensure improved clinical and economic outcomes among patients with thermal burns.
556 Hospital Length of Stay for Patients with Small and Medium Burns Impacted by Distance to Burn Center
Authors: Sibbett Stephen , Oh Jamie , Arbabi Saman , Carrougher Gretchen J , Gibran Nicole S
Published: March 2020

Introduction

Understanding contributors to patient length of stay is critical for burn center resource management and efficiency. In this study, we analyzed how distance from patient homes to a burn center impacts hospital length of stay.

Methods

Under IRB approval, we reviewed our trauma registry for burn patients admitted to a regional burn center from 2011 to 2018. Inclusion was limited to patients from the burn center state. Patients were grouped by distance from the home zip code to the burn center (≤100 and >100 miles) according to what might be ground or air transport. Chi-square and Mann-Whitney tests were used to determine differences between groups by race, burn size (TBSA), hospital length of stay (LOS), LOS/TBSA, mortality, and disposition to home. Burn size was categorized by TBSA into small (0–20%), medium (21–50%) and large (51–100%) burns.

Results

Our study population was predominantly white, non-Hispanic males. Mean burn size was significantly higher in patients who traveled more than the >100 miles to the burn center (Table). Mean LOS/TBSA was not significant between the two groups. However, controlling for burn size, patients with small and medium burns that lived farther from the burn center had significantly longer hospital stays. There was no significant difference in length of stay for patients with large burns, mortality or disposition to home between the two distance groups.

Conclusions

At a burn center with a large catchment area, patients with burn size < 50%TBSA who lived more than 100 miles from the burn center had significantly longer hospital stays than those who lived closer to the burn center. This may indicate that patients who are referred to a regional burn center for care of smaller burns may require care beyond the level of their local hospitals. It is worth noting that using burn size as an indication of complexity of care may be misleading as body site location of the burn (e.g. hand, face or feet) impacts the recovery.

Applicability of Research to Practice

For a burn center that serves patients across a vast region, this investigation might be useful in identifying opportunities to provide care for patients who live far from tertiary burn care.
562 “A Long process:” a Qualitative Analysis of Burn Survivors’ Treatment and Recovery Process
Authors: Baldwin Stephanie , Kimberly Dukes , Christel Katherine N , Hagedorn Joshua , Ruba Emily , Wibbenmeyer Lucy
Published: March 2020

Introduction

The treatment and recovery from a burn injury is a long process that can affect a survivor’s appearance, mobility, daily function, and emotional wellbeing. In this study, we sought to identify various factors in survivors’ treatment and recovery process.

Methods

We conducted thematic analysis on transcripts of in-depth, semi-structured interviews with 11 burn survivors who had been treated at a Midwest tertiary facility. Survivors were purposefully selected for variability in age, gender, injury size, injury mechanism and quality of life responses. All transcripts were coded by at least two authors. We managed coded results in MAXQda, a qualitative data management software program.

Results

The mean age of interviewees was 51 years (35–63 years) and time from the injury was 5.4 years (2 months to 26 years). Their burn sizes ranged from < 10% in 4 people to 70–79% in one. Participants reported varied perceptions of care quality and provider relationships from the initial hospital stay. Some recalled communication issues from the hospital throughout the long recovery process. Many used graphic terms for the unfamiliar treatment methods.

Survivors reported ongoing issues with their skin and mobility that continued to impact activities of daily living even years later. Many did not have clear or realistic expectations or understanding of the recovery process. Wound care was overwhelming and provoked fear for many survivors even with formal instruction. Most participants developed different ways to treat their injuries at home. Barriers to recovery included finances, comorbidities, and environmental characteristics, including rurality.

Conclusions

Even years later, the burn injury can continue to evolve, create fears, and affect daily living for survivors. To help patients understand the realistic course of recovery, providers could focus on clear communication about the injury and recovery. Providers should recognize survivors with barriers who may need referrals for further support.

Applicability of Research to Practice

Reflecting on the subjective accounts of survivors will help identify opportunities to improve patient experiences during treatment and throughout the recovery process.
584 Maintaining Success in Patient Safety and Quality Metrics Through Teamwork and Contextual Modification
Authors: Thomas Mini , Ha Aemilio W , Joe Victor C , Chin Theresa L , Bernal Nicole O
Published: March 2020

Introduction

Hospitals constantly invest heavily in improving patient quality and safety metrics. Oftentimes, success is achievable for a single parameter but becomes challenging to achieve in all quality metrics. Our Burn Unit aimed for overarching principles of teamwork and contextual modification to obtain outstanding quality metrics in all six areas of patient quality. This quality improvement project aimed at reducing patient harms related to CLABSI, CAUTI, VTE, C.Diff, Falls, and HAPI.

Methods

Hospital leadership launched a dashboard of all six patient harm areas that is updated and reported daily during the leadership huddle. Apart from ensuring best practices for each quality metric, Burn Unit focused on teamwork and contextual modifications.

Team work: Utilizing engaged multidisciplinary team, apparent cause analysis of identified cases helped in detecting fallibilities. Additionally, proactive actions were implemented for high risk patients by routine audits and discussions during daily rounds. Frequent reminders, appreciations, and celebration of success were also helpful strategies.

Contextual modification: Unit and population specific interventions were actively sought for each quality metric. For HAPI, delineating existing burns or skin conditions from that of hospital acquired pressure injury helped to eliminate false positives. Identification and modification of patient care environment was vital in reducing the number of falls. Chlorhexidine gluconate bathing of burn wounds reduced the bioburden to help decrease CAUTI/CLABSIs.

Results

Burn Unit events related to CLABSI, CAUTI, VTE, C.Diff, Falls, and HAPI were compared to other ICUs, Step down, Telemetry, and Med-Surg units. The BICU was below national benchmarks for all six quality indicators and had outstanding success within the hospital. Our last patient harm was 328 days ago compared to the other 11 units which averaged 32 days. In the non-ICU units, Falls were the most frequent patient harm compared to CLABSI or CAUTIS for the ICUs. In Comparing to previous year, in 2019, BICU progressed in CAUTI, Falls, and HAPI while sustaining 2018 excellence in the other three areas.

Conclusions

Quality metrics can be simultaneously achieved by strengthening team work and contextual modifications beyond following best practices and protocols.

Applicability of Research to Practice

Quality metrics can be simultaneously achieved by strengthening team work and contextual modifications beyond following best practices and protocols.

Strong teamwork from engaged staff and contextual modifications should be intertwined with scientific evidences for obtaining quality metrics in patient care.
588 Defining Components of a Professional Practice Model (PPM) That Drives Growth and Promotes Cultural Change in a Large Regional Referral Burn Center
Authors: Echols Jane , Berry Lisa , Dowling Lynn , Gamble Ashley , Wheeler Michael , Mullins Robert F , Fagan Shawn , Hassan Zaheed , Homsombath Bounthavy
Published: March 2020

Introduction

As a burn center experiences growth and expansion, it is as important for nurse executives and nurse managers to understand the culture of their unit as it is to understand the financial needs of their unit. Culture and philosophy may need to change in order for growth to be realized and often, this is met with resistance. Establishing a new culture that is accepted and that results: in continued successful growth and acceptance of new philosophies begins with implementing a PPM. It is vital that there is acknowledgement of current philosophies and efforts to include input from staff. The goal of this project is to describe efforts taken to create this success.

Methods

Cultural change, along with better staff retention rates was achieved through various efforts such as specialty training/apprenticeship, fostering a nurse mentor program, bridge to nursing efforts for non-licensed staff, and shared governance committees.

Results

In the midst of tremendous growth, we have successfully maintained well below the hospital goal of 15% and in this year, we have seen sustainability of the rates in all units.

TURNOVER RATES (Hospital Goal = 15%)

Conclusions

Implementing various components of a Professional Practice Model in the midst of growth and change, fosters acceptance of cultural change and supports nurse retention efforts during these times.

Applicability of Research to Practice

Evaluating efforts of implementing a PPM validates infrastructure and contributes to overall sustainability.
597 Opioid-limiting Mandate Did Not Increase Readmissions for a Single Burn Center
Authors: Nurczyk Kamil , Sljivic Sanja , Pogson Kaylyn , Chrisco Lori , Nizamani Rabia , Jones Samuel W , Williams Felicia N
Published: March 2020

Introduction

Our state’s Strengthen Opioid Misuse Prevention (“STOP”) Act was enacted on January 1 st 2018 to reduce prescription opioid misuse. We sought to evaluate the impact of opioid-limiting legislation on readmission rates among burn patients to our tertiary care burn center related to uncontrolled pain.

Methods

Patients were identified using an institutional Burn Center registry and linked to clinical and administrative data. All patients admitted between July 1 st, 2014 to June 20 th, 2019 were eligible for inclusion. Injury mechanism categories and reasons for readmissions were evaluated. Statistical analysis was carried out using chi-squared test and significance was accepted as p< 0.05.

Results

Of the 7872 total admissions, 160 (2%) were readmissions. Mean number of readmissions for every year was 32. There was an increase in number of readmissions in 2018 observed but it was not statistically significant (2014 n=12, 2015 n=35, 2016 n=21, 2017 n=33, 2018 n=40, 2019 n=19). The reasons for readmission included wound progression, graft failure, infection, and pain. There was an increase in readmissions for infection, wound progression and graft failure after January 2018, p< 0.05. The percentage of patients readmitted for pain increased between 2014 to 2019 but it was not statistically significant.

Conclusions

The primary reasons for readmissions to our burn center were pain, infection, graft failure, and progression of disease. Despite the opioid-limiting law there was not an increase in readmissions related to pain.

Applicability of Research to Practice

This study demonstrates that our current discharge planning strategies are managing pain expectations for patients. Our focus should be shifted towards improving infection control and wound care.
603 Fluid Considerations: Enhancing Burn Nurse Competency
Authors: Thompson Keith , Castillo Mark A , Santos Adrienne , Helms Alexandra J , Rizzo Julie A , Salinas Victor M , Reid Colleen , Abbott Monica L
Published: March 2020

Introduction

One of the most pivotal points for any burn patient is the initial fluid resuscitation. Nurses must maintain burn competencies and be familiar with perfusion indicators. Diverse levels of experience, unusually low census, frequent staff turnover, and changes in resuscitation strategies prompted concern regarding staff education. We developed a new resuscitation course for burn nurses, and aimed to determine whether it improves their confidence and knowledge.

Methods

Prior to training, a 7-item survey and a 10-item knowledge assessment were distributed to staff to assess baseline knowledge and confidence. In January 2019, nurses were provided a 45-min lecture about the unit’s fluid resuscitation protocol, critical indicators of end-organ perfusion, and adjunctive resuscitation tools. Teams were provided information on a real case scenario and asked to create a resuscitation plan. This was followed by a collaborative discussion. Staff then completed a follow-up survey and assessment. Nurses were provided a copy of the unit’s fluid resuscitation clinical practice guideline and a copy of a peer-reviewed journal article. In April 2019, staff members were not given a lecture, but were asked to repeat the questionnaire portion from the previous course to assess knowledge retention. In August 2019 staff received a 45-min lecture regarding blood gas interpretation as it applies to burn resuscitation, common burn resuscitation missteps, and when to call the physician. Staff received a burn resuscitation checklist to improve nurse/physician communication. The staff was given a 5-item satisfaction survey related to course content.

Results

The initial confidence survey (n=64) overall average was 8/10 with 0 being least confident and 10 extremely confident. The post-training average was 9/10. One of the largest confidence improvements was staff with less than 5 years of burn experience, which increased from 6.5/10 to 8/10. The initial baseline knowledge assessment (n=64) overall average was 80%. The post-lecture assessment average was 94%. The knowledge retention questionnaire (n=48) average score was 90%. Finally, the satisfaction survey (n=60) showed an overall score of 94%.

Conclusions

Data gathered suggest that brief lectures combined with collaborative discussion and case studies may be an effective tool for enhancing burn competencies and confidence among staff, especially for those with less than 5 years’ burn experience. Since this was a small sample size and single-center project, more research is needed to optimize the approach.

Applicability of Research to Practice

Managing burn injuries, particularly in the hours immediately following injury, requires expertise and training. This project provides one method for improving nurse competency.
605 Integrative Nursing for Burn Patients: Necessity for Bridging Gaps in Spiritual Care
Authors: Henderson Tammy L , Thomas Mini , Joe Victor C
Published: March 2020

Introduction

Spirituality is universal and is a major factor in the search for meaning in life. Spiritual care helps to overcome the fear of the unknown and anxiety related to distress or dying. The majority of healthcare providers do not feel competent or confident to deliver spiritual care. Currently there are gaps in spiritual care delivery, despite the availability of spiritual care services during patient’s and families’ imminent spiritual privations.

Methods

A written survey was conducted among the clinical nurses in the burn unit to identify the nurse’s perception regarding spiritual care. The survey was voluntary and anonymous. The survey contained six multiple choice questions and a comment section. (See Table 1)

Results

There was an 88% response rate (n=30) from all nurses (n=34) in the unit. While majority (90.3%) of staff felt spiritual care was an important component in the overall care, only 13.3% felt confident to provide the care. Among the survey participants, 77.4% agreed they had come across a time when they were not able to obtain spiritual care for their patient. Among the survey responders, 77.4% believed a nurse could be trained to deliver spiritual care in urgent situations to fill the gap in the absence of hospital chaplain. Finally, the nursing staff was asked if they would be interested in receiving education and 38.7% agreed they were interested in spiritual care education (Table 1).

Conclusions

Burn unit nurses reported spiritual care as an essential component for the holistic care of patients. However, nurses admit they lack confidence in providing spiritual care and agreed to the need for spiritual care education, with about a third of them being willing to obtain the education. As a result of this assessment, education will be provided to nurses in the burn unit as a pilot project. The overall goal is to educate the nurses throughout the facility who are interested in improving their spiritual care delivery.

Applicability of Research to Practice

Proper nursing education is needed to develop competency and confidence to provide spiritual care and minimize the gaps in spiritual care services during a patient’s imminent death or spiritual distress.