bluuebunny/crossref_metadata_2025 huggingface dataset:
551 Improving Outpatient Access and Reducing Length of Stay Through a Burn Treatment Nurse Pilot Program
Authors: tonkinson tracey , Powell Taylor , Chambers Mona , Sandidge Charles , Orton Caitlin M , Pham Tam N
Published: April 2024

Introduction

To address a growing volume of both external referrals and follow up needs within a regional burn center, the outpatient burn clinic tested the feasibility and potential benefits of a Burn Treatment Nurse (BTN) Program. This pilot utilized a full time RN position to perform wound care for inpatient and outpatient anesthesia assisted procedures (AAP’s), and to independently evaluate acute burn referrals and post discharge patients with a quick turnaround time. This analysis reports on the first 6 months results by service level utilization and performance of initiative.

Methods

The BTN program was implemented following a collaborative effort among the outpatient clinic, the burn service line and hospital administration. As part of the BTN QI tracking, we prospectively collected newly generated clinic revenue, number of independent RN visits, length of inpatient length of stay (LOS) on acute care and collected feedback from provider stakeholders.

Results

At the conclusion of the first 6 months, the BTN program has allowed for an additional 357 patient visits. It generated an additional revenue of $286,129, a 19% increase in revenue for the burn clinic. The BTN also contributed to an overall decrease in LOS on acute care. Pre implementation, mean LOS was 9.2 days, after implementation mean LOS was 6.8 days (Figure 1). Not only did BTN provide positive outcomes for the clinic and hospital, anesthesia and nursing providers expressed an overall feeling of success and strong support for the continuation of the BTN program.

Conclusions

The BTN capability has expanded critical access for those needing expedited outpatient care. This innovative program has improved outpatient access and contributed to decreased inpatient LOS for our regional burn center.

Applicability of Research to Practice

Burn centers with a growing outpatient volume should consider implementing a nurse with flexible inpatient/outpatient roles to improve both outpatient and inpatient access efficiency.
558 Implementation of a Nurse Driven Approach to Early Mobilization of a Cultured Epidermal Autograft Patient
Authors: Snyder Emily , Kastner Kara M
Published: April 2024

Introduction

Early mobilization in those who suffer burn injuries is a vital part of recovery. Early mobilization can decrease length of stay, promote independence, minimize weakness and increase range of motion (ROM) (McGillicuddy et al., 2022). The use of cultured epidermal autograft (CEA) can often limit early mobilization in the burn patient due to the risk of graft loss/shearing. A nurse driven early mobilization protocol was implemented on a single patient with 45% TBSA who received two rounds of CEA.

Methods

Nurse driven early mobilization was completed on a single patient after the risks/benefits were discussed with the burn physician. Preceding the surgical application of the CEA, a collaborative multidisciplinary approach was taken to create a mobilization schedule for the patient.

The Burn Educator (BE) provided 1:1 early mobilization education, a daily patient schedule, and a helpful tip handout for the RN team to reference with a goal of preventing graft loss/shearing.

The first stage of CEA was placed to the patient’s back and thighs. Beginning on post-operative day (POD) four, the Burn Nurse Supervisor, BE, and bedside RN began mobilizing per the schedule. The patient was assisted to the edge of the bed (EOB) utilizing an inflatable positioning mat. The patient would then stand and walk inside the room. During the drying time, the patient would alternate positions between sitting EOB, chair, and/or prone in the bed with the assistance of the RN or therapy team. On POD six, the patient returned to the operating room for additional CEA placement to bilateral arms. The patient continued to mobilize every day after POD six, increasing his standing and walking time each day.

Results

Early Mobilization of this patient did not compromise the integrity of the CEA. Some slight sheering to the back on one thigh was noted due to the patient moving up in the chair without RN assistance. The patient was discharged home from the hospital after 48 days, not requiring transfer to a rehabilitation facility.

Conclusions

In this single case study review, it was concluded that with proper education and collaboration with a multidisciplinary burn team, a nurse driven early mobilization protocol resulted in no significant graft loss/sheering. Additionally, it aided in the prevention of complications associated with prolonged immobility, allowing the patient to discharge home and eliminating the need for inpatient rehabilitation.

Applicability of Research to Practice

Early mobilization can be applied to patients who have received CEA without risking harm to the graft sites. However, clear communication and planning is necessary to be successful.

References:

McGillicuddy, J., Bello, G., Bergeron, K., & Lee, J. (2022). 71 burn intensive care unit early mobility competency based orientation. Journal of Burn Care & Research, 43(Supplement_1), S48–S48. https://doi.org/10.1093/jbcr/irac012.074
569 Insurance Payor Increases the Incidence of Depression and PTSD in Burn Patients
Authors: Pezzopane Laura K , Loftus John , McGuire Beth , Bean Toni , Fornalski Nicole , Bernal Nicole P
Published: April 2024

Introduction

Intriduction: Work-related burn injuries have the added stress of dependence on a third-party payor. Patients using Bureau of Worker’s Compensation (BWC) report frustration and dissatisfaction with the claim coverage process. In 2021, based on our initial study's result, we began using the Patient Health Questionnaire-9 (PHQ-9), a 9-item DSM-IV-based self-reported depression screening tool. We added the PTSD Checklist (PCL-5), a 20-question self-administered screening tool to screen for Post-Traumatic Stress Disorder (PSTD). We hypothesized that there is a correlation between insurance type and increased scores on the PHQ-9 and PCL-5. We hypothesized that the risk of depression and PTSD is affected by a patient’s access to care, referral approval, and financial burden of treatment, and differs based on payor.

Methods

Method: A retrospective review of our outpatient database was conducted of burn clinic visits with a completed PHQ-9 and PCL-5 between 7/1/2021-6/30/2023. This was considered exempt by the IRB (Institutional Review Board) committee based on use of deidentified database. The PHQ-9 is completed at initial visit and then once every 2 weeks; the PCL-5 on initial visit and then once per month. This data was recorded in the EMR (Electronic Medical Record) flowsheet and then transferred to the deidentified database. Additional information analyzed included total body surface area (TBSA) and need for admission and/or surgical procedure.

Results: Results

1401 visits with PHQ-9 and PCL-5 collection were reviewed. The average scores for both the PHQ-9 and PCL-5 were higher with patients that had BWC as their payor with a significant difference in the PHQ-9. (Table 1) The TBSA was significantly higher in the patients that underwent surgery and/or admission. This group of patients, those that required surgery had significantly higher PHQ-9, and a trend toward higher PCL-5 scores. (Table 2) When divided into the payors, the BWC group has the highest PHQ-9 and PCL-5 scores, but total patients are too small in each group to establish significance.

Conclusions: Conclusions

Compared to the preliminary study, we can say with confidence that patients with BWC are at higher risk for depression and PTSD. The limitation of this study design does not allow us to determine causality, and patient reported outcomes would be necessary. There is an additional increased risk of depression and PTSD if the outpatient requires surgery with or without admission.

Applicability of Research to Practice: Applicability of research to practice

This research is designed to identify specific needs in work-related injuries in hopes of BWC changing this practice.
593 Pilot Study: Self-scheduling Therapy Increases Burn Patients' Activity Tolerance and Compliance
Authors: Bell Kara L
Published: April 2024

Introduction

During a hospital visit, patients often lack autonomy in making decisions for aspects of their patient care (e.g., meal times, medication management, procedures, dressing changes, labs/vitals, etc.). Prior research shows that patient autonomy in clinical decision making can yield positive results in treatment related-decisions (Jonsen et al., 2002). The purpose of this pilot study was to study the effect of having patients schedule their own therapy timing on PT/OT activity compliance and tolerance in a burn population.

Methods

This is a prospective pilot study conducted on weekdays from January through March of 2023. Study participants consisted of all adult burn admissions with TBSA >5%. Patients with necrotizing fasciitis, Stevens Johnson syndrome, and toxic epidermal necrolysis with therapy consults were also included. Patients were excluded if intubated and re-assessed following extubation once alert and oriented. All aspects of the study were completed by the Burn Coordinator on staff. As part of this pilot project, each patient was evaluated by PT/OT and given the opportunity to choose a therapy time for all following visits as appropriate. Therapy schedules were subject to be adjusted based on medical holds and restrictions. Once the therapy time was determined, a laminated sheet was placed on each patient’s door identifying the therapy time for the day to coordinate with other disciplines. Next, a therapy log was compiled and audited weekly by the Burn Coordinator. Nursing staff were also educated at shift change by the Burn Coordinator. The Burn Coordinator maintained a printed schedule with patient times and had the ability to adjust scheduling due to time conflicts, admissions, and discharges. Patients not requiring a co-treatment were seen sequentially by PT/OT to maintain consistency with a self-scheduled timeline. Participant’s PT/OT compliance and tolerance post-pilot will be compared to their compliance and tolerance pre-pilot (October-November 2022) where therapists were responsible for patient scheduling per their availability.

Results

Participant’s PT/OT compliance and tolerance was compared to the prior standard of care at the institution. Prior to the pilot study, there was a higher incidence of declining therapy services for PT/OT when the provider chose the time. During study there was a decrease in decline of therapy services, increased time tolerated during session, increased total number of visits, and increase in early mobility. The number of therapy visits pre vs post study was found to be statistically significant.

Conclusions

Patient autonomy in therapy selection time leads to increased tolerance and compliance in a burn patient population.

Applicability of Research to Practice

-Identifies the need for self scheduling to increase functional outcomes

-The project empowered the burn patients to have autonomy within their acute care stay
611 Comparison of Autologous Skin Cell Suspension to Conventional Surgical Treatment in Burn Patients
Authors: King booker , Carter Elisabeth A , William Dabbs , Agala Chris B , Chrisco Lori , Williams Felicia
Published: April 2024

Introduction

In 2018, a device was approved for the treatment of burn injuries. This autologous cell harvesting device is used for the delivery of a regenerative cell suspension, utilizing a patient’s own skin. The study aims to examine outcomes of the device compared to conventional surgical treatment in adult burn patients.

Methods

A retrospective study of burn outcomes in burn patients, admitted from 2015-2022 to a single burn center, was conducted investigating the clinical performance of the autologous skin cell suspension (ASCS) to conventional surgical treatment. Patients ≥18 years of age, with a total body surface area (TBSA) of ≥20% were included. Data were collected utilizing the burn registry and chart review. Patients were divided into two groups: those who received ASCS and those who received conventional surgical treatment (control). We used Fisher’s exact and chi square tests to compare categorical variables, Wilcoxon rank sum test for continuous variables to conduct between-group comparisons, and generalized linear models to assess associations between predictors and outcomes.

Results

A total of 229 patients were identified, 78 were treated with ASCS, and 151 patients received control. Baseline characteristics were comparable in the two groups. The average cost for the ASCS group was $1,244,219 while the control group was $866,072 which was statistically significant. Mean post-hospital plastics clinic visits in the ASCS group was 6.1 and 6.7 in the control group. The mean burn clinic visits was 4.2 among ASCS patients, compared to 3.7 in control group. After adjustment from baseline characteristics, the ASCS group were less likely to be on a ventilator (OR: 0.31, 95% CI: 0.13-0.70); had 1.2 times the number of burn clinic visits than control (IRR: 1.2, 95% CI: 1.03-1.39); LOS for the ASCS group was 0.86 times that of the control group (IRR:0.86, 95% CI: 0.83-0.89); and wound healing was lower (0.82 times) than that of control (IRR:0.82, 95% CI:0.79-0.84); shorter ICU LOS (IRR: 0.56, 95% CI:0.53-0.59); fewer plastics clinic visits (IRR:0.84, 95% CI: 0.70-0.99); fewer vent days (IRR:0.55, 95% CI: 0.52-0.58); 7% higher hospital cost (IRR:1.07, 95% CI: 1.07-1.07). There was no difference in mortality between the groups.

Conclusions

The findings of this study show that receipt of ASCS may be beneficial to some patients by reducing the likelihood of ventilator dependence, quicker wound healing, shorter ICU stay, shorter hospital LOS, fewer plastics clinic visits and slightly higher hospital cost, but no difference in mortality.

There is a need for a multi-center, retrospective study to better understand the benefits of using an autologous skin harvesting device in the treatment of large burns.

Applicability of Research to Practice

Further understanding the impact of surgical interventions will assist in better surgical outcomes in the burn population.
715 Initial Use of PLA Skin Substitute at a Large Public Safety-Net Hospital
Authors: Delamater Jessica , Shagabayeva Larisa , Cobler-Lichter Michael , Collie Brianna L , Lyons Nicole B , Satahoo Shevonne S , Kaufman Joyce I , Pizano Louis R , Schulman Carl I
Published: April 2024

Introduction

The loss of available xenograft as a skin substitute posed significant problems for our burn patients with partial thickness burns and the inability to transition to outpatient wound care or with intractable pain. This led to increasing length of stay and increased utilization of resources. The public hospital system was also challenged with additional unique patient problems that were left without a good solution. We hypothesized that the introduction and use of a PLA skin substitute had decreased costs and utilization of resources after its introduction into a large public safety-net hospital.

Methods

We began using a PLA skin substitute in April 2022. The hospital length of stay for patients admitted to the burn floor was compared for 3 months before and after the introduction of the PLA skin substitute. To account for the transition and ramp up of use, January through March were compared to June through August, thereby excluding April and May as a transition period. In addition, the utilization of enzymatic debridement and its cost were also compared for 3 months before and after the PLA skin substitute was introduced.

Results

The number of tubes of enzymatic debridement went down from 308 to 142 with an associated cost savings of $38,000. Additionally, the length of stay decreased from an average of 13.5 days to 8.9 days. Given the cost of a single hospital day this extrapolates to a yearly savings of over $200,000. It was also noted that certain patient populations that traditionally had a difficult time transitioning to outpatient care, such as homeless patients and international patients, were more quickly discharged after PLA skin substitute placement.

Conclusions

This study demonstrated a decrease in both resource utilization and costs very quickly after the introduction of a PLA skin substitute in a large public safety net hospital. Future studies need to look at longer times before and after the introduction of the skin substitute to validate that these reductions are sustained.

Applicability of Research to Practice

These findings suggest both patients and health care systems may benefit from more widespread use of a PLA skin substitute in the treatment of burn patients.
739 Epidemiology of Accidental Burn Injuries: National Trends in Hospitalizations and Emergency Department Visits (2017-2022)
Authors: Little Darby , Mason Stephanie A
Published: April 2024

Introduction

Understanding the evolving epidemiological trends of burns is essential for informing prevention strategies and healthcare resource allocation. While previous studies have described these trends within specific provinces, a comprehensive analysis of country-wide data is lacking.

Methods

We conducted a national retrospective population-based study of all burn-related emergency department (ED) visits and hospitalizations over a 5-year period (2017-2022). Data were extracted from a national repository of health administrative data. Injuries due to assault and suicide attempt were not included.

Results

Over a 5-year period there were 13,795 burn-related hospitalizations. There were four burn injury mechanisms identified in the database, from least to most common being related to electric current, explosion, fire and flame, and hot substances. The incidence of burns requiring hospitalization in the country remained constant over the 5-year period at 0.007%, though the absolute number of admissions generally increased over time. ED visit data were only available for 6 provinces in which there has been an overall decline in burn-related ED visits. The overall incidence of burns presenting to the ED decreased from 0.13% to 0.12% over the study period. Furthermore, the proportion of ED visits requiring hospitalization has increased over time from 5.4% to 6.4%.

Conclusions

In summary, this national population-based study of burn injuries from 2017-2022 has demonstrated that while the incidence of burn-related ED visits in several provinces has decreased, the national incidence of burn-related hospitalizations in the country has remained stable. These findings shed light on the changing landscape of burn injuries and underscore the need for continued monitoring and targeted prevention strategies.

Applicability of Research to Practice

This study offers important insights into the epidemiology of burn injuries from 2017-2022 and provides a foundation for evidence-based decision-making in burn injury resource allocation.
754 Venous Thromboembolism Incidence and Risk Factors in Burn Patients
Authors: Stanton Eloise , Yenikomshian Haig A , Gillenwater Justin
Published: April 2024

Introduction

In burn care, there is a noticeable lack of comprehensive studies on the incidence and risk factors related to Venous Thromboembolism (VTE) in burn patients. Understanding VTE in this context is crucial, as it can lead to severe complications and patient morbidity/mortality. This abstract investigates VTE incidence and risk factors in burn patients in hopes of informing VTE prevention measures and improving overall patient care in the field of burn medicine.

Methods

We conducted an analysis of the US National Trauma Data Bank (NTDB) spanning from 2007 to 2021 to identify burn-injured patients. Our primary focus was on determining the incidence of VTE. As predictor variables, we considered factors such as age, sex, smoking status, history of anticoagulation use, diabetes, and prior history of stroke. We abstracted comorbidities using event codes within the database.

Results

442,623 patients were identified who had sustained burn injuries within the NTDB between 2007 to 2021. Among this cohort, 7,384 individuals (approximately 1.7%) experienced a VTE event during their hospitalization. Of these, 4,138 (56.0%) were deep vein thromboses and 1,504 (20.4%) were pulmonary emboli. Patients with VTE were significantly older than those without (37.7 versus 35.2, p < .001) and were significantly more likely to be male (82.5% vs. 78.9% p < .001) and obese (7.4% vs. 3.4% p < .001). Patients with VTE also had significantly higher %TBSA burns (16.5% vs. 13.2%, p < .001). Patients with VTE were also significantly more likely to be smokers (28.9% vs. 26.5%, p=.025), have preexisting hypertension (9.0% vs. 8.1%, p=.002), have a previous myocardial infarction (7.5% vs. 4.8%, p < .001), have alcohol use disorder (14.0% vs. 6.6%, p < .001) or have substance abuse (31.7% vs. 20.1%, p < .001). There were no signficant differences between the two cohorts in regard to history of stroke, peripheral vascular disease, diabetes mellitus, steroid use, or renal disease (Table 1).

Conclusions

This study sheds light on several risk factors, including age, obesity, male sex, and comorbidities such as hypertension, myocardial infarction, and substance use disorders, which merit attention in clinical practice when selecting VTE prevention strategies. Addressing these factors and developing tailored interventions can help improve patient care, mitigate complications, and enhance outcomes. This study underscores the importance of considering VTE risk in burn patients as an integral component of comprehensive burn care.

Applicability of Research to Practice

By identifying specific risk factors and highlighting the incidence of VTE among burn patients, healthcare providers can implement more targeted VTE prevention and management strategies. This knowledge empowers clinicians to make informed decisions, ensuring that patients receive timely and tailored interventions, ultimately enhancing the quality of care and patient outcomes in the management of burn injuries.
756 Key Characteristics and Best Practices for Burn Patient Education: A Modified Scoping Review and Comparison
Authors: Smith Grace E
Published: April 2024

Introduction

Within the Western industrialized countries, the incidence of burns is roughly 40,000 per year in the United States. There are currently 69 verified burn centers in the United States. Providing optimal burn care requires centers to provide an intensive team, increased knowledge, and various equipment.1 Because of the high incidence of burn injuries in the United States, educational material is provided to patients during their recovery. However, 36% of the United States adult population has limited health literacy skills, likely, many patients don't understand all of the written materials they receive. Individuals with a lower health literacy are more likely to be readmitted to the hospital after discharge. Adapting patient education materials to meet personalized characteristics can increase patient’s recovery.

Adapting patient education materials may address diversity, equity, inclusion (DEI), trauma-informed care (TIC), and health literacy.

Methods

A modified scoping review and PRISMA guidelines5 were used to answer two questions: 1. What are the key characteristics and best practices in DEI, TIC, and Health Literacy in patient education for established burn centers? 2. What are the characteristics of patient education in established burn centers in DEI, TIC, and Health Literacy?

Results

A Key Characteristic Chart was developed, and a sample of best practice recommendations for mental health, gender neutral, language, and grade level based on the literature. After, two collections were reviewed using the Key Characteristic Chart. A sample of DEI, TIC, and Health literacy characteristics provides data on two collections.

Conclusions

This comparison of the two collections revealed multiple characteristics relating to DEI, TIC, and health literacy. Continuation of developing adapted patient education from the two collections may improve patient-centered care relating to DEI, TIC, and health literacy.

Applicability of Research to Practice

Providing patient-specific rather than general information can increase knowledge and satisfaction and decrease anxiety.6 Healthcare professionals need in-service training on providing patient education through multiple teaching strategies. There should also be a focus on minimizing trauma to burn survivors from the earliest point of contact and throughout the recovery journey. This includes providing patient education that shows characteristics of TIC to emphasize safety from physical and emotional harm and re-traumatization.
760 Simulation Enhances Resident Performance Using Autologous Skin Cell Spray
Authors: Schulman Carl I , Satahoo Shevonne S , Pizano Louis R , Kaufman Joyce I
Published: April 2024

Introduction

Surgical simulation has been shown to improve efficiency, performance, and shorten time to mastery for complicated operative procedures. Newer technologies used in the operating room can add to this complexity, especially in a training environment. Simulation training is not always considered when introducing a new medical device or product into the operating room. We hypothesized that simulation training would improve confidence and performance when using Autologous Skin Cell Spray (ASCS) in surgery residents during their burn rotation.

Methods

The training was performed at the Surgical Training & Education Center at a large academic medical center. Residents were asked to read the instructional materials and watch the training videos before coming into the simulation lab. During the lab training, the resident performed each step of the process themselves while proctored by the burn attending and the simulation lab director. The process was allowed to proceed as slowly as necessary while answering all questions and providing feedback to the resident on their performance. A qualitative survey using a five-point Likert scale (strongly disagree, disagree, neutral, agree, strongly agree) was administered after their burn rotation.

Results

Eight PGY3 residents completed the training and subsequently used ASCS in the OR. The survey evaluated their perceptions about the training program and its translation into performance in the OR. The program was felt to be of appropriate length (4.5/5) and thoroughness (4.625/5). There was very high agreement that the simulation training improved their confidence (4.25/5), independence (4.75/5) and performance (4.75/5) when using ASCS in the OR. Each resident used ASCS an average of 2.5 times during their 2-month rotation.

Conclusions

Integrating simulation training improved self-reported confidence, independence, and performance for surgical residents using ASCS. Simulation training has the potential to decrease the time to proficiency and independent use of new technologies in the burn operating room. It may also increase efficiency and decrease operative time, especially in academic training programs. Further research is needed to quantify these real-world benefits.

Applicability of Research to Practice

This study enhances our understanding of using simulation to enhance resident performance using complex new technologies on burn patients.
777 The Impact of Cutaneous Functional Unit Concepts on Myoelectric Prosthetic Training Following Electrical Injury
Authors: McGillicuddy Jennie , Lee Jeanne , Hinchcliff Katharine Moss
Published: April 2024

Introduction

Myoelectric prosthetics are an emerging technology assisting those affected by limb loss with resuming functional use of a dominant side. Functional arm use involves action in a variety of planes. Traditionally Range of Motion (ROM) is evaluated and treated from an arthrokinematic standpoint. However in cases of limb loss with significant compromised tissue, such as electrical burns, prosthetic training may be optimized if a cutaneokinematic approach is utilized, with regard to Cutaneous Functional Units (CFU).

Methods

A 23-year-old man presented to Occupational Therapy after sustaining an electrical injury necessitating trans-radial amputation and skin grafting of the dominant arm. The treatment plan included training of muscle sites of the forearm with electrodes placed over the muscles of grafted areas for myoelectric prosthesis operation. The client identified meaningful tasks and terminal device (TD) grips including handshake grip for interviews, cylindrical grip for moving a water bottle to a desk, lateral grip for tablet carrying, and 2 point pinch for shoe tying. Practical application of CFU concepts were introduced early. The grasp of the TD was measured at table top height and during actual tasks. Percentage of accuracy with full electrode connectivity for operation of the TD with 5 repetitions was measured over 12 weeks.

Results

Training in functional planes in consideration of CFU required more overall time as related to electrode connectivity for muscle site activation of a TD (Table 1). This time was necessary for client-centered care.

Conclusions

Skin recruitment shifts due to burn scars, impacting electrode connectivity specifically during function as compared to at a tabletop height. Factors such as muscle site strength, endurance and signal separation, as well as positive changes in soft tissue from scar management interventions are considered as related to results. However it is apparent that early incorporation of CFU principles results in functional long term gains. The ability to shift CFU concepts from principles into practice over the continuum of care is a valuable tool for increasing efficacy of targeted training.

Applicability of Research to Practice

As CFU principles transition to be a focus of care, further study is needed on the direct impact of CFU on function with more participants following electrical injury and limb loss, which may assist with guiding and shifting treatment approaches.
796 Free Flaps in Acute Burns: A 12-Year Single-Center Experience and Systematic Review of the Literature
Authors: Egro Francesco , Arellano Jose Antonio , Liu Hilary , Alessandri-Bonetti Mario , Jeong Tiffany , Kasmirski Julia , Ziembicki Jenny A , Stofman Guy M
Published: April 2024

Introduction

Free tissue transfer is usually considered a last resort in severe burn cases when local flaps are not a viable option. Since free flaps are seldom employed in burn reconstruction, there is a paucity of literature on the topic, especially in acute burn reconstruction. The aim of the study is to describe outcomes of burn patients requiring free tissue transfer at a single institution and review free flap failure in acute burn reconstruction reported in the literature, especially regarding how timing affects outcomes.

Methods

A retrospective cohort study was conducted to review all patients who underwent free tissue transfer for burn-related injuries at a single institution between 2012 and 2023.

A systematic review and meta-analysis was conducted according to PRISMA guidelines and registered on the PROSPERO database (CRD42023404478). The following databases were accessed: Embase, PubMed, World of Science, and Cochrane Library. Studies reporting the free flap failure rate in burn patients were included.

Results

12 patients required a free flap for their reconstruction. Ten flaps were performed during the acute care and two were performed for delayed reconstruction. The mean age was 44.8◻16.6 years, and the mean BMI was 25.8◻6.7. The mean follow-up time was 13.8◻14.6 months. The most common indication for free flap reconstruction was bone exposure (92%). The overall complication rate was 50%. Major complications included free flap loss (17%), hematoma (17%), infection (8%), venous thrombosis of the anastomosis (17%), and amputation (8%). 42% of the patients required re-operations.

In the literature, 454 free flaps were performed for acute burn reconstruction in 427 patients, with a total flap loss rate of 9.91% [95% CI: 7.48%, 13.02%]. Data on acute burn reconstruction timing from the injury was available for 275 flaps performed in 260 patients (88% male, 12% female). The pooled prevalence of free flap failure in three different time intervals ( < 5 days, 5-21 days, 22 days-6 weeks) was 7.32% [95% CI: 2.38% - 20.37%], 15.75% [95% CI: 10.70% - 22.59%], and 6.82% [95% CI: 3.10% - 14.36%], respectively.

Conclusions

Free flap reconstruction carries a high risk of complications and should be considered only as a last resort for limb or life-threatening situations. However, the timing of the reconstruction appears to influence surgical outcomes. Free flap reconstruction performed between day and day 21 from burn injury had a trend towards higher flap loss rates.

Applicability of Research to Practice

This research provides valuable insights into the applicability of free tissue transfer in burn reconstruction. This study demonstrates the high complication risk associated with free flap reconstruction and emphasizes the potential impact of timing on surgical outcomes, which can inform clinical practice and decision-making in severe burn cases.
Preclinical development of EXT608, an investigational parathyroid hormone derivative with extended half-life for the treatment of hypoparathyroidism
Authors: Hall Daniel B , Kostyla Caroline H , Hales Laura M , Soliman Tarik M
Published: April 2024

Hypoparathyroidism, a deficiency of parathyroid hormone (PTH), results in hypocalcemia, hyperphosphatemia, and hypercalciuria. The disease is poorly controlled by calcium and vitamin D supplements or native PTH(1-84) replacement therapy. A version of PTH is being developed using D-VITylation technology, whereby vitamin D is conjugated to a therapeutic peptide, which confers a long plasma half-life by virtue of binding to the abundant vitamin D binding protein (DBP). D-VITylation of PTH caused no reduction in activity at the PTHR1 receptor, and resulted in a plasma elimination half-life of 7–15 h in rats and 24–32 h in cynomolgus monkeys. Analysis of steady-state pharmacokinetics as a function of dose showed flat profiles with smaller peak:trough ratios at low doses, indicative of slower subcutaneous absorption. In thyroparathyroidectomized (TPTx) rats, PTH(1-34)-vitamin D conjugates restored serum calcium and phosphate levels into the normal range over the 24 h dosing period, and increased bone turnover markers and reduced bone mineral density. Urinary calcium was initially elevated, but normalized by the end of treatment on day 27. In healthy monkeys, a single dose of PTH(1-34)-vitamin D conjugates elevated serum calcium levels above the normal range for a period of 24–48 h while simultaneously reducing urinary calcium. Therefore, the lead compound, EXT608, is a promising candidate as a therapeutic that can truly mimic the endogenous activity of PTH and warrants further study in patients with hypoparathyroidism.
Sex dimorphic response to osteocyte miR21 deletion in murine calvaria bone as determined by RNAseq analysis
Authors: Peng Gang , Deosthale Padmini , Pianeta Roquelina , Messersmith Hannah M , Plotkin Lilian I
Published: April 2024

Low levels of microRNA (miR) 21 may explain the higher osteocyte apoptosis with Cx43-deficient and aged female mice. However, miR21 exerts a sex-divergent role in osteocytes, regulating bone mass and architecture through non-cell autonomous effects on osteoblasts and osteoclasts, via sex-specific regulation of osteocyte cytokine production. miR21 deficiency improves bone strength in females, and, to a higher extent, in male miR21-deficient mice. To understand the molecular basis for the effects of miR21 deletion, mRNA was isolated from miR21fl/fl (controls) or miR21-deficient (by deletion in cells expressing Cre recombinase under the control of the 8 kb fragment of the DMP1 promoter: miR21ΔOt mice). miR21 was 50% lower in miR21ΔOt whole calvaria bone compared to control mice of the corresponding sex. RNAseq was performed in 4 samples/sex and genotype. There were 152 genes with <.05 P-value and >1 absolute log2 fold change in the male data analysis, and expression of most genes was higher in the miR21fl/fl group. Two of the genes, Actn3 and Myh4, had a false discovery rate < 0.1. Gene enrichment analysis of significant genes on both KEGG pathways and gene ontology (GO) gene sets shows that the significant genes were enriched in muscle contraction. Some muscle-related genes like Actn3 were included in multiple significant pathways. For females, only 65 genes had P-value <.05 and >1 absolute log2 fold change. Yet, no significant KEGG or GO pathways, including ≥5 significant genes, were seen, and no overlap of significant genes was found between male and female samples. Therefore, deletion of miR21 has a stronger effect on male transcriptome in calvaria, compared to females. Further, no enrichment of any pathway was detected in female samples. Thus, either there are no differences between 2 groups in female or the effect size is small, and a larger sample size is needed to uncover miR21-dependent differences.
Novel chikungunya and dengue vaccines: travel medicine applications
Authors: Steffen Robert , Hamer Davidson H , Chen Lin H , Caumes Eric , Lau Colleen L
Published: April 2024

Recent epidemics of dengue and chikungunya have highlighted the urgent need for vaccines to reduce the risk of infection in travellers. Given challenges with tracking chikungunya outbreaks in real-time and the widespread resurgence of dengue, broader indications for the use of the new chikungunya and dengue vaccines should be considered.
Verifying the nonreporting hemolysis index for potassium, phosphate, magnesium, AST, LDH, iron, CA 19-9, and vitamin D, using Beckman Coulter AU5800 and DxI800 automated analyzers
Authors: Sheerin Samuel
Published: April 2024

Background

Hemolysis is a common reason for nonreporting results in biochemistry and is measured using the hemolysis index (HI), with nonreporting limits set for analytes by manufacturers.

Objective

To verify the nonreporting HI limit for potassium, phosphate, magnesium, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), iron, CA19-9, and vitamin D on the Beckman Coulter AU5800/DxI800 analyzers.

Method

Hemolysate was created from EDTA-lined tubes of whole blood using an osmotic shock procedure. The hemolysate underwent serial dilutions with saline and was spiked in paired serum. The delta changes in HI and analyte concentration were measured, assessed using regression analysis, and compared against calculated reference change values.

Results

A linear relationship between increasing HI and increasing analyte concentration (R2 > 0.9) was observed for potassium (y = 0.8864x), phosphate (y = 0.1079x), magnesium (y = 0.0678x), AST (y = 29.035x), and LDH (y = 350x). Increasing HI values did not have a linear effect on iron (y = −0.2544x), CA19-9 (y = 2.7019x), or vitamin D (y = 8.036x) concentrations.

Conclusion

The results from this experiment support increasing the HI nonreporting limit to 100 mg/dL for potassium; 200 mg/dL for magnesium; and 300 mg/dL for phosphate, CA19-9, and vitamin D. The iron assay is not affected by hemolysis as high as 500 mg/dL. The current HI nonreporting limit of 50 mg/dL is appropriate for LDH.
Atmospheric characterization and tighter constraints on the orbital misalignment of WASP-94 A b with HARPS
Authors: Ahrer E , Seidel J V , Doyle L , Gandhi S , Prinoth B , Cegla H M , McDonald C H , Astudillo-Defru N , Ayache E , Nealon R , Veras Dimitri , Wheatley P J , Ehrenreich D
Published: April 2024

We present high spectral resolution observations of the hot Jupiter WASP-94 A b using the HARPS instrument on ESO’s 3.6-m telescope in La Silla, Chile. We probed for Na absorption in its atmosphere as well as constrained the previously reported misaligned retrograde orbit using the Rossiter–McLaughlin effect. Additionally, we undertook a combined atmospheric retrieval analysis with previously published low-resolution data. We confirm the retrograde orbit as well as constrain the orbital misalignment with our measurement of a projected spin-orbit obliquity of λ = 123.0 ± 3.0°. We find a tentative detection of Na absorption in the atmosphere of WASP-94 A b, independent of the treatment of the Rossiter–McLaughlin effect in our analysis (3.6σ and 4.4σ). We combine our HARPS high-resolution data with low-resolution data from the literature and find that while the posterior distribution of the Na abundance results in a tighter constraint than using a single data set, the detection significance does not improve (3.2σ), which we attribute to degeneracies between the low- and high-resolution data.
On the detection and precise localization of merging black holes events through strong gravitational lensing
Authors: Wempe Ewoud , Koopmans Léon V E , Wierda A Renske A C , Hannuksela Otto A , Van Den Broeck Chris
Published: April 2024

To unlock the full spectrum of astrophysical and cosmological applications of gravitational-wave detections, it is essential to localize the associated black hole mergers to high precision inside their host galaxies. One possible method to achieve this is to compare the properties of multiple detections of gravitationally lensed binary black hole merger events with the properties of strong gravitational lens systems located in the joint sky localization of the gravitational-wave detections. In this work, we simulate the population of binary black hole mergers lensed by galaxy-scale lenses and detectable by LIGO-Virgo-Kagra in the coming decade and the population of galaxy-scale strong lenses that will be detected by Euclid. We use these simulations to investigate the prospects for localizing strongly lensed binary black hole mergers inside the lensed galaxies of ‘Euclid-like’ galaxy-scale strong lenses. We find that for 20–$50\, \rm \%$ of strongly lensed gravitational-wave events the lens system is detectable with Euclid, if the event falls in its survey footprint. Of these, we expect to correctly identify the strongly lensed host galaxy as likely (with posterior probability) host galaxy – based on Bayesian evidence ranking of candidate hosts – for 34.6–$21.9\,\mathrm{ per\,cent}$ of quadruply lensed gravitational-wave events when given an a priori 1–5 $\deg ^{2}$ gravitational-wave-only sky localization. For triply and doubly lensed gravitational-wave events, this becomes 29.8–$14.9\,\mathrm{ per\,cent}$ and 16.4–$6.6\,\mathrm{ per\,cent}$ respectively. If successfully identified, however, the localization can be better than a fraction of the host-galaxy size, i.e. of order milli-arcseconds. A first detection in the coming decade, however, probably requires dedicated deep and high-resolution follow-ups and continued upgrades in the current and planned gravitational-wave detectors.
Increasing the power of weak lensing data with multipole-based intrinsic alignment estimators
Authors: Singh Sukhdeep , Shakir Ali , Jagvaral Yesukhei , Mandelbaum Rachel
Published: April 2024

It has long been known that galaxy shapes align coherently with the large-scale density field. Characterizing this effect is essential to interpreting measurements of weak gravitational lensing, the deflection of light from distant galaxies by matter overdensities along the line of sight, as it also produces coherent galaxy alignments that we wish to interpret in terms of a cosmological model. Existing direct measurements of intrinsic alignments using galaxy samples with high-quality shape and redshift measurements typically use well-understood but sub-optimal projected estimators, which do not make good use of the information in the data when comparing those estimators to theoretical models. We demonstrate a more optimal estimator, based on a multipole expansion of the correlation functions or power spectra, for direct measurements of galaxy intrinsic alignments. We show that even using the lowest order multipole alone increases the significance of inferred model parameters using simulated and real data, without any additional modelling complexity. We apply this estimator to measurements of parameters of the non-linear alignment model using data from the Sloan Digital Sky survey, demonstrating consistent results with a factor of ∼2 greater precision in parameter fits to intrinsic alignments models. This result is functionally equivalent to quadrupling the survey area, but without the attendant costs – thereby demonstrating the value in using this new estimator in current and future intrinsic alignments measurements using spectroscopic galaxy samples.
Disentanglement of the chemodynamical assembly: mapping the Milky Way discs
Authors: Cantelli Elvis , Teixeira Ramachrisna
Published: April 2024

The formation and structure of the Milky Way have a fundamental role in our understanding of the universe and its evolution, and thanks to the Gaia mission and large spectroscopic surveys, we live an exceptional moment of data availability, allowing us to trace the building blocks of the Galactic disc and their relations. In this sense, we propose here the exploration of a large data set in a top-down fashion, elaborating a similarity map of the local Galactic volume in order to segregate and characterize its main components, searching for hints about their relations. We have used the t-SNE algorithm with chemical, orbital and kinematic properties of the stars to produce 2D manifolds and dissect their structure by isolating populations to further analyse their behaviour. The young thin disc could be clearly separated from the older thick disc, also showing a puzzling transition zone with hints about the aftermath of the Gaia–Sausage–Enceladus merger. Moving groups and resonant features also appear prominently in the maps, splitting the disc into inner and outer portions as consequence of the resonances produced by the Galactic bar. The dynamical halo appears as an extreme end related to the heated portion of the thick disc, showing sub-structures corresponding to known accreted populations. Open and globular clusters also appear in their chemical/evolutionary context. We present details of the developed strategy, an overview of the different populations and their relations, as well as a discussion and insights of our results in the scenario of Galactic evolution.
On the inefficiency of particle re-acceleration mechanisms in the cores of massive stellar clusters
Authors: Vieu T , Härer L , Reville B
Published: April 2024

We consider scenarios for non-thermal particle acceleration and re-acceleration in the central cores of compact massive star clusters, aided by insights from high-resolution hydrodynamic simulations. We show that (i) particles are unlikely to interact with many shocks during their lifetimes in the core; (ii) colliding flows do not produce hard spectra; and (iii) turbulent re-acceleration in the core is suppressed. Inefficient re-acceleration mechanisms are not expected to produce hard components nor to increase the maximum energy within the cores of massive star clusters. Models in which the observed ultra-high-energy gamma rays originate in the core of massive stellar clusters are thus disfavoured.