bluuebunny/crossref_metadata_2025 huggingface dataset:
621 Ethical Considerations to Prevent Burns in Patients Who Smoke While Receiving Home Oxygen Therapy
Authors: Khoo Kimberly H , Yoon Joshua S , Hultman Charles S , Caffrey Julie
Published: March 2022

Introduction

Home oxygen therapy (HOT) is prescribed to patients with pulmonary dysfunction as a means of improving survival and quality of life. However, ignition of HOT can lead to burns that carry significant morbidity and mortality. This is especially true for patients who actively smoke while on HOT, with prior studies showing that 87.3% of HOT-related burns were due to smoking. An ethical issue thus arises for providers who routinely treat this patient population: how to balance providing beneficial treatment for a patient with the responsibility to protect that patient from suffering unnecessary burn injuries.

Methods

A literature review was conducted to determine the conversations surrounding this ethical dilemma in the scientific community. Thought was given to various solutions to address issues, and each solution was analyzed with respect to the traditional ethical principles of autonomy, beneficence, nonmaleficence, and justice.

Results

Multiple prevention considerations should be made for this patient population of active smokers on HOT. The first is to encourage more judicious prescription of home oxygen. This approach supports the principle of nonmaleficence as utilizing more prudence with prescription may prevent unnecessarily putting a patient at risk. A second strategy would be to discontinue a patient’s HOT if they were found to be an active smoker despite proper education; however, this solution conflicts with beneficence, especially if the patient relies heavily on HOT. A third, more drastic approach would be to withhold treatment of patients who repeatedly present with burns acquired secondary to smoking while on HOT. Refusal to treat conflicts not only with beneficence and maleficence but also with justice, as social factors play into which patients are more likely to smoke and, thus, may present with smoking-related burns while on HOT. Lastly, it is possible to address this challenge with broader, upstream solutions such as more thorough, longitudinal patient education on smoking cessation and the risks of smoking while on HOT. By doing so, physicians support all four of the traditional ethical principles.

Conclusions

Patients who suffer from burn injuries secondary to HOT ignition present a unique ethical challenge. Though physicians are tasked with the duty to provide optimal care for these patients, they are also shouldered with the responsibility of patient education and advocacy. Physicians should address this outstanding dilemma by thinking more critically about potential solutions that are bolstered by ethical considerations.
625 Patient Centered Depression and Anxiety Screening in an Adult Burn Clinic
Authors: Wojcik Jodi
Published: March 2022

Introduction

Depression and anxiety are seen in burn patients at rates up to 45%. Untreated, they can lead to long-term complications of posttraumatic stress disorder. Treating the psychological consequences of burn injury leads to increased quality of life for patients.

Methods

Rapid-cycle quality improvement using four plan-do-study-act cycles was used to evaluate interventions. Reviewing the data helped guide new tests of change each cycle. Data were analyzed using run charts to assess each intervention's impact.

Results

A medical screening rate of 100% was achieved. Thirty three percent of patients screened were positive for depression and/or anxiety. Of the patients who screened positive, 100% chose an intervention on the Shared Decision Making Tool.

Conclusions

Universal screening increases recognition of anxiety and depression in a vulnerable population of burn patients. Using a Shared Decision Making tool increases patients centerdness and selecting an intervention for treatment.
704 Ceftazidime / Avibactam Efficacy for Treating Carbapenem-resistant Infections in Critically Ill Patients with Thermal Injuries
Authors: Hill David M , Martin Kelsey , Arif Faisal , Sultan-Ali Ibrahim , Velamuri Sai R
Published: March 2022

Introduction

Rising antimicrobial resistance is a pressing public health concern. Emergence of carbapenem-resistant organisms has led to increased use of novel antibiotics, such as ceftazidime/avibactam (CZ/AV). However, recent studies have shown increasing treatment failures and resistance rates associated with ceftazidime/avibactam use. The efficacy of CZ/AV has not been studied in patients with thermal injuries, where pharmacokinetic derangements are common and longer lengths of stay augment risk of requiring several antimicrobial courses, leading to higher resistance rates. The objective of this study was to evaluate the outcomes of patients with thermal injuries including clinical success, the frequency of adverse effects, and emergence of resistance.

Methods

The design was a retrospective chart review. Patients were included if admitted with thermal injuries and receiving at least 48 hours of CZ/AV between Jan. 1, 2017 and July 2020. Demographics and treatment data were reported using descriptive statistics. Treatment success, description of treatment failures, and adverse events were described. Logistic regression was used to control and analyze failures.

Results

Fifteen patients with 17 courses evaluated. Most were male (87 %) and African American (53 %). The mean age and weight was 47.7 ±13.6 and 96.3 ± 29.4. Seventy-three percent had a flame injury. Mean TBSA was 34 ± 18.7. Twenty percent had an inhalation injury and 80 % a significant substance use history. Clinical success occurred in 65% (11/17) although 29% died. E. cloacae (88%) was the most common treated pathogen, but 81% were polymicrobial. The most common sources were wounds (29%), blood (29%), and lungs (26%). Median days until CZ/AV initiation was 32 (14,76). CZ/AV was dosed at 2.5 g every 8 hours in all courses. Median treatment duration was 12 days (9,14). Fifty-three percent received CVVH with a mean delivered dose of 47.6 ± 9.5 ml/kg/hr. Resistance developed in 19% (3/17) of courses, but follow up sensitivities were rarely available. Logistic regression did not reveal any variables significantly associated with failure. There were no adverse events attributed to CA/AV

Conclusions

Although lower than desired, clinical success rates in this sample were similar to other reported populations treated with CZ/AV. However, the emergence of resistance occurred more frequently, and was likely underreported in this sample. HVHF did not contribute to failure, but CZ/AV was aggressively dosed in this cohort.
712 Association between administration of hydroxycobalamin and acute kidney injury in patients with burn injury
Authors: Lo Marcus , Cartotto Robert , Ho George , Mason Stephanie A
Published: March 2022

Introduction

Hydroxycobalamin (HC) is administered to patients with suspected hydrogen cyanide poisoning. Some reports suggest that this practice may be associated with acute kidney injury (AKI). We aimed to evaluate the association between HC administration and AKI after burn injury.

Methods

We conducted a retrospective matched cohort study. All adults admitted to a regional ABA-verified burn center within 24 hours of injury between 2015-2019 with >10% total body surface area (TBSA) flame burn injury were reviewed. We excluded patients who were palliated within 48 hours of admission, and those with pre-existing renal disease. Patients who received HC, either pre-hospital, in the emergency department, or the burn center, were matched on age (+/-2 years) and %TBSA (+/-5%) to up to 5 patients who did not receive HC. Rates of AKI within 7 days of admission, as defined by KDIGO criteria, were then compared. Secondary outcomes included receipt of renal replacement therapy, death, ventilator days, and discharge disposition.

Results

We identified 10 patients who received HC; these patients were matched to 42 patients who did not receive HC. The median age of the HC group was 57 (IQR 43-66), compared to 65 in the non-HC group (IQR 57-65) (p= 0.98). The median %TBSA burn and %TBSA full thickness burn in the HC group and control was 16.5 (14-19) vs 13.5 (11-18) respectively (p= 0.22) and 3.5 vs 3.5 (0-9.5) respectively (p= 0.93). The incidence of inhalation injury in the HC group (n=8, 80%) was significantly higher than in the non-HC group (n=7, 17%)(p< 0.001). All HC patients were intubated within 24 hours of admission vs. only 48% of controls (p=0.003). The HC group also had significantly higher median SOFA scores on admission (9.5 vs 4, p< 0.001) and had a significantly higher admission creatinine [1.08 (0.95-1.26) vs 0.86 (0.71-1.02) mg/dl), p= 0.02]. The median 24-hour crystalloid fluid administered was 5911 mL/kg/%TBSA in the HC group vs 2774 mL/kg/%TBSA burn in controls (p= 0.004). All patients in the HC group developed AKI (n=10, 100%), compared to 64% (n=27) of non-HC patients (p=0.03). There was no significant difference in rates of death (20% vs 10%, p=0.35), Renal Replacement Therapy (20% vs 7%, p=0.21), discharge disposition, or ventilator days between groups.

Conclusions

We identified a small number of patients who received HC over a 5-year period at our burn center. There was an association between HC administration and development of AKI, but there were no differences in mortality, RRT, or ventilator days. HC administration is rare, and our data suggest that the sickest burn injured patients receive it. Larger studies are required to determine if HC administration is associated with AKI, or whether the increased rate of AKI in our study reflects illness severity.
719 Effects of Obesity on Outcomes of Adult Burn Patients at a Single Institution
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Williams Felicia
Published: March 2022

Introduction

Obesity is a global epidemic that continues to worsen. In 2016, more than 1.9 billion adults were considered overweight worldwide and over 650 million were obese. It is well-known that excess adipose tissue may alter inflammatory and immune mediator regulations, which can lead to challenges in managing resuscitation efforts, respiratory support, and thromboprophylaxis of burn patients. The objective of this study was to evaluate the outcomes of burn patients with obesity at our institution.

Methods

This was a single-site, retrospective review using our institutional Burn Center registry. All adult patients (18 years or older) admitted to our Burn Center between July 1, 2013 and June 30, 2021 who were classified as obese (i.e., body mass index > 30.0) were included in this study. All adult patients who were classified as underweight, normal weight, or overweight were also included for comparative purposes. Variables of interest included demographics, burn mechanism, length of stay (LOS), cost of hospitalization, and mortality.

Results

There were 7,626 patients included in this study, with the largest percentage of patients included in the obese category (38.4%). Among the obese population, most of the patients (53.2%) were classified under ‘Obesity Class I’ (i.e., body mass index 30.0 – 34.9). The majority of patients in each category were male, except in the ‘Obesity Class III’ category (i.e., body mass index > 40.0) where 54.8% of the population were female. The mean age of the entire study sample was 44.9 years +/- 17.5 years, while the mean total body surface area (TBSA) involvement was 5.1% +/- 10.0%. The mean LOS of the entire study population was 10.3 days +/- 22.6 days, with patients in the ‘Obesity Class III’ category having the longest LOS with 14.0 days +/- 36.5 days. The cost of hospitalization was lowest in the overweight group with $82,661, while the highest cost was in the ‘Obesity Class III’ group with $130,683. The overall hospital mortality for the entire study population was 3.0% with the highest mortality noted in the ‘Obesity Class III’ group (4.7%).

Conclusions

Obesity affects all aspects of a burn patient’s care throughout their hospitalization. In our study, obesity was associated with longer LOS, cost of hospitalization, and mortality; therefore, it is imperative to understand the negative effects that obesity can have on burn patients, not just in terms of their acute management, but also their continued care after hospitalization.
741 Burn Injury Elevates the Risk of Sepsis in Pregnant Women
Authors: Bagby Shelby P , Song Juquan , Wermine Kendall , Golovko George , El Ayadi Amina , Wolf Steven E
Published: March 2022

Introduction

Pregnancy naturally strains a woman’s body, and is exacerbated by additional stressors, such as severe burn. This study seeks to establish a national incidence rate of burns during pregnancy, as well as categorize the patients epidemiologically and by percent total body surface area (%TBSA) burned. We posit that pregnancies complicated by burn injuries have worse outcomes in mortality and comorbidities in comparison to pregnancies not complicated by burns.

Methods

Using an electronic medical record database, TriNetX, a retrospective cohort study was performed to identify burned pregnant patients within the last 20 years. The burn cohort included all pregnant women aged 12-55 who experienced a burn injury on the same day as pregnancy or anytime within nine months after the first record of pregnancy. The non-burned cohort included women who did not experience a burn within nine months of the recorded pregnancy. Outcomes compared were sepsis, pregnancy with abortive outcome, ectopic pregnancy, spontaneous abortion, complications of labor and delivery, preterm labor, postpartum hemorrhage, maternal mortality, and acute respiratory distress syndrome (ARDS). After matching for age at pregnancy, each outcome was compared at one, three, and five years after pregnancy. Risk ratios (RR) with a 95% confidence interval (CI) were used to compare cohorts, and a p-value < 0.05 was deemed significant.

Results

The TriNetX database contained 21,438,975 females between the ages of 12-55. Among these, pregnant women with burn injuries were found to have an incidence of 4.32% in the United States in the last 20 years (pregnant females with burn n = 4,721; females with burn n = 109,294). Of burns categorized by %TBSA burned, 84% were between 1-10%. Within one year of pregnancy, burned patients have a three-fold increase in risk of development of sepsis compared to non-burned women (RR = 3, 95% CI = 1.518, 5.929), but are less likely to experience pregnancy with abortive outcome (RR = 0.612, 95% CI = 0.509, 0.735), complications during labor and delivery (RR = 0.863, 95% CI = 0.803, 0.928) or spontaneous abortion (RR = 0.707, 95% CI = 0.556, 0.899).

Conclusions

Pregnancy complicated by burn injury has a lower national incidence rate than the generally accepted 7% of reproductively aged females. Burned patients were more likely to experience sepsis than their non-burned counterparts one year after pregnancy, however, risk of maternal mortality was the same between the burned and non-burned patients within one year after pregnancy with a curious decrease in miscarriage and labor and delivery complications.
743 Virtual burn care - friend or foe? A systematic review
Authors: Malic Claudia , Mondor Eli , Barnabe Jaymie , Laguan Robyn M
Published: March 2022

Introduction

Interest in virtual care has grown, but evidence surrounding its use for burn injuries is variable. This systematic review assesses the impact of virtual burn care in the past decade (2010-2020) by providing an overview of recent advances in the field. Data on efficacy, feasibility, cost-effectiveness, usability, pros/cons, satisfaction/acceptability, clinical outcomes, and triage effects are presented. Conclusions on its post-pandemic sustainability are drawn.

Methods

A systematic review with qualitative synthesis was performed according to PRISMA guidelines. Quality of included studies was assessed by validated tools. CINAHL, OVID MEDLINE, APA PsycINFO, and the CENTRAL trials registry were searched. Grey literature was searched for in OAIster, Duck Duck Go, Bandolier Knowledge, LILACS and McMaster Health Systems Evidence. Primary literature published between 01/01/2010-12/31/2020 investigating any of the noted outcomes of interest was retrieved for data extraction.

Results

A total of 486 studies were identified for screening. 412 and 26 citations were excluded in title/abstract and full text screening, respectively. After removing 8 unretrievable works and 3 straggling duplicates, 50 citations were included. Most works were published from 2016-2020 (n=35, 70%). The most common uses (with some overlap) were acute assessment (n=35, 70%), remote follow-up (n=18, 36%) and tele-rounding (n=4, 8%). Remote photographic burn size (not depth) estimation was found feasible and acceptably accurate. Patient and provider satisfaction was high overall. Patient outcomes with virtual follow-ups were largely comparable to equivalent in-person services, though some adjunct programs saw little benefit. Increased specialist access, more accurate assessment/triage and saved travel time/cost were commonly noted. Challenges included logistics and language barriers for international interventions, IT issues and internet access limitations, HIPAA compliance and some wound/scar assessment challenges (e.g. burn depth and scar vascularity).

Conclusions

Evidence suggests that virtual burn care is largely safe, efficacious and could be feasible for continued use post-COVID-19 provided technological infrastructure is attainable and suitable regulation exists. Virtual acute specialist burn assessment is particularly well supported.
746 Nurse Driven Fluid Resuscitation in the Burn Center
Authors: Werthman Emily H , Cox Carrie A , Caffrey Julie
Published: March 2022

Introduction

The prior practice of the burn center was to resuscitate burn injuries over 20% total body surface area (TBSA) using a provider led modified Brooke fluid resuscitation formula. In that model of fluid resuscitation, the burn center provider ordered an initial fluid rate and adjusted hourly, where appropriate based on nurse recorded outputs. In Q4 2020 a nurse-driven fluid resuscitation was implemented in the adult Burn Intensive Care Unit (BICU). The primary purpose of the survey research is to evaluate the effect of the nurse-driven fluid resuscitation on nurse and physician communication.

Methods

Survey research was initiated in Q3 2020 with a pre-practice change survey for BICU staff. The 3-part survey included 10 questions. The post survey will be repeated in August and remain open through October or until 70% of participants have completed the survey, whichever comes first.

Results

Paired t-tests will be used compare survey research results pre and post-protocol implementation. In the pre-implementation survey there was a response rate of 44% (11/25). The average years of experience in the burn center was 11.64 years (median 7, SD 10.66). All survey questions were asked based on a 5-point Likert scale with anchors of 1 “strongly disagree” and 5 “strongly agree.” Question 1 the average score was 3.67. Question 2 the average score was 3.5. Question 3 the average score was 3.58. Question 4 the average score was 3.33. Question 5 the average score was 3.5. Content analysis was used to explore responses to open-ended questions. Three themes were identified: training, lack of communication, and over-resuscitation.

Conclusions

The pre-implementation survey revealed highest scores on nurses and physicians having a good map of each other’s skills and lowest on providers and nurses discussing ways to prevent errors. Content analysis also revealed common concerns about miscommunication and lack of resuscitation training leading to over resuscitation. Upon completion of the post-implementation survey, we anticipate reporting changes in low scoring questions. We look forward to reporting these results as part of this abstract.
752 Baking Bread and Other New Hobbies: Characterizing Burn Center Admissions During the COVID-19 Pandemic
Authors: McLawhorn Melissa M , Burkey Sarah E , Delatore Cara , Brantley Melissa , Moffatt Lauren T , Johnson Laura S , Shupp Jeffrey W
Published: March 2022

Introduction

The effects of the ongoing COVID19 pandemic are wide-reaching and still emerging. Fear of the virus, public health messaging, and government-instituted lockdowns have altered how Americans live, work, and use the healthcare system. There is minimal data that assesses how the COVID-19 pandemic and associated stay at home orders have influenced the etiology of burn injuries. With the majority of burns occurring in the home, it is possible lock down orders have significantly impacted etiology of major burn injuries. This project aims to characterize the demographics and injury characteristics of burn patients seen at a regional burn center during the COVID-19 pandemic.

Methods

Following IRB approval, our institution queried it’s burn registry from March 2020-June 2021. Data on demographics, injury circumstance and details, interventions, COVID-19 status, and outcomes were collected. Descriptive statistics were obtained for the population.

Results

There were 622 inpatient admissions during the study timeframe. Patients were primarily Black (44.4%) or Caucasian (32.6%) males (65.6%) identifying as Non-Hispanic (81.8%). The mean age was 46.73±18.6 years. Mean total TBSA burned was 6.7±10.7%, 2nd and 3rd degree percentages were 2.11±4.64 and 0.62±5.2 respectively with 47 total inhalation injuries. Top burn etiologies were 244 (39.2%) scald and 175 (28.1%) flame with 249 (40%) coded etiology associated with food prep or consumption.

The majority of the burns occurred at home (93%). Time from injury to admission was 616.98±2199.42 minutes and time to first excision from admission was 4314.3 ± 5657.3 minutes. ICU and hospital length of stay were 12.7±18.3 and 8.73±13.3 days. In-hospital mortality was 31 (5%). Nineteen patients tested positive for COVID-19 during this time.

Conclusions

Nearly half of all burn center admissions were for cooking related etiologies during this time. Time to admission was over 10 hours in a population dense area. More information of site specific pre-pandemic etiology and treatment data are needed to fully understand these initial findings. Further sub-analyses may also elucidate the influence of pandemic related behavioral changes as public health mandates evolved over time.
753 Segregation, Vulnerability, and Fundamental Causes: Understanding the Social Dimensions of Burn Injury
Authors: Ngana Colette
Published: March 2022

Introduction

Sociologists have long investigated the enduring link between place and health. Despite prolific research in this field, there are health issues that remain obscured in the literature. The goal of this work is to examine the spatial-health relationship(s) between place of residence and burn injuries, the socially produced vulnerability of individuals living in high-risk areas, and the experience of being burned in these identified areas. Fundamental cause theory, which focuses on an individual’s ability to either avoid health risks or minimize the consequences of these risks, is employed to demonstrate the worsening effects of socioeconomic status (classism) and race (racism) on burn injuries. Managing health risks is dependent upon access to and utilization of flexible resources (knowledge, money, freedom, power, prestige, and social networks) that are differentially distributed across populations based on social conditions like age, race-ethnicity, socioeconomic status, and neighborhood infrastructure.

Methods

Exploratory spatial and cluster analysis using ArcGIS (a geographic information system) of accidental, at-home burn incidence in an historically redlined county.

Results

Analysis shows burn injuries tend to cluster in areas marked by low-income, higher numbers of racial-ethnic minorities, and poorer quality housing. Table 1 shows preliminary descriptive data about the study population.

Conclusions

Despite advances in treatment and prevention, there are socially-constructed and salient environmental risks that leave some communities vulnerable to burn injury. Historical practices, like racial residential segregation and redlining, have concentrated racial-ethnic minority communities marked by lower-income, poorer quality housing, and other burn-risk factors.
759 Burn Care During the COVID-19 Pandemic: Assessing the Current Literature
Authors: Tranchina Stephen P , Tran Justin , Ghafoor Elias A , Moffatt Lauren T , Palmieri Tina L , Shupp Jeffrey W , Johnson Laura S , Skipton Romanowski Kathleen S
Published: March 2022

Introduction

The emergence of SARS-CoV-2 and the subsequent COVID-19 pandemic has been a significant disruptor to traditional medical care. Burn patients are an interesting population in which to evaluate this disruption due to the complicated, multidisciplinary nature of injury management. Understanding the current landscape of burn care during the pandemic is a crucial first step in preparing for future pandemic impacts. The purpose of this study was to identify the current status of burn treatment during COVID by evaluating existing literature surrounding burns and COVID.

Methods

A literature review of articles published between March 2020 and August 2021 was conducted to determine trends in studies evaluating burn patients and burn center operation during this time frame. All ABA abstracts published in 2020 containing the key words “burn,” “COVID,” and/or “coronavirus” were reviewed. Additionally, a Pubmed search was conducted using the same keywords. Each abstract and article was sorted into one of four themes: Census/Etiology, Burn patients with COVID, Safe Practices/Protocols, and Telemedicine.

Results

A total of 23 ABA abstracts and 126 articles were collected in the initial search. 63 articles were ultimately excluded because they did not report on burn patients. By theme, the following trends were seen: 1. Census/Etiology: Data on demographics of burn patients during this period was varied. Admissions for adult and/or pediatric burns increased for multiple burn centers, while others reported decreases. Consistently, the most common etiology of burn injury was scald, and an increased proportion of injuries were found to occur at home. Changes in the rates of first, second, and third-degree burns were also observed. 2. Burn patients with COVID: Overall, numerous reports indicated decreases in patient length of stay. However, several groups found no differences in length of stay, surgery rate, and length of follow-up. 3. Safe Practices: A recurring trend was observed of numerous burn centers having to implement increased safety protocols due to COVID-19. Select burn centers updated prevention guidelines for burn surgeons and patient care. 4. Telemedicine: The implementation of telemedicine helped minimize risk and maximize resources, However, much remains to be standardized, including the quality of images used.

Conclusions

This analysis of the current literature identified several overarching themes in the care of burn patients. Continued evaluation can identify innovations from the past year that should become best practices, as well as optimize preparation efforts for future disruptions in care.
762 Resumption of Surgical Missions in Light of COVID-19: A Paradigm Shift
Authors: Dabek Robert J , Fuzaylov Gennadiy
Published: March 2022

Introduction

The COVID-19 pandemic has disrupted the lives of billions of people globally. Some medical systems continue to be overburdened due to the viral illness leading to incredible public health challenges domestically as well as abroad. However, with vaccination distribution increasing globally, many are pushing for a return to some form of normalcy. In the medical community, some are weighing the risks of returning to global health missions and considering protective strategies to minimize risk of viral spread.

Methods

Here we describe our experience in returning to an annual burn reconstruction mission in a low- and middle-income country (LMIC).

Results

We have implemented protective strategies and successfully carried out a return mission trip. Our team of 10 individuals was able to perform over 80 procedures on 26 pediatric patients in 4 operative days. There were no major complications reported.

Conclusions

Protection of our team and our patients from the risk of COVID-19 infection was paramount given the high mortality rate and disease duration. We applied a variety of protective strategies and altered mission protocol to limit exposure and transmission. The primary modifications (including; eliminating day of clinic with increased utilization of telemedicine for preoperative screening, only one vaccinated care giver permitted in the hospital, COVID-19 pre-operative screening for parents and patients, and increasing operative complexity) are likely to remain in place for the duration of the pandemic.
768 The Significant Impact of Having a Dedicated Ambulatory Clinical Social Worker in the Burn Clinic
Authors: Spotts Margaret , Dines Margaret M , Foster Crystal , Wiktor Arek J , Weber Elizabeth B
Published: March 2022

Introduction

A licensed clinical social worker (LCSW) has been recognized as an essential role within the Burn Center inpatient multidisciplinary team. However, for ambulatory patients facing acute crisis, resources can be scarce; relying on clinic nursing staff or an inpatient LCSW to problem solve psychosocial concerns can leave large gaps of patient care unaddressed. An Ambulatory LCSW (ALCSW) assists transition of care working to prevent unnecessary Emergency Room visits and readmissions. We sought to examine our experience utilizing an ALCSW in the Burn Center.

Methods

A full-time burn ALCSW position was approved in fall of 2020 at our ABA verified Burn Center. The role includes extensive assessments of mental health, substance use, domestic violence, and safety concerns, connecting clinic patients to resources for transportation, benefits, insurance coverage, employment, food, and housing. The ALCSW also conducts short term patient centered, family & group therapy sessions. A retrospective review was performed on duties of the ALCSW comparing 9 months (December-August) pre and post hire. Data collected included visit types, hours of patient care, and interventions performed.

Results

During the first 9 months, the ALCSW completed 1,008 patient encounters (approximately 25 hours of direct patient care per week) and 510 psychosocial assessments. In the first three months alone 258 substance use screens, 166 mental health assessments, 44 ASD/PTSD therapy sessions, 205 Homeless Shelter referrals and 128 community resource encounters were performed that would have otherwise been left unaddressed or added to the workload of our Burn Clinic RN or provider.

The ALCSW was able to see up to 89.39% more patients per month (n=89) compared to the inpatient LCSW who only responding to clinic patients with emergent needs (n=13). The increase of ALCSW encounters showed a 35.37% increase of completed visits without IP admission (n=pre 665 vs post 1029), 39.73% decrease of IP admissions after clinic visit (n=pre 73 vs post 44), and 17.82% increase of patients without inpatient admissions entirely (n=pre 572 vs post 696). In addition, the added effort of an ambulatory LCSW, has increased SOAR support group participation by 60.13% in calendar year 2021 compared to calendar year 2020 (n= pre 63 vs post 158).

Conclusions

Hiring a dedicated Burn ALCSW can substantially increase the resources available to outpatients, fill voids of patient care, limit unnecessary hospital resources, and prevent admissions.
775 The Ongoing Impact of the COVID Pandemic on Young Burn Survivors and their Families
Authors: Jackson Brad , Mikolaj Kerry , Boulter Trudy , Schiffer Nichole M
Published: March 2022

Introduction

The COVID pandemic continues to bring numerous challenges for young burn survivors and their families. This project addressed the ongoing impact that COVID-19 is still having on youth burn survivors and their caregivers.

Our burn camp program moved to a virtual format for 2020 but returned to an in person camp experience for 2021. This project is an extension of our assessment in 2020 by asking youth and their families to reflect on the persistent effects of COVID-19 into 2021.

Methods

Prior to each camp year, we asked campers (ages 8 – 18) and their caregivers / parents to complete questionnaires about their year, rating and specifying the personal impacts of COVID as part of their overall camp application. We also asked “what has helped you get through tough times this year?” In 2020 we had 47 campers and caregivers / parents participate with an increase to 60 campers and caregivers / parents for 2021.

Results

The majority of youth continued to rate the impact of COVID-19 as “Somewhat” or “Highly” from 2020 to 2021, however the percent of youth rating these higher levels of impact decreased in 2021. The majority of caregivers rated the impact in 2020 as “Somewhat” while the percentage rating these higher levels of impact increased in 2021 with more caregivers also endorsing “Highly”.

Campers AND caregivers / parents identified the same top 3 impacts in 2020 and 2021:

1. Online school / virtual learning

2. Friends / Social

3. Quarantine

The impact on the fourth highest area of Sports / Activities decreased from 2020 to 2021. In both years, youth and caregivers rated Quality time with Family as a positive impact.

Campers and caregivers endorsed Family, Friends, Faith, and What I learned recovering from my burn injury as factors helping them get through tough times.

Conclusions

Children, youth, and families who have experienced a burn injury continue to report both negative and positive impacts from the COVID-19 pandemic.

Not all youth and families are equally affected, but burn survivors and their caregivers rated the highest impacts as online school / virtual learning, friends / social, and quarantine in both 2020 and 2021.

Family and friends were the greatest sources of support during tough times

Burn camp provided the opportunity for connection in the face of ongoing impacts of COVID-19.
786 Electrical Injury Resulting In Bilateral Upper Extremity Amputation: Improving Independence And Quality Of Life
Authors: Adams Emily , Murtaugh Brooke
Published: March 2022

Introduction

Fifty seven year old male who sustained an electrical burn injury that resulted in bilateral below elbow amputation began inpatient rehabilitation program. Patient was motivated to increase independence to return home prior to prosthetic fitting and training being completed. Quality options for adaptive equipment required to increase independence were not sufficient to meet patients needs, thus innovative specialty fabrication of adaptive equipment were required to meet patient’s goals of independence.

Methods

Occupational therapist to use thermoplastic material to fabricate various adaptive equipment in order to address patient's goals to increase independence with self care tasks. Occupational therapist and patient to have one time consult with hospital maintenance employee to create pant hook to use for ease of donning/doffing over hips. Patient participated in daily Occupational therapy sessions focused on trialing adaptive equipment and to provide feedback for any desired changes of equipment to maximize patient progress and success with reaching independence with self cares and return to life roles.

Results

Patient met all goals to become independent with self care tasks including: toileting, dressing and showering as a result of using fabricated adaptive equipment and techniques addressed during therapy sessions. Patient able to return home independently following discharge from inpatient rehabilitation stay.

Conclusions

Use of easily accessible ezeform thermoplastic material can result in fabrication of adaptive equipment to increase patient's independence. It is important to maintain a creative outlook as a clinician and to continue to collaborate with our patient's to identify barriers to success and explore options to increase patient's desired independence.
788 Upper Extremity and Lower Extremity Net Devices for Use after Application of Cultured Epidermal Autograft
Authors: Hayes Callie J , Anyan Walter R , Lucio Xavier , Perry Daphne A , Hopkins Ronda , Clark Jillian S , Durose Lily
Published: March 2022

Introduction

Early positioning of the burn patient to prevent scar contracture is a fundamental aspect of the therapy treatment plan1. Positioning is complicated by different types of grafting including cultured epidermal autograft (CEA). Use of CEA requires a period of airing out and therefore positioning devices must allow adequate air flow to the posterior aspect of the grafted limb while immobilizing the extremity. Previous lower extremity net devices have been presented for use2-3, however this design increases hip flexion which can promote contracture. Additionally, there is no similar net device presented for use for the upper extremity.

Methods

Both the upper extremity and lower extremity net device designs are made using 1” PVC pipe. A mix of Tee, 90⁰ and 45⁰ couplers are used to link together the PVC pipe. A PVC cutter is needed to cut the pieces. Once the pieces have been fit together and are aligned, the pieces are secured with a bonding PVC adhesive. The devices are then sanitized for patient use. A double layer of burn netting is used over the device to support the extremity while not allowing too much slack. The following graphics provide a basic template for an average adult adjusting lengths and width as needed. For the lower extremity, a measurement from the fold of the buttocks to the heel is needed to determine overall length of the device. The average cost for 1 lifter is $15-20. Additional custom plantar foot plates can be added to the lower extremity device to prevent ankle dorsiflexion as demonstrated by the poster presentation by Dean et. al. 3 For the upper extremity, an armboard or use of bedside table can be used to support the device. These particular designs are an outline for adult patients, although could be modified for pediatrics.

Results

Net devices for the upper and lower extremity allow good positioning of limb while providing adequate air flow and off-loading during the required air out periods using CEA. These designs provide a template for burn therapists to utilize as a baseline. This particular lower extremity device decreases hip flexion as compared to other existing devices. The upper extremity template provides an option that has not previously been articulated.

Conclusions

Positioning the upper and lower extremity after CEA application can be achieved using custom net devices. Net devices provide a cost-effective, quick and simple solution that allow adequate ventilation to the posterior aspect of the limb while maintaining a good position during immobilization.
805 Case Report: Atrial Perforation in the Setting of Electrical Injury and Subsequent Cardiopulmonary Resuscitation
Authors: Gallagher Kathleen C , Beyene Robel , Gondek Stephen , Smith Joshua , Mubang Ronnie
Published: March 2022

Introduction

Electrical injuries cause 500 to 1000 deaths per year in the United States and are the fourth leading cause of death in the workplace. Rates and types of cardiac complication secondary to electrical injuries vary widely throughout the literature. Case reports describing cardiac perforation in the setting of electrical injury are exceedingly sparse. To our knowledge, there are no documented cases of cardiac perforation as a direct result of electrical injury.

Methods

This is a case report and review of relevant literature.

Results

Case Description:

We present a case of myocardial perforation in the setting of high voltage electrical injury. An otherwise healthy 46-year old male sustained a 13.8 kV electrical. Resuscitation included bystander cardiopulmonary resuscitation (CPR), defibrillation by emergency medical responders, finger thoracostomies and massive transfusion protocol in the trauma bay, and finally emergent sternotomy and repair of two injuries to the right atrial appendage. Given this patient’s pattern of injury, including a sternal fracture and bilateral upper anterior rib fractures, the etiology of his right atrial perforation is more likely due to mechanical injury from CPR instead of thermal or electrical injury to the myocardium. However, intraoperative findings confound this theory as no defects were identified in the pericardium of the mediastinal pleura during the operation. This would argue against mechanical injury during CPR. However, the presence of a left hemothorax may could indicate that a pericardial injury was missed in the operation. We argue that the most likely cause of injury is mechanical perforation of the pericardium and myocardium during CPR with a possible missed pericardiotomy during surgical exploration. An alternative hypothesis is an isolated electrical injury to the myocardium and left hemothorax from rib fractures without communication between the two cavities. This patient expired on postoperative day two due to anoxic brain injury.

Conclusions

This case highlights myocardial injury as a rare but lethal complication of high voltage electrical injury and serves as a reminder that cardiac perforation and hemodynamic collapse due to hypovolemic shock can compound and complicate the resuscitation and management of a patient with electrical injury. Further, the widely varying data regarding cardiac complications secondary to electrical injury warrants further investigation and large-scale prospective data.
816 Up-regulation of Immune Related Key Genes in Burn Induced Cardiac Dysfunction
Authors: Mobli Keyan , Wen Jake J , Radhakrishnan Geetha , Radhakrishnan Ravi S
Published: March 2022

Introduction

The cytokine cascade is a prime factor in inflammation following burn injury, leading to cardiac dysfunction. Studies on immune-related key cardiac genes after burn injury remain limited. The TLRs act individually or as heterodimers, interacting with adaptor proteins to initiate MyD88 or TICAM1 (TRIF) dependent responses. This results in signaling cascades through NFkB, which activates downstream JNK/p38 signaling or cytokine secretion. Dysregulation of TLR and related signaling pathways has severe consequences and is implicated in autoimmune diseases and chronic inflammation. The objective of this study is to identify the immune-related key genes and explore the pathways by microarray specific to members of the TLR signaling family as well as adaptor and effector proteins, and downstream members of TLR activation including the NFkB, JNK/p38, IRF and JAK/STAT signaling pathways.

Methods

The microarray was applied to profile expression of 84 genes inTLR-mediated signal transduction and innate immunity. The Qiagen web-based tools in GeneGlobe Data Analysis Center was used to analyze burn-induced up-regulation of these genes. String-DB version 11.5 was employed to analyze differentially expressed gene function and interaction. Real-time qPCR was utilized to validate the data. GO enrichment analysis (FDR< 0.05) using "clusterProfiler" predicted the roles of immune-key genes in the 3 aspects of biological processes (BP), cellular components (CC), and molecular functions (MF). The biological pathway analysis was performed to obtain the pathways. The protein-protein interaction (PPI) network was built using "Multiple Protein" of the string database (http://stringdb.org/, version 15.0). The DEGs were visualized by using the qPCR.

Results

32 up-regulated genes were identified. Functional enrichment analysis showed that these genes were enriched in cytokine receptor activity, immune receptor activity, and integrin family cell surface interactions.14 of 32 genes belong to the TLR signaling pathway; 5 of 32 genes to cytokines and inflammation; 5 of 32 genes belong to apoptosis; 6 in the MARP signaling pathway; 4 genes belong to the IL-1 signaling pathway; 4 genes in the IL-6 signaling pathway); 3 genes in toIL-2 signaling pathway and 3 genes belong to oxidative stress responses. Process study demonstrated the genes are associated with regulation of cytokine production (GO:0001817), immune response (GO:0006955), and defense response (GO:0006952).

Conclusions

This study provides evidence that microarray plays a role in identification of burn-induced cardiac dysfunction DEGs. Deep analysis of up-regulated genes after burn injury supported the idea that the proinflammatory cascade results in cardiac inflammation.
Regulatory Interventions in Consumer Financial Markets: The Case of Credit Cards
Authors: Galenianos Manolis , Gavazza Alessandro
Published: March 2022

We build a framework to understand the effects of regulatory interventions in credit markets, such as caps on interest rates. We focus on the credit card market, in which we observe US consumers borrowing at high and very dispersed interest rates despite receiving many credit card offers. Our framework includes two main features to account for these patterns: the endogenous effort of examining offers and product differentiation. Our calibration suggests that most borrowers examine few of the offers they receive, and thereby forego cards with low interest rates and high non-price benefits. The calibrated model implies that interest-rate caps reduce credit supply and significantly curb lenders’ market power, thereby increasing consumer surplus. Moderate caps may yield larger gains in consumer surplus than tighter ones.
Survey of nonconventional yeasts for lipid and hydrocarbon biotechnology
Authors: Rodriguez-Ocasio Efrain , Khalid Ammara , Truka Charles J , Blenner Mark A , Jarboe Laura R
Published: March 2022

Nonconventional yeasts have an untapped potential to expand biotechnology and enable process development necessary for a circular economy. They are especially convenient for the field of lipid and hydrocarbon biotechnology because they offer faster growth than plants and easier scalability than microalgae and exhibit increased tolerance relative to some bacteria. The ability of industrial organisms to import and metabolically transform lipids and hydrocarbons is crucial in such applications. Here, we assessed the ability of 14 yeasts to utilize 18 model lipids and hydrocarbons from six functional groups and three carbon chain lengths. The studied strains covered 12 genera from nine families. Nine nonconventional yeasts performed better than Saccharomyces cerevisiae, the most common industrial yeast. Rhodotorula toruloides, Candida maltosa, Scheffersomyces stipitis, and Yarrowia lipolytica were observed to grow significantly better and on more types of lipids and lipid molecules than other strains. They were all able to utilize mid- to long-chain fatty acids, fatty alcohols, alkanes, alkenes, and dicarboxylic acids, including 28 previously unreported substrates across the four yeasts. Interestingly, a phylogenetic analysis showed a short evolutionary distance between the R. toruloides, C. maltosa, and S. stipitis, even though R. toruloides is classified under a different phylum. This work provides valuable insight into the lipid substrate range of nonconventional yeasts that can inform species selection decisions and viability of lipid feedstocks.