bluuebunny/crossref_metadata_2025_split huggingface dataset:
1 The Impact of No Next of Kin Decision Makers on End-of-life Care
Authors: Ota Ryan K , Johnson Maxwell B , Pickering Trevor A , Garner Warren L , Gillenwater Justin , Yenikomshian Haig A 
Published: March 2020

Abstract

Introduction
For critically ill burn patients without a next of kin (NOK), the medical team is tasked with becoming the surrogate decision maker. This poses difficult ethical and legal challenges for burn providers. Despite this frequent problem, there has been no investigation of how the presence of a NOK affects treatment in burn patients. This study is the first to evaluate this relationship.

Methods
A retrospective chart review was performed on a cohort of patients who died during the acute phase of their burn care from a single burn center from 2015 to 2019. Inclusion criteria were age ≥18 years and mortality within 4-weeks of admission. Exclusion criteria were death from dermatologic disease or trauma. Variables collected included age, gender, mechanism of injury, length of stay (LOS), total body surface area (TBSA), revised Baux score, and the presence of a NOK. Fisher’s Exact Test and Student’s t-test were used for analysis.

Results
In total, 67 patients met inclusion criteria. Of these patients, 14 (21%) did not have a NOK involved in medical decisions. Table 1 shows the means and odds ratio between the two groups. Patients without a NOK were younger (p &lt; 0.05), more likely to be homeless (p &lt; 0.01), had higher TBSA (p &lt; 0.01), had shorter LOS (p &lt; 0.01), and were 5 times less likely to receive comfort care (p &lt; 0.05). Gender and ethnicity were not statistically significant.

Conclusions
Patients without a NOK present to participate in medical decisions are transitioned to comfort care less often despite having a higher burden of injury. This disparity in standard of care between the two groups demonstrates a need for a cultural shift in burn care to prevent suffering of these marginalized patients. Burn providers should be empowered to reduce suffering when no decision maker is present.

Applicability of Research to Practice
We report that the absence of a NOK has a significant impact leading to a decreased initiation of comfort care in critically ill burn patients. National protocols should be created to allow burn providers to act as a surrogate to prevent prolonged suffering.
10 Hypoglycemic Episodes Predict Length of Stay in Patients with Acute Burns
Authors: Pham Christopher H , Vrouwe Sebastian Q , Tsai Karen , Collier Zachary J , Grote Andrea C , Angell Trevor E , Garner Warren L , Gillenwater Justin , Yenikomshian Haig A 
Published: March 2020

Abstract

Introduction
Hypoglycemic episodes are associated with worse hospital outcomes, and their incidence varies by institution. We sought to define the prevalence of hypoglycemic episodes at our burn center and determine their association with hospital outcomes.

Methods
We retrospectively reviewed all consecutive adult and pediatric patients admitted to our burn center from 2015 to 2019. Patient demographics and burn characteristics were recorded. The primary outcome was mortality, and secondary outcomes were total length of stay (LOS) and intensive care unit LOS (ICU LOS). All patients experiencing hypoglycemic episodes were compared to patients who did not experience hypoglycemic episodes (controls) using two-tailed t, chi-squared, and multivariate logistic and multiple linear regression analyses.

Results
A total of 914 patients with acute burns were admitted during the study period. Thirty-three patients (4%) experienced hypoglycemic episodes (&lt; 60 mg/dL). Of these, 17 patients (52%) experienced a single hypoglycemic episode, while the remainder (N=16) experienced multiple hypoglycemic episodes. There were no significant differences in age, sex, or presence of inhalation injury between hypoglycemic patients and controls. Patients that experienced a hypoglycemic episode had significantly greater TBSA involvement (23% vs. 11%, p&lt; 0.00), higher prevalence of diabetes (48% vs. 20%, p&lt; 0.00), higher mortality (18% vs. 7%, p=0.01), longer total LOS (39 vs. 13 days, p&lt; 0.00), and longer ICU LOS (28 vs. 4 days, p&lt; 0.00). A single hypoglycemic episode was associated with prolonging total LOS by 19 days (p&lt; 0.00) and ICU LOS by 18 days (p&lt; 0.00). Hypoglycemic episodes were not associated with higher odds of mortality (OR=0.9, 95% CI 0.3–3.0, p &gt;0.05).
There were no differences in outcomes between patients with single or multiple hypoglycemic episodes. Patients with multiple hypoglycemic episodes more frequently had a history of diabetes (81% vs. 18%, p&lt; 0.00), and worse glucose control (HbA1c, 9% vs. 7%, p=0.04) compared to patients with single episodes.

Conclusions
Hypoglycemic episodes were associated with longer total and ICU LOS in our study but did not portend higher mortality.

Applicability of Research to Practice
Quality improvement efforts to prevent hypoglycemic episodes should focus efforts on known diabetics with high HbA1c levels.
43 Activation of CCL2/CCR2 Signaling Axis Is Responsible for Spinal Cord Inflammation and Loss of Muscle Mass in Mice After Burn Injury
Authors: Khan Mohammed A , Sakuma Miyuki , Yasuhara Shingo , Ma Li , Chen Jingyuan , Palaniyar Nades , Martyn Jeevendra , Ren Yang 
Published: March 2020

Abstract

Introduction
Burn-induced systemic inflammation (BISI) can induce inflammatory responses in peripheral nervous system and also cause neuroinflammation in the central nervous system, leading to morbidity and mortality. The mechanisms of neuromotor impairment involving CCL2/CCR2 signaling axis are largely unknown. We hypothesized that BISI causes neuroinflammation in the spinal cord, and this inflammatory response can lead to motor neuronal damage, disintegration of nerve termini and eventually muscle wasting.

Methods
Cytokines/chemokines were estimated by Cytokine Antibody Array. Nerve termini and muscle fibers in abdominal muscle, and motor neuronal apoptosis in the spinal cord were analyzed by fluorescent microscopy and immunochemical analyses.
Loss of muscle mass was assessed by wet weight of the muscles compared with control in mice after BISI.

Results
Our data showed that CCL2 was significantly increased in the serum (&gt;2.4 fold) at day 1 and 3 after BISI in vivo. Iin the extracellular medium (&gt;2.0 fold) of organotypic spinal cord explant after exposure to exogenous histones ex vivo at day1. Neuroinflammation in the spinal cord after BISI caused motor neuronal apoptosis, nerve termini disintegration, and loss of muscle mass of soleus (63.4 + 5.1%), tibialis (72.3 + 2.7%) and gastrocnemius (70.2 + 1.1%) compared to sham burn injured wild-type (WT) or YFP-neurons expressing transgenic mice. In contrast, GTS-21 reduced neuroinflammation and significantly prevented loss of muscle mass of soleus (86.8 + 0.2%), tibialis (85.4 + 4.5%) and gastrocnemius (89.0 + 4.0%). Depletion of macrophages by PBS-liposomes in burned mice showed transmigration of CCR2-containing monocytes-derived macrophages (CCR2-MDMΦ) in the ventral horn of the spinal cord, and led to the loss of all three muscles (soleus, 62.4 + 2.6%; tibialis, 86.3 + 3.5; gastrocnemius, 81.4 + 1.7%). Nevertheless, depletion of macrophages by Clophosomes in burned mice inhibited the transmigration of CCR2-MDMΦ, and protected muscle mass (soleus, 96.6 + 3.9%; tibialis, 101 + 3.9%; gastrocnemius, 98.3 + 1.2%) significantly. Subsequently, we demonstrated that the knocking out of CCR2 gene in mice protected motor neuronal apoptosis and inhibited loss of muscle mass of soleus, tibialis and gastrocnemius from 63.4 + 5.1%, 72.3 + 2.7% and 70.2 + 1.1% in WT mice to 82.1 + 4.7%, 85.4 + 4.5% and 95.8 + 3.2% in CCR2KO mice, respectively, after BISI.

Conclusions
Collectively, these results suggest activated macrophages creep to the spinal cord through CCL2/CCR2 signaling axis after BISI to cause neuroinflammation, leading to motor neuronal damage, nerve disintegration and muscle wasting.

Applicability of Research to Practice
These findings will be useful to understand the pathology occurring in burned patients and to develop the therapeutics measures to protect them from BISI.
49 Indocyanine Green Angiography in the Surgical Evaluation of Partial Thickness Burn Wounds
Authors: Mulay Sagar , Klein Gabriel , Dagum Alexander , Sandoval Steven , Borrero Michael 
Published: March 2020

Abstract

Introduction
While treatment of 1st and 3rd degree burns is fairly well understood, second-degree burns pose a challenge. This can lead to delayed treatment, or unnecessary operations, either of which can lead to scarring, contractures, infections, and poor cosmetic outcomes. While Laser Doppler Imaging has been used to differentiate second degree burns it is not reliable in studying uneven surfaces, requires long scan times, and has limited penetration. ICG angiography, which has gained wide use in breast reconstruction, can circumvent many of these issues. In this study, we used ICG angiography to investigate 2nd degree burns in an effort to develop an objective measure to differentiate deep from superficial 2nd degree burns.

Methods
All patients with 2nd degree burns covering greater than 1% total body surface and consented to the study were enrolled. Exclusion criteria included iodide allergy and the inability to follow up. All burns presented within 48 hours of injury. Patients were evaluated with ICG imaging on presentation and re-imaged at 24-hour intervals up to 72 hours after the initial injury and at the time of excision. The patients were managed by a blinded Burn Surgeon, with follow up pictures performed at 2 weeks, 1 month, 6 months, and 1 year. All images were analyzed using software to determine if areas with different scores ended up receiving operative or conservative treatment.

Results
Thus far 6 patients have enrolled in the study. All patients presented following flash burns, with BSA ranging from 10–30%. Of the 6 patients, only one required operative treatment. For the five patients treated conservatively areas of burn presented with SPY Q readings ranging from 70–110. These readings improved universally with each subsequent image, often by 10–20 each image, although one burn was found to double its perfusion by 72 hours post-injury. In contrast, the patient requiring operative intervention presented with a SPY-Q reading of 20–30. While there was a minor improvement, the maximum reading the area of resection reached was only 40–50. The patient was eventually taken to the OR for debridement and STSG.

Conclusions
While these preliminary results are limited due to the small sample size of our population, we feel that this study demonstrates the utility of ICG angiography in the diagnosis of second-degree burns. Our previous work on a porcine model verified that SPY can be used to measure both vertical and horizontal burn progression, and our early results in this study show a sharp difference between the patients treated conservatively, and the one patient requiring operative intervention.

Applicability of Research to Practice
Using these results, we plan to develop an objective cut off that will serve as a benchmark for when operative intervention is required. And with a secondary objective to evaluate the level excision.
68 Application of the Modified Hospital Length of Stay Predictor
Authors: Dao Sylvia , Lynch Heather 
Published: March 2020

Abstract

Introduction
Developing formulas to predict accurate length of stay (LOS) is challenging in burn patients as many complex variables can effect LOS. A recently published article in 2016 provided new formulas (NFs) to predict hospital LOS. Our goal is to compare our patients actual LOS (ALOS) to the NFs published, the traditional 1day/%TBSA rule, and to the hospital expected LOS (ELOS) based on patients CMI/DRGs.

Methods
Data was collected from Jan ‘16 to Dec ‘18 on all patients &gt;18 years of age using NTRACS burn registry. We excluded deaths, non-burns, readmissions, any records with missing information, and any patients transferred to another acute care hospital. We performed multiple regression to examine the relationship between LOS with age, inhalational injury (INHINJ), and TBSA on all patients. We divided this population into three groups per the NFs recommendations: 1) INHINJ; 2) without INHINJ &lt; 40 years old; 3) without INHINJ &gt;40 years old. Using these three groups, we calculated the difference between ALOS to 1) the traditional LOS formula, 2) the NFs as established in the 2016 article, and to 3) the hospitals ELOS metrics. For acuity comparison, we also calculated average CMI in each study group. The NFs published are as follows:

Results
The multiple regression model with all three variables (Age, % TBSA, and INHINJ) produced R² = 0.321, F(3,883) = 139.23, p &lt; .05. INHINJ, age, and TBSA had significant positive regression, indicating an increase or presence of all three variables will lengthen LOS. The regression equation is: LOS = (-3.93) +1.71(AGE) +1.11(TBSA) +15.81 (Inhalation). Every year increase in age increased LOS by 1.71 days. Every 1% increase in TBSA increased LOS by 1.11 days. Presence of INHINJ (0= no INHINJ; 1= INHINJ) increased LOS by 15.81 days. Table 1 depicts the mean ± SD of the difference in LOS (predicted - actual) for the three predictive models of LOS. Negative values indicate underestimation of LOS and positive values indicate overestimate of LOS.

Conclusions
Application of the predictive LOS formulas has underestimated LOS in this population, with the exception of the NFs to predict LOS on patients &gt;40 years old without INHINJ. Furthermore, an R² value of 0.32 indicates that the variables utilized in this study do not account for 68% of the variation we see. This is further exemplified by the wide standard deviations, particularly in the INHINJ group.

Applicability of Research to Practice
Directly Applicable.
119 A Nitric Oxide Releasing Bio-active Wound Dressing for Burn Wound Infection Treatment
Authors: Roy Jahnabi , Estes Lori , Christy Robert J , Handa Hitesh , Natesan Shanmugasundaram 
Published: March 2020

Abstract

Introduction
The future of multi-domain battlefield operation requires wound dressings to prevent infection at the point of injury. Majority of antimicrobial agents only target wound infection while other healing events are left to their natural fates. Nitric oxide (NO) acts against both gram-positive and -negative bacteria and has the potential to positively affect wound healing. In this study we have developed a novel wound dressing integrated with a NO donor - S-nitroso- glutathione (GSNO) in a hybrid formulation of alginate and poly(vinyl alcohol) (PVA) to prevent/treat burn wound infection.

Methods
The NO releasing wound dressing was fabricated using PVA, alginate, and glycerol, crosslinked with CaCl2 incorporating GSNO. Thereafter, release kinetics were measured up to 4 days. The antibacterial efficacy was determined against both P. aeruginosa and S. aureus. Then the biocompatibility of the NO wound dressing was assessed using in vitro fibroblast proliferation and wound healing assay. Finally, the efficacy of the wound dressing was assessed in vivo using a 3-cm diameter porcine burn wound infection model.

Results
The Alginate-PVA-GSNO dressing showed a desired physiological level NO flux of 4.42 × 10-10 mol cm-2 min-1 for 72 hours. Alginate−PVA−GSNO dressings showed ~3 log reduction in S. aureus and ~2 log reduction in P. aeruginosa CFU/mg when compared to control. The NO-releasing dressing improved fibroblast proliferation and migration resulting in complete closure of the wound within 48 h in vitro. The safety and efficacy of NO-releasing dressing were successfully established in the both P. aeruginosa and S. aureus infected porcine burn wounds. Histological assessments are carried out to determine the effect of NO-releasing dressing on overall healing process.

Conclusions
This study shows Alginate−PVA-GSNO wound dressing provides antimicrobial and wound healing properties in vitro. Preliminary in vivo wound healing studies established the safety and efficacy profile of NO-releasing dressing to treat burn wounds.

Applicability of Research to Practice
An easy to apply, field deployable and effective antimicrobial wound dressing is still a major requisite for combat burn wounds. NO delivering alginate-PVA based wound dressing may be an ideal candidate to inhibit infection as well as promote the wound healing process.
128 The Effects of Acupuncture on Pain on the Burn Service
Authors: Chin Theresa L , Burton Kimberly , Thomas Mini , Bernal Nicole O , Nourani Bobby , Nunez Molly , Li Sheng , Rychlock Rachel , Horie Mariko , Malik Shaista , Joe Victor C 
Published: March 2020

Abstract

Introduction
Acupuncture is a well known modality in traditional Chinese medicine to treat various ailments including pain. There is increasing evidence that acupuncture reduces postoperative pain, but it is poorly studied, especially in burn and wound patients. We report our initial experience with acupuncture treatment associated with burns and wounds on our burn service.

Methods
Our hospital now employs acupuncturists as part of implementation of integrative health modalities. Data on Burn service patients who underwent acupuncture were prospectively collected. Patients consented prior to treatment. Additional reasons for treatment other than pain were collected. Pain scores before and after the session were recorded. If patients were sleeping at the end of treatment and a pain score could not be obtained, the pain score was assigned zero. Side effects, including local bleeding, bruising, needling discomfort and short-term nerve irritation, were followed.

Results
From March to October 2019, nineteen patients on the Burn service were treated with acupuncture for a total of 178 sessions. Median age was 56 years (IQR:46–64.5). One pediatric patient was treated. Most (70%, n=14) were burn patients and 6 patients had other types of wounds. Median TBSA for burn patients was 8.5% (IQR:5.4–10.4). The number of treatments per patient ranged from 1–23 with a median of 5 (IQR:2.5–19). The median pain score prior to acupuncture treatment was 3 (IQR:0–5) and after treatment was 0 (IQR:0–2.25). Almost half (48%) of the treatments included other symptoms besides pain, most commonly for sleeping disorders (n=33) and anxiety (n=28). No side effects of acupuncture were reported. The most common auricular acupuncture points were shenmen and sympathetic, which targets relaxation and pain. Large Intestine 4, located on the hand, and Liver 3, located on the foot, were the most common body acupuncture points, which target relaxation and generalized pain.

Conclusions
Acupuncture appears to mitigate burn and wound pain and can be used to treat other acute ailments besides pain. There are few side effects of acupuncture on burn and wound patients. Based on our initial experience, a prospective observational study to identify the efficacy of acupuncture in burn patients for pain control and other symptoms is being developed.

Applicability of Research to Practice
In light of the opioid crisis, new applications of nonopioid modalities for pain management should be investigated. Acupuncture is low risk with potential benefit without opioids. Furthermore, other symptoms such as sleep disturbances and anxiety may be treated without pharmacologic medications.
533 Establishment and Effects of a Method for Wound Repair in Patients with Extensive Deep Burns Using Fresh Skin Allografts and Autologous Micrograft
Authors: Shen Chuanan , Sun Tianjun , Deng Huping , Niu Yuezeng 
Published: March 2020

Abstract

Introduction
This study was to establish a method for wound repair in patients with extensive deep burns using fresh allogeneic scalp combined with autologous micrograft.

Methods
Two patients with burn injuries involving 90% (3rd degree, 70%) and 97% (3rd degree, 85%) total body surface area (TBSA) respectively were treated with fresh scalp allografts donated by 32 males aged (31.5 ± 8.2) years or autologous micrografting. The bilateral limbs with third-degree burns were selected as treatment and control groups. Wounds in the treatment group were treated with fresh allogeneic scalp and autologous micrograft, while wound in the control group received MEEK grafting. Preoperatively, the surgical area on the extremities was calculated to estimate the necessary amount of allogeneic scalp and MEEK grafts. Fresh scalps (0.30 - 0.35 mm) were harvested from each donor to prepare a larger piece of skin allograft. Autologous micrografts were transported onto the epidermis of the skin allograft. The treatment and control group received grafting according to our protocol. The donors received follow-up visits after 3 months to see if there is alopecia and scar hypertrophy. The wound coverage rate was observed in both treatment and control groups on postoperative weeks 2, 3, 4 and 5.

Results
The donor sites in all allogeneic skin donors healed within 10 days postoperatively. The scalp recovered well without any alopecia or scar hypertrophy during the follow-up visits. The wound coverage rate of the treatment group was approximate to or higher than that of the control group.

Conclusions
Considering that allogeneic skin is scarce and expensive and the patient’s relatives are willing to help save the patient’s life by donating the scalp, this method may be a feasible clinical treatment option.

Applicability of Research to Practice
This study is a clinical study which is highly applicable in practice.
544 Examining the Characteristics of Eligible Burn Survivors Who Did Not Consent to Participate in a Longitudinal National Database
Authors: Wolfe Audrey E , Stockly Olivia , Grant Gabrielle G , Gibran Nicole S , Carrougher Gretchen J , Holavanahalli Radha K , McMullen Kara , Schneider Jeffrey C , Ryan Colleen M 
Published: March 2020

Abstract

Introduction
As one of the largest prospective, longitudinal, multi-center research data repositories for burn survivors, the Burn Model System (BMS) National Database is in a unique position to explore the characteristics of burn survivors who choose not to participate in long-term research. Given recent shifts in research priorities to include underserved and vulnerable populations, the purpose of this study was to assess the extent to which the research population of the BMS National Database is representative.

Methods
Data from the BMS national database collected from 1994 through June 2019 were analyzed. Demographic characteristics were compared between individuals who did and did not consent to be participants of the BMS database. Regression analyses were used examine any correlation between demographic characteristics and study participation controlling for BMS site and eligibility criteria.

Results
A total of 7,451 burn survivors age 0–99 years old (6,418 consented; 1,033 did not consent) were included in the analysis. The two populations did not differ significantly by gender or race. However, individuals who did not consent for the BMS database were older and more often Hispanic/Latino (p&lt; 0.001) (Table 1). In regression analyses, age and ethnicity were significant predictors for enrollment into the BMS database with individuals over 80 years of age being 80% less likely to consent and those who are Hispanic/Latino being approximately 66% less likely to consent (Table 2).

Conclusions
It is important to understand the extent to which the BMS database captures individuals most affected by burn injuries who are considered underserved or vulnerable. In this long-term study older adults (80+ years old) and individuals who identify as Hispanic/Latino were less likely to consent and enroll. Researchers are challenged to understand why these individuals are not participating in longitudinal research and develop strategies to improve enrollment in these vulnerable populations.

Applicability of Research to Practice
Underserved and vulnerable burn survivor populations must be represented in research studies to gather as much information as possible about their recovery and long-term outcomes. Information on outcomes is vital for care decisions.