bluuebunny/crossref_metadata_2025_split huggingface dataset:
92 Improved Burn Healing Classification via Artificial Intelligence
Authors: Baxter Ronald D , Carter Jeffrey E , Craig Christopher K , Williams Jeffrey W , Holmes James H 
Published: March 2020

Abstract

Introduction
Current methods of assessment for burn severity and healing potential are insufficient but this determination remains critical in providing optimal burn care. A novel device using multispectral imaging and artificial intelligence (AI) has shown prior success aiding in this process. Promising initial results of this proof-of-concept case series have been presented previously, invoking much interest from the burn care community. These results reflect the final results of this study and provide support for continued investigation with this device for the treatment of burn wounds.

Methods
Subjects with thermal burns were enrolled within 72 hours of injury. The goal was to enroll at least 12 burn wounds from each category of severity: 1°; superficial 2°; deep 2°; and 3°. Upon enrollment burns were imaged with the study device serially for up to 7 days post-burn. The true healing potential of each imaged burn area was determined using either healing assessment at 21 days post-burn or multiple punch biopsies of the burn wound taken at time of excision and grafting. This ground truth was used to train the AI algorithm to automatically identify the margins of non-healing burn tissue within device images. Accuracy of the study device to identify and differentiate healing and non-healing burn tissue within the captured wound area was computed.

Results
Data from 38 subjects with 58 total burns and 393 wound images were obtained during this study. Following completion of training, AI predictions achieved 90.7% sensitivity with 87.5% specificity in predicting non-healing burn tissue using cross-validation. Results improved throughout the study as more wound images were used in AI training (Figure 1).

Conclusions
The AI algorithm trained on 58 burn wounds (38 subjects) had an area under the curve of 0.955 and has continued to improve with the addition of more burn wounds. Expansion of this study has been initiated at multiple burn centers to continue collecting data for AI algorithm training.

Applicability of Research to Practice
These results demonstrate feasibility of utilizing AI-assisted diagnosis in burn wounds and possible application in the management of burn patients.
106 Heads or Tails? Scalp versus Non-scalp Donor Sites for Split-thickness Skin Grafting of Burns: A Systematic Review and Retrospective Review
Authors: Rokui Sorush , Pawliuk Colleen , Bone Jeffrey , Papp Anthony , Hynes Sally 
Published: March 2020

Abstract

Introduction
The scalp is an appealing donor site for split-thickness skin grafting (STSG) of burns due to its concealment upon hair regrowth and healing potential; however, it is often reserved for massive burns with limited donor sites. This study aims to understand scalp donor site (SDS) outcomes and complications to elucidate viability of the SDS as a first-line option for coverage of burns.

Methods
A systematic review across five databases was conducted. Original research reporting cohort outcomes of STSG coverage of burns using the SDS was included. Donor site healing time, graft thickness, graft take, and complications were analyzed. Thereafter, a retrospective chart review of patients who had SDS-STSGs for burns from 2010–2018 was done. Outcomes and complications were compared to non-SDS-STSGs (NSDS-STSGs) in criteria-matched controls.

Results
Systematic Review: 1489 articles were reviewed. 15 cohort studies met inclusion criteria, yielding 1761 patients who has SDS-STSG (mean age=17 yrs, mean TBSA=37%). Alopecia and folliculitis occurred in 5% and 3% of patients, respectively; folliculitis was associated with certain hair types. Other complications (eg. hypertrophic scarring, hair transfer) were seen in less than 1.5% of patients. Rapid donor site healing times (mean=8 days) and capacity for re-harvest (mean=2 harvests/patient) were noted.
Retrospective Review: 30 patients underwent grafting with SDS-STSGs, 23 of whom also received NSDS-STSGs and were thus self-controls; criteria-matched controls were found for the remaining 7. Graft thickness and graft take did not differ between SDS and NSDS groups, while donor site healing time was faster for SDSs vs NSDSs (9 vs 11 days, p=0.02).
SDS complications included: alopecia (n=2), delayed healing (3), and folliculitis (1). NSDS complications included: delayed healing (n=1), dyspigmentation (2), and hypertrophic scarring (3). These complications could not be attributed to age, ethnicity, graft thickness, number of graft harvests, comorbidity burden, TBSA, or inhalational injury status.

Conclusions
The scalp donor site may represent a viable first-line option for split-thickness skin grafting of burns. Our cohort suggests that scalp donor sites pose comparable risks to non-scalp donor sites. Further studies elucidating the role of hair type in SDS-STSG complications are required to optimize outcomes with patient-specific donor site selection.

Applicability of Research to Practice
In select patients, the scalp may be considered as a first-line donor site for split-thickness skin grafting of burns, with potentially faster donor site healing time and comparable risks to non-scalp donor sites. Some scalp-specific complications may be linked to differences in hair type.
123 Burn Patients’ Pain Experiences and Perceptions at a Regional Burn Center
Authors: Duchin Emma R , Moore Megan , Carrougher Gretchen J , Min Emily K , Gordon Debra B , Stewart Barclay T , Sabel Jody , Jo-Nes Anne , Pham Tam N 
Published: March 2020

Abstract

Introduction
Burns are often painful injuries, associated with a long recovery. Little is known about patients’ pain experience or understanding of burn pain. Patients may also not be receiving sufficient pain education to optimize their pain experience. The aim of this project was to obtain patients’ perspectives to inform future burn pain education efforts at a regional burn center.

Methods
We conducted mixed-methods interviews in inpatient and outpatient units. Participants were &gt;=14 years with acute burn injury, who received at least two wound care episodes, and were able to cognitively participate. Provider stakeholders designed the interview using a modified Delphi technique. Survey questions focused on patients’ pain experiences, understanding and desire to gain knowledge of burn pain and management. Descriptive quantitative analysis was performed on categorical data. Recorded interview segments were transcribed for content analysis using an online, HIPAA-compliant software.

Results
We interviewed 21 adult burn patients. Participants reported variable pain and pain management effectiveness, with inpatients reporting more severe pain than outpatients. Only 11% of inpatients reported having received enough pain information, compared to 50% of outpatients. Participants expressed, in decreasing order of importance, a need for more information on burn-related pain, medications and alternative treatments, analgesic weaning, and addiction risk. In-person education ranked as the most desirable education method, followed by pamphlets and video education. Qualitative content analysis yielded 3 major themes: patient’s pain experience, range of expectations, and clinical information/services desired. Mental and physical effects were key parts of participants’ pain experiences, with many participants reporting mental anguish in addition to pain. Most participants’ pain expectations were matched by their experience, while some individuals described higher pain levels than they anticipated. Positive experiences with the burn care team primarily revolved around provided education and information on pain, whereas negative experiences concentrated on wound care events. Participants desired more information on sleep and pain medications, realistic expectations of recovery timelines, and available mental health services.

Conclusions
Burn patients report variable pain experiences and a strong desire to receive additional pain education. This project informs key strategies to educate burn patients on pain. A high-level of interest in pain, pharmacologic and alternative therapies, weaning and addiction risks indicates a need for newer targeted education materials.

Applicability of Research to Practice
Burn patients’ perspectives help inform strategies and content creation for education materials that burn centers can provide.
523 Silkworm Silk as an Alternative to Two Common Epidermal Substitutes for the Treatment of Acute Superficial Burns
Authors: Schiefer Jennifer L , Fuchs Paul 
Published: March 2020

Abstract

Introduction
During the treatment of superficial burn injuries patients are often confronted with painful dressing changes. Therefore we usually treat these wounds with materials that can stay on the wound and slowly peel off during re-epithelialization. Since 2013 we started using pure silk as cost efficient alternative for the treatment of these wounds. Therefore we wanted to compare it directly with the other dressings.

Methods
In a prospective intra-individual design we evaluated the wound healing of 50 patients with superficial burn injuries. Hereof 30 patients received both silk and Nylon mesh with collagen and 20 further patients received silk and a synthetic epidermal substitute for the treatment of their burn injuries. Following a standardized case report form, we monitored pain, active bleeding, exudation, dressing change and inflammation. Furthermore we evaluated scar quality objectively with the Cutometer, Mexameter and Tewameter as well as subjectively with the patient and observer scar scale (POSAS) and the Vancouver scar scale (VSS).

Results
During wound healing no significant differences could be found regarding wound closure, inflammation and acute bleeding. Pain levels fell fast during after dressing application and during wound healing. Long-term results in functional and aesthetic outcome were similar. High satisfaction rates were reported for all dressings, with different individual preferences.

Conclusions
All three dressings provided a safe and effective healing environment, with low complication rates in regard to infection and exudation. Additionally, no significant differences regarding scarring could be found with an overall pleasing aesthetic outcome.

Applicability of Research to Practice
Silkworm silk is now the standard of care in our clinic for superficial burns.
564 Use of the Pediatric Quality of Life Measure in the Burn Camps Population
Authors: Mikolaj Kerry , Boulter Trudy , Jackson Brad , Schuetz Tim 
Published: March 2020

Abstract

Introduction
The Pediatric Quality of Life Inventory (PedsQL) is a tool used to measure health-related quality of life in children and adolescents. The PedsQL measures physical, emotional, social, and academic function. Our burn camp program provides comprehensive programming in a supportive, challenging environment to enhance care of a child with a burn injury. Our camp addresses: isolation, social skill development, body image, negative beliefs, risk-taking, and academic challenges. The lessons learned at camp are unique and build lifelong success. The PedsQL will provide data on changes that are being made with our campers over time. We hypothesize positive changes in PedsQL scores with the addition of burn camp.

Methods
The PedsQL consists of forms for children ages 2–4, 5–7, 8–12, and 13–18. Pediatric self-report is measured in children and adolescents ages 5–18. There is a separate parent proxy-report of the child’s health-related quality of life for ages 2–18. Before camp begins, parents are mailed the parent report to fill out and are due back prior to the first day of camp. Campers fill out the form on the first day of camp. Data is entered into an excel spreadsheet. Follow up parent and child/adolescent surveys are then sent out 3 months post camp. Three month follow up data is entered and compared to original scores. Three scores are generated from the data including total score, psychosocial score, and physical health score. A higher score indicates a better Health-Related Quality of Life.

Results
We trialed the use of the PedsQL in our adolescent burn camp, consisting of 23 campers ages 13–18. We received 8 (34%) follow up surveys. The results of these scores are trending in a positive direction. We used the PedsQL for our burn camp program consisting of 77 campers ages 8–18. We will obtain 3 month follow up data by Dec 2019 and will assess the data and report the changes.

Conclusions
The PedsQL is a tool that can help our camp program track changes/progress in our campers in the areas listed above. We have seen positive changes in our small sample size and predict we will see positive changes with our larger camp population in the next few months.

Applicability of Research to Practice
Using outcome measures for medical specialty camps is necessary and currently lacking in the literature. The PedsQL tool is used in healthy, acute and chronic health conditions, making it applicable for burn camp programs. The PedsQL has established norms for the healthy population for benchmarking purposes and community health comparisons. This tool will help our burn camp program assess the psychosocial, physical and academic growth of our campers.
593 Ambient Room Temperature in a Burn Intensive Care Unit - A Quality Improvement Project
Authors: Rogers Alan D , Cartotto Robert , Ho George 
Published: March 2020

Abstract

Introduction
In patients with burns &gt; 20% TBSA, hypermetabolism, evaporative water loss, infection risk and discomfort are all amplified by exposure to cold ambient temperatures. Post-operative patient hypothermia is also detrimental. It is essential to not only maintain a warm patient room temperature, but also to be able to rapidly increase room temperature in the burn ICU. The purpose of this study was to measure typical patient room temperatures in a burn ICU at an adult regional ABA-verified burn center, and to evaluate our ability to intervene and raise room temperature.

Methods
The ambient temperatures of nine patient rooms were recorded from 14 June to 14 August, 2019. Temperature was measured every minute by a wall-mounted smart sensor placed at standardized positions away from windows or electronic equipment. All devices were tested prior to use, with temperature and humidity accurate and standardized to &lt; 0.2oC and 2% respectively at 18-25oC. Data was transmitted to a mobile smartphone.
On 15 August 2019 all room temperatures were manually adjusted to ‘maximum’. This was identified as a sound change initiative, and replicated a potential medical order to increase the ambient temperature should a hypothermic patient be imminently returning from the operating room or resuscitation area after admission.

Results
Over the baseline observation period (Figure 1) the mean ± SD room temperature was 23.3 ± 1oC. Temperatures deviated below a mean of 22oC during 166 hours per room (11.5%, range 3–362).
Following the intervention on 15 August (Figure 2), ambient temperature increased minimally in 6/9 rooms and only by 2–3°C in two rooms (mean rise of 1.03oC; range -0.88oC to 3.26oC).

Conclusions
The burn ICU rooms are relatively cold and our ability to raise ambient temperature quickly is limited. Further QI change ideas include: 1) a facility engineering assessment 2) set alarms on the smart sensors to alert staff when room temperature falls below a designated threshold.

Applicability of Research to Practice
This project has identified an important future QI initiative to maintain warm ambient patient room temperatures in the burn ICU.
608 The Impact of a Nurse Morbidity and Mortality Meeting
Authors: Figel Ginny , Jelnicky Liz M 
Published: March 2020

Abstract

Introduction
Physicians have long held Morbidity and Mortality (M&M) conferences to discuss complications and deaths. The format for these conferences is to lay out the case, discuss the care performed, and generate discussion on areas of opportunity. Physician M&M usually focuses on teaching and the presenter may not be the caregiver. There is not much literature on the use of this teaching methodology in nursing. Due to the strong culture of safety on the unit, it was determined that creating a Nurse M&M could prove beneficial for discussion of complications, deaths, errors, and good catches as they related to nursing care.

Methods
Nurse M&M is held monthly for one hour. All personnel involved in the cases are informed ahead of time what will be discussed. They are given the opportunity to present the individual case or give personal testimony as to the situation from their point of view. Each case is presented in the same format. The initial slides cover background, history of present illness, and the origin of the report. Next is the pertinent review from the electronic medical record and discussions had with those involved in the case. The floor is then open for discussion. If there was a variation in practice, the policy that relates to the error is reviewed. Topics for Nurse M&M are gathered through many venues. The hospital uses an online reporting system for electronic submission of adverse events, variations in care, and good catches. The entire multidisciplinary team have all individually reported something they wanted discussed at Nurse M&M. If clarification is needed on a case, the question is directed to the appropriate decision maker and followed up on.

Results
Nurse M&M is the most highly attended, non-mandatory, meeting held on the unit. The nursing staff was surveyed to determine their perceptions on how the addition of Nurse M&M had effected them. The results were overwhelmingly positive. All nurses surveyed rated the statement, “I feel that Nurse M&M has had a positive outcome on the unit’s collective practice”, as agree or strongly agree. Over time, the notes taken have evolved from just the discussion to action items created off the case. The staff have will now self-report events before they are entered into the online system.

Conclusions
The nursing staff are highly engaged Nurse M&M. The staff are open to discussing errors in a way that fosters educational growth and critical thinking development. If the case being discussed is because of a personal error, more often than not, the person responsible will discuss why they made the decision they did and facilitate the discussion as to what could have been done differently. The nurses’ commitment to being present, engaged, and open minded are strong signs of the healthy work environment present on the unit.

Applicability of Research to Practice
The format of a nursing M&M conference is applicable to all units. Patient safety and nurse engagement are the top factors effected by Nurse M&M.
625 Death Due to Fractal Wood Burning: An Emerging Public Health Problem
Authors: Campbell Harold , Nizamani Rabia , Jones Samuel W , Cairns Bruce , Williams Felicia N 
Published: March 2020

Abstract

Introduction
The art of pyrography, creating designs in wood with a thermal heat source, dates back to prehistory. Risks include cutaneous burns and airway injury. Fractal woodburning is a niche method of pyrography utilizing a high-voltage electrical source to burn branched designs – Lichtenberg patterns – into the surface of wood. While this technique has grown in popularity, the associated risks are not well described.

Methods
We describe a patient who presented to our burn center after sustaining high-voltage electrical burns from a homemade high-voltage device constructed for fractal woodburning. We also evaluated publicly reported cases of death or injury due to this technique.

Results
An otherwise healthy 17-year-old male was admitted to our burn center with injuries sustained while making fractal wood art. The patient improvised a high-voltage transformer from a discarded microwave, generating 2000 volts from household current. While using this device to burn Lichtenberg patterns in wood, he contacted the electrodes and sustained full-thickness electrical burns to the neck, chest, and bilateral upper extremities. Bilateral upper extremity fasciotomies were required on admission. Multiple subsequent operative procedures culminated with autografting to the majority of the wounds and ongoing complex reconstruction of the left thumb.
In evaluating online news reports, we found 21 unique individuals with death or injury attributed to fractal woodburning. Four sustained substantial injuries, while 17 reportedly died. The first reported incident occurred in July 2016 and the most recent report was from July 2019. Ages ranged from 17 years old to the 60s. Eighteen individuals were younger than 50 years old. All of the mortalities and 3 of the 4 injuries occurred in males. Of the survivors, 3 sustained significant upper extremity injuries and 2 suffered cardiac arrest at the time of injury. The devices used in 4 incidents were microwave transformers and generated 2000 volts. Device characteristics were not identified in the remainder of cases.

Conclusions
Fractal woodburning is associated with devastating high-voltage electrical injuries and death. Prevention efforts should be focused on the potential risks of this art form.

Applicability of Research to Practice
News reports likely underestimate the actual incidence of injury and death due to fractal woodburning, however, even this limited data suggests an emerging public health problem requiring further study and public education.
661 Dietitian Order-writing in a Burn Intensive Care Unit
Authors: Graves Caran 
Published: March 2020

Abstract

Introduction
Recent changes in Center for Medicare & Medicaid Services guidelines recommend that Registered Dietitians (RD) write nutrition-related orders for hospitalized patients. The goal is to improve patient care and assist other clinical providers. Permitted orders may include diets, enteral nutrition and monitoring along with referrals per hospital policies. RD order-writing started in our intensive care units (ICU) the past year. This study reviewed the type and number of orders written by the RD.

Methods
The ICU RD prospectively (January 17, 2019 – August 31, 2019) tallied RD orders including: diet and supplement changes, enteral nutrition, calorimetry, nitrogen balance and intake orders (calorie count). Orders that could have been completed by the RD but were completed by a doctor or physician assistant (PA) were also noted. Data was analyzed using descriptive statistics and results reported as percent of patient days and type of order completed.

Results
Results were collected on a total of 1775 patient day. The majority (1519 = 85.5%) did not require changes in nutritional intervention or monitoring (see Table). Of the 446 nutrition related orders written, the RD completed 347 (77.8%) with 99 (22.2%) completed by the PA. Changes to enteral nutrition, calorie counts and nutrition-related tests (calorimetry and nitrogen balance) the most common. The majority of changes occurred during team rounds.

Conclusions
Most patients did not require changes in diets, nutrition support or nutritional assessment parameters. The most common changes were stopping/starting calorie counts and adjusting enteral nutrition or nutritional monitoring. RD order-writing decreased the number of orders the MD or PA completed.

Applicability of Research to Practice
Order-writing protocols can assist the burn medical team with workflow and allow for more timely nutritional interventions when needed.