bluuebunny/crossref_metadata_2025_split huggingface dataset:
780 A Systematic Review and Meta-analysis of 30-day Readmission Rates Following Burns
Authors: Branski Ludwik , Tapking Christian , Hundeshagen Gabriel , Boson Alexis , Rontoyanni Victoria G , Kowalewski Karl-Friedrich , Kneser Ulrich , Hirche Christoph R 
Published: March 2020

Abstract

Introduction
Unplanned hospital readmissions in surgical areas account for high costs and have become an area of focus for health care providers and insurance companies. The aim of this systematic review is to identify the rate and common reasons for unplanned 30-day readmission following burns.

Methods
This study was performed following the PRISMA guidelines. Pubmed, Web of Science and CENTRAL databases were searched for publications without date or language restrictions. Extracted outcomes included 30-day readmission rate and reasons for readmission. Pooled 30-day readmission rate was estimated from weighted individual study estimates using random-effect models. Pooled estimates for risk factors are reported as odds ratios (ORs) and 95% confidence intervals (CIs).

Results
A total of eight studies were included into qualitative analysis and six (four adults, two children) into quantitative analysis. The overall readmission rate was 7.4% (95% CI 4.1 - 10.7) in adults and 2.7% (95% CI 2.2 - 3.2) in children. Based on two studies in 112,312 adult burn patients, burn size greater than 20% total body surface area (TBSA) was not a significant predictor of readmission rate (OR 1.75, 95% CI 0.64 – 4.75; NS). The most common reasons were infection/sepsis, wound healing complications, and pain in both adults and children.

Conclusions
Unplanned readmissions following burns are generally low and appear more common in adults than in pediatric patients. However, only few studies are reporting on 30-day readmission rates following burns. Evidence is limited to support a significant association between greater burn size and higher readmission rates.

Applicability of Research to Practice
Since cost effectiveness and utilized hospital capacity are becoming an area of focus for improvement in health care, future studies should assess the risk factors of unplanned readmission following burns. Follow-up assessments and outpatient resources, even if not underlined by this data, could reduce readmission rates.
788 Improving Burn Camp Attendance: A Quality Improvement Study and Implications for Future Planning
Authors: Williford Desiree N , Tiani Alaina , Harrah Gabrielle N , Durkin Kristine , Leonard Linda , Hajduk Gina , Aballay Ariel , Duncan Christina 
Published: March 2020

Abstract

Introduction
Based on research showing the benefits of camp settings, our overnight, 5-day summer camp is designed to provide social support, acceptance, rehabilitation, and normative childhood experiences for our pediatric burn survivors (ages 7–17). Typical recreational activities (e.g., swimming, sports, crafts) and burn-specific programming (e.g., peer support discussions) are infused into camp. Despite this enriching opportunity, some individuals decide not to attend camp. The purpose of this quality improvement study was to better understand factors influencing decisions not to attend our summer camp and to identify strategies for overcoming these barriers to optimize attendance in the future.

Methods
Beginning in February 2019, we attempted to contact and interview 81 guardians of children who were eligible and invited to our summer camp but did not attend in 2017 and/or 2018. Attempts to contact were made via telephone by a trained burncamp staff member. Three attempts to contact were made per family unless otherwise reached. Our interview guide elicited reasons that led to their decision not to attend camp. Interviews were completed in approximately 30 minutes or less.

Results
Sixty-four contacts were unsuccessful, resulting in a 79% failure to contact rate. Only 17 individuals (21%) were successfully contacted. Thirteen caregivers (16%) completed the interview via telephone, while 4 (5%) refused to take part in the interview. Principal reasons for non-attendance included school attendance, parental beliefs about camp (e.g., child being away from home), other conflicting activities (e.g., other camps, vacations), and perceived lack of need for support (e.g., my child is doing well/does not need to go to a burn camp).

Conclusions
Despite the positive psychosocial outcomes observed among survivors who attend camp, large numbers of families and youth are not attending. While the purpose of the study was to explore factors influencing decisions not to attend camp, we also learned that it is important to address barriers to successfully contacting families. Challenges in planning the logistics of camp, specific strategies for engaging families over time, and ideas for addressing reported barriers to attendance (e.g., empowering well-adjusted survivors to attend to support others) will be discussed in this presentation.

Applicability of Research to Practice
Results from this quality improvement project have impacted camp planning and recruitment strategies. Findings may lead to increased enrollment rates and enhanced awareness of camp and its benefits.
794 Assessment of Nursing Knowledge and Preparedness for Nuclear Disaster
Authors: Grady Rich , Metivier Meghan , Prelack Kathrina , Ryan Colleen M 
Published: March 2020

Abstract

Introduction
In the event of nuclear incident, burn care teams are most likely to be called upon to respond. Yet, knowledge gaps exist related to nuclear disaster response. The primary objective of this study is to determine nurses’ baseline knowledge of preparedness for and treatment of victims of a nuclear event.

Methods
As part of a quality assurance initiative, we surveyed staff nurses in an acute pediatric burn facility to assess their knowledge of nuclear sources in the local area, preparedness for a nuclear event, and treatment of radiation exposure. Survey domains included a nursing self-assessment of knowledge base and comfort in treating victims of nuclear events, followed by questions assessing nursing knowledge of the proper response to nuclear fallout as well as treatment of symptoms to acute radiation exposure. Questions were provided in nominal category format (multiple choice, or true/false) and Likert scale. Data was summarized using frequencies and descriptive statistics.

Results
A total of 26 nurses responded to this survey. Their average number of years of experience in nursing was 22 years (range:1–43 years); 80% of participants had a baccalaureate degree or higher in nursing. Survey analysis revealed that 85% percent of participants reported not having had formal training in nuclear disaster response, and 65% reported being uncomfortable both in their knowledge base and their ability to provide care to patients with acute radiation exposure. Eighty percent reported not feeling able to treat victims of a major nuclear disaster. Only two nurses demonstrated a perfect score in questions related to response and treatment of radiation exposure. On average participants answered 68% of questions correctly. A large majority reported the need for more education.

Conclusions
A significant knowledge gap exists in proper response and treatment of nuclear disaster victims. Nurses in our facility report a lack of comfort in both their knowledge base and ability to treat these patients. Educational programming is needed and is being developed in our facility to improve competency and skill around nuclear disaster events.

Applicability of Research to Practice
Results of this survey will be used to develop educational programming in nuclear disaster response. A post education survey will be used to assess change in nursing knowledge and preparedness according to these initial findings.
802 Increasing Collaboration and Communication in Burn Resuscitations Through Education and Simulation
Authors: Castronovo Courtney , Smith David , Moynihan Holly 
Published: March 2020

Abstract

Introduction
Implementing the nurse driven burn resuscitation protocol on severely injured burn patients can often be intimidating to many nurses and there are many opportunities for mathematical errors.These errors have the potential to affect the patients’ fluid resuscitation and outcomes. Nurses often reported discomfort with navigating the protocol while stabilizing the patient.The aim of this inquiry was to see if offering and providing education to the intensive care unit (ICU) and emergency department (ED) nurses would increase their comfort levels initiating, and navigating our nurse driven modified parkland formula. Additionally, we hoped that by providing education to the ED nurses, this would lead to a smoother transition for patient hand-off by increasing collaboration among services.

Methods
Nurses were surveyed using a 5 point Likert Scale assessing comfort level prior to the education to obtain a baseline. Education was then implemented, and a follow up survey using the same scale was completed 3 months later to assess knowledge retention. Additionally, nurses were given similar practice questions as previously given in the simulation to assess application to practice.

Results
To date, we have had 14 nurses complete the education. Of those nurses, 2 were from the ED, and 14 were from the ICU. 57% of the nurses had less than 5 years of nursing experience. Of the respondents, there was a large increase noted in nurses comfort levels with accessing the burn admission resources, initiating the burn resuscitation protocol, and titrating the intravenous fluids based on hourly urine output based on the post survey results.

Conclusions
Continued education and evaluation is needed to determine if education sustains increased caregiver comfort levels, improves resuscitation outcomes, and enhances ED to ICU collaboration.

Applicability of Research to Practice
Research has shown that simulations for low volume, high acuity patient scenarios increase comfort levels of caregivers while enhancing collaboration, and communication. A study explored the effect of burn specific simulations on patient safety and nursing education. This study concluded that simulations had a profound effect on improving these two factors by practicing technical and communication skills (D’Asta, Homsi, Sforzi, Wilson, & Luca, 2019)
D’Asta, F., Homsi, J., Sforzi, I., Wilson, D., & Luca, M. D. (2019). “SIMBurns”: A high-fidelity simulation program in emergency burn management developed through international collaboration. Burns, 45(1), 120–127. doi: 10.1016/j.burns.2018.08.030
809 Culture Change in the Burn Unit: A Comprehensive Pressure Injury Reduction Strategy
Authors: Werthman Emily h 
Published: March 2020

Abstract

Introduction
In our regional burn center, which treats approximately 800 patients annually, the prevention of pressure injuries continues to challenge the burn team. The nursing team, in particular, was demoralized by a steady prevalence rate despite utilizing evidence based practice. A comprehensive pressure injury reduction plan was developed to provide new strategies to prevent pressure injuries and to provide real time data about the effectiveness of nursing interventions.

Methods
A team of physicians, nurses, nutritionists, pharmacists, physical and occupational therapists developed a plan to encourage all members of the team to become active participants in pressure injury prevention. The first method was the introduction of a weekly pressure injury survey for all burn patients. This survey ensures any emerging pressure injury is recorded and appropriate interventions taken. Secondly, a new pressure mapping device was installed in all ICU beds in the burn center. The pressure mapping device provides data to nurses during patient repositioning. This important data demonstrated to nurses, in real time, if their offloading was effective. Lastly, a weekly pressure injury analysis provided root cause analysis of any pressure injuries discovered in weekly surveys. As a result, nurses were provided real time feedback about the effectiveness of prevention techniques.

Results
Reporting of pressure injuries increased over 50% in the first year of the program. In addition, since the inception of the weekly prevalence surveys, the burn center has not not had a pressure injury progress past a stage two. The overall prevalence of pressure injuries has dropped each quarter,

Conclusions
Providing nurses with real time feedback in the form of real time full body pressure mapping, weekly prevalence and pressure injury analysis allows nurses to quickly change prevention techniques to better offload patients. While pressure injury rates have decreased, nurse involvement in pressure injury prevention has increased.

Applicability of Research to Practice
Pressure injuries continue to pose a significant challenge to burn patients. Given the continuing emergence of pressure injuries, nurses in our burn center were left demoralized and dissatisfied with their evidence based practice. Providing nurses with real time data to support the effectiveness of their prevention techniques has dramatically changed the culture in our burn center. Nurses are now able to view real time data about their practice through pressure mapping, weekly surveys and pressure injury cause analysis. As a result, nurses are more engaged in the important work of pressure injury prevention.
830 Voice Activated Tool: A Successful Assistance for Patients with Limited Hand Function
Authors: Thomas Mini , Chung David , de La Cruz Christopher 
Published: March 2020

Abstract

Introduction
Burn survivors require significant assistance in physical functions and independence during their recovery and rehabilitation phase. Amputation, splints, bulky dressings, and pain attribute to limited or lack of hand mobility. Voice activated tools (VAT) have rapidly grown in popularity including in healthcare. Prior to the implementation of this project, patients mostly depended on soft touch call lights which were suboptimal for most patients. We piloted VAT to assist in hand functions of patients with limited or lack of hand mobility.

Methods
The project was piloted in collaboration with IT, Occupational Therapy, Nursing, and patients’ family. IT enabled with uninterrupted source of wireless network connection in the patients’ room. Voice assistance was incorporated both through mobile phone and an added virtual assistant tool. Patients’ personal devices were used to promote utilization of stored information in the device. Occupational therapist assisted in mounting the device through a spring clamp and gooseneck cell phone holder to visualize the device screen. Speech therapists, nurses, and patient family helped in training the patient to voice appropriate commands. The patient utilized VAT for a wide variety of purposes including calling nurses, ordering hospital meals, phone calls, music, web browsing, and more. A survey was done to evaluate health care team’s opinion on VAT usage.

Results
Of the total burn team members, 34 (77%) staff responded to the survey including physicians, nurses, therapists, and nursing assistants. All survey responders reported VAT as a useful tool to be offered to all future patients with limited hand mobility. Majority (74%) of responders witnessed or participated in the successful use of VAT during the pilot period. Survey participants reported three reasons for the current soft touch call light system to be suboptimal: 1.Too sensitive, 2. Not all patients can use it 3.

Conclusions
Voice activated tool can be successfully utilized for assisting patients with limited hand mobility considering the current available tool is suboptimal. Adoption of a simple and popular technology of VAT can be easily incorporated in hospitals through collaboration of health care team.

Applicability of Research to Practice
Use of VAT could be successfully implemented for other hospital units including paralyzed patients, blind, and patients with orthopedic conditions or trauma to hands. Additionally, VAT could be incorporated in to rehabilitation and home training of patients with limited hand mobility. Further, VAT could be considered in the designing and planning of hospitals.
834 Early Ambulation Initiative Following LE Grafts in Comparison to Our Center’s Traditional Standard of Care: A Retrospective Data Review
Authors: LePage Lisa , Jeffreys Danielle T 
Published: March 2020

Abstract

Introduction
Our ambulation guideline following LE grafting is loosely defined as bedrest vs. lateral transfers only until POD#5. Patient’s mobility status is increased POD#5 with WB per physician discretion. A proposal was created to initiate mobility earlier than POD#5 for patients with LE grafts. Two of our three surgeons were in agreement with the early ambulation protocol. The third surgeon wished to follow the traditional ambulation practice guideline. This request was respected and made known to all staff for carryover. This afforded us the opportunity of a comparison group with our center’s traditional standard of care functioning as the control group.

Methods
The proposed early ambulation protocol was influenced by evidence-based practice guidelines as well as surgeon input. Criteria was based upon the location of grafting, graft crossing a joint, size of wound being grafted (&lt; or = 400 cm), and general medical status of the patient. Our early ambulation protocol was established as follows: POD#1 Lateral transfers with involved LE elevated. POD#2 Dependent LE at edge of bed, WBAT short distance ambulation to chair or bathroom with AD. POD#3–4 Increase ambulation as tolerated, assess need for continued splinting, appropriateness of progressive ambulation, AROM exercises. POD# 4–5 Progress ambulation with AD as needed, stairs as needed for discharge, home exercise program. Our inclusion criteria consisted of patients of any age, LE burns with STSG not involving joints/involving joints with appropriate immobilization. Exclusion criteria consisted of fractures of involved LE, patients who were non-ambulatory at baseline, wounds &gt;400 cm2, STSG to plantar aspect of foot, medically unstable patients, and surgeon discretion.

Results
Data reviewed over an eight month period of time yielded 27 patients who met our established criteria; 26 had no graft loss on the first dressing change. The patient with graft loss was attributed to graft placement directly over bone of the distal phalanx. Comparatively, no loss was noted in the control group with 10/10 patients ambulating on POD#5. Of note, early ambulation was granted for several patients with larger surface areas with no graft loss demonstrated, but were not included in this study.

Conclusions
In conclusion, 96% of patients demonstrated no graft loss with first dressing change following our early ambulation guideline. All patients who followed the traditional ambulation guideline demonstrated no graft loss on the first dressing change. Based on our findings, early mobility is not detrimental to graft integrity following specific established guidelines.

Applicability of Research to Practice
Our data supports early mobility of LE grafting up to 400 cm2 with 96% success rate. This may be supportive of further research with early mobility involving a larger surface area of LE STSG.
837 Clinical Experience Using Functional Outcome Measures in the Outpatient Burn Center
Authors: Boals Melissa , Curtis Lisa , Cochran Amalia , Bailey John Kevin , Coffey Rebecca 
Published: March 2020

Abstract

Introduction
For patients with severe burns, the emphasis has shifted from survival to maximizing functional outcomes. Outcome measures are tools that help establish a baseline status and monitor progression towards meaningful tasks such as activities of daily living (ADLs) and mobility (Staley et al. 1996). The goal of this retrospective study is to describe the use of functional outcome measures in burn patients in an outpatient setting using standardized measures.

Methods
A retrospective chart review of burn patients seen in the outpatient burn clinic between February 1, 2017 and May 31, 2019 was conducted. Only patients seen for burn injury, treated as outpatients, and with functional outcome measures recorded were included in the study. Pertinent demographic and clinical data were collected as well as outcome measures. All patients had grip strength dynamometry performed. Patients with upper extremity and lower extremity burns were administered the The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Lower Extremity Functional Scale (LEFS). Return to work data was also collected if the patient was employed at baseline.

Results
A total of 113 out patients were included in the analysis. Mean age was 43 years (20–88 years) with a mean TBSA of 6.1% (0.1 -67%). The mean number of OT and PT visits in the clinic were both 1.4. Initial grip strength measurements were obtained in 67 patients at a mean of post burn day (PBD) 33 and an average grip strength of 21.29 kg (right) and 26.8 kg (left). Follow up grip strength measurements were obtained in 45 patients on mean PBD 43 with right hand 49.98 kg and left hand of 51.28 kg. Initial QuickDASH was administered to 89 patients on PBD 47 with a mean percent disability of 48.72 (0–100). Second QuickDASH was given to 45 patients on PBD 68 with a mean percent disability score of 37.01 (0 – 95.45) - Initial LEFS was given to 77 patients mean PBD 61 with a mean % of maximal function score of 44%. Second LEFS was given to 40 patients mean PBD 71 with a mean % maximal function score of 58%. Mean return to work for the 46 patients who were employed was 53.6 days post burn.

Conclusions
Positive improvements were shown in grip strength and lower extremity function, but a decline in function was demonstrated for upper extremity function. This decline may be the result of a nearly 50% attrition rate on follow up QuickDASH measures due to discharge of highly functional individuals, meaning the remaining upper extremity burn patients had more severe injuries and dysfunction.

Applicability of Research to Practice
Ongoing research is needed to identify the best timing of outcome measures and how to best incorporate this information into burn treatment plans.