bluuebunny/crossref_metadata_2025_split huggingface dataset:
11 Tube Feeding Through Surgery, Impact on Glucose Control in Burn Patients
Authors: Cooper Chloe R , Hess Andrea L , Hope Brianna , Hope Landon , Sorensen Grant , Wagner Clayton E , O’Banion Scott , Kesey Jennifer , Griswold John 
Published: March 2020

Abstract

Introduction
The hypermetabolic state experienced by burn patients post injury puts nutritional support at the forefront of these patients’ care. Enhanced Recovery After Surgery (ERAS) algorithms include a radical approach of feeding patients up to surgery with reported advantages like earlier recovery of GI function, among others. The purpose of this study was to assess perioperative blood glucose (BG) levels in patients fed up to and through surgery at our institution.

Methods
Charts of selected surgical burn patients were reviewed and categorized on the basis of diabetic status and whether they had procedures in which feeds were continued to within four hours of surgery (“fed”) and stopped at least four hours prior to surgery (“unfed”). Percent change in pre- and post-op BG levels were compared between groups. Wilcoxon Rank-Sum and Two-Sample testing were used for statistical analyses.

Results
See Table 1. Data collection yielded 32 patients with 106 unfed and 92 fed procedures. There was a significantly larger percent change in BG levels from 24-hr pre-op to 12- and 24-hr post-op in the unfed vs. fed groups across all procedures, prior to grouping based on diabetic status (p = 0.014 and p = 0.009, respectively). There was a statistically significant difference in the percent change in BG levels from 24-hr pre-op to 12- and 24-hr post-op in the pre-diabetes group (p = 0.021 and p = 0.026, respectively).

Conclusions
Our data shows better BG control in fed procedures with lower percent change from pre-op to post-op overall, and in the pre-diabetes group. These findings are in line with ERAS literature. Controlling BG ranges post-op is critical to prevent complications and promote healing. Improved BG control using perioperative nutrition could guide practices related to perioperative workup of burn patients. This is worth further investigation since better BG management has been associated with superior patient outcomes.

Applicability of Research to Practice
1) Using enteral nutrition up to and/or through surgery contributes to better glycemic control postoperatively in surgical burn patients.
2) The most pronounced benefits of perioperative enteral nutrition in terms of glycemic control are seen in burn patients with pre-diabetes.
22 16-year State-wide Population-based Analysis of Burn and Inhalation Injury – Demographics, Injury Characteristics, Management, and One-year Outcomes
Authors: Hewes Philip D , Bell Derek 
Published: March 2020

Abstract

Introduction
Estimates on frequency and outcomes of burn or inhalation injury in the United States are limited since reported databases are confined to specific phases of care, included facilities, length of follow-up, facility/provider/patient identification and/or lack of longitudinal tracking. A population-based database addresses these issues.

Methods
We queried a statewide mandated-reporting database for the years from 2000 through 2015 at the time of injury using a set of ICD9-CM codes for second degree or deeper burns, inhalation injury, and chemical and electrical burns. Burn total body surface area percentage by anatomical region was assigned as appropriate using modified and age-stratified Lund and Browder charts. Records for each patient were extracted out to one year pre- and post-injury, as available. Provider and facility burn volume and survival was stratified into quartiles. We applied the Committee on Trauma/American Burn Association referral criteria to the index presentation. Kaplan-Meier curves were generated to 1-year post injury for testing combinations of burn percent total body surface area of 20% and inhalation injury for age ranges &lt; 15, 15 - 60, and &gt;60 years. Regression models were developed to model the probabilities of in-patient, 90-day, and 365-day mortality and readmission.

Results
56,712 patients were included. Overall, 22% of patients meeting referral criteria were never seen at a burn center within 1-year post-injury. The greatest positive predictors of in-patient mortality were facility case volume and burn percent total body surface area. The greatest negative predictors were high provider burn case volume (for highest quartile, adjusted odds ratio 0.08, 95% confidence intervals 0.06 – 0.12). The highest risk of unscheduled 30-day readmission was associated with index presentation to a non-burn care facility (p &lt; 0.001). For all groups, the first 100 days had the greatest mortality rate, the most severe being among patients of age greater than 60 with &gt;20% burn percent total body surface area and inhalation injury, with a 40% survival rate.

Conclusions
This study is the first to be able to simultaneously evaluate in-patient, post-discharge, and facility-based parameters for outcomes. A significant number of patients are not accounted with current databases.

Applicability of Research to Practice
A population-based approach with longitudinal tracking allows for greater realization of the outcomes of all patients following burn injury. Existing association-supported or government databases fail to account for a significant portion of burn victims, motivating further evaluation of burn care efforts.
25 Social Integration in the First 2 Years After Moderate to Severe Burn Injury: A Burn Model System National Database Study
Authors: McMullen Kara , Bamer Alyssa M , Gibran Nicole S , Holavanahalli Radha K , Schneider Jeffrey C , Carrougher Gretchen J , Amtmann Dagmar 
Published: March 2020

Abstract

Introduction
Feeling a part of community and participating in social life are important aspects of overall quality of life. Burn survivors consider community reintegration one of the most important issues affecting their recovery. Integration, including social integration, has been studied in this population, but longitudinal analyses to examine factors associated with successful integration are lacking. The current study aims to assess variables associated with social integration during the first two years post-burn.

Methods
Adult (18+ years) burn survivors enrolled in the Burn Model System national longitudinal database responded to questionnaires at hospital discharge and 6-, 12-, and 24-months postburn. Social integration was assessed at all follow-up timepoints using the Community Integration Questionnaire Social Integration Component Scale, which has a possible range of scores from 0 (no community integration) to 12 (excellent community integration). To examine variables associated with social integration over time, linear mixed effect models utilizing generalized least squares with maximum likelihood and robust standard errors were used. Independent variables in the model included age, sex, % total body surface area (TBSA) burned, race/ethnicity, living status at time of injury, facial burn, history of psychiatric treatment preburn, employment at follow-up assessment, and SF-12 or VR-12 mental health component scores at the time of each follow-up assessment.

Results
Data from 1,848 adult burn survivors were included in the analyses. Average age of the survivors was 42.9 years, 74.0% were male, 77.7% were white, 47.0% were married or living common-law with a partner, and mean total body surface area burned was 18.2%. Factors associated with better social integration over time included younger age, female sex, lower TBSA (&lt; 40%) burn size, white/non-Hispanic race, no preburn psychiatric treatment, postburn employment, and better mental health. Time was not a significant predictor, indicating that social integration scores remain relatively stable over the 24-month follow-up period.

Conclusions
We identified several factors that contribute to greater social integration including age, gender, burn size, race/ethnicity, employment, and mental health, with the association between age, gender, and employment status and community integration a novel finding in this population.

Applicability of Research to Practice
This study suggests that while most factors associated with social integration are not modifiable, interventions aimed at improving mental health and helping burn survivors return to work could also improve self-reported social integration.
27 Utilization of an Ethics Service in a Large Urban Burn Center
Authors: Greenway Andrew , Heffernan Jamie , Markow Nicole , Yang Jennifer , Gibbons Linda , Stewart Jacob , Walker Joan , Huberman Barrie J 
Published: March 2020

Abstract

Introduction
Ethical dilemmas arise related to tension between one or more values held by stake-holders. Identifying which ethical principles (i.e., autonomy, beneficence, non-maleficence, and justice) are in tension represents one way to categorize ethical dilemmas that arise in clinical cases. The purpose of this review is to describe the population of patients for whom Medical Ethicists (ME) were consulted and identify the primary ethical principles in tension for these cases.

Methods
A retrospective chart review of patients admitted from 2/2014–8/2019 (n=3701) capturing ME notes. Each note was independently rated by burn team RNs and medical ethicists to identify which two of the four common ethical principles were perceived to be in tension. Reviewers also noted if surrogate decision-making and/or goals of care were prominent themes in the case. Additional data points include circumstances of injury, total body surface area (TBSA) involved, age, mortality, length of stay (LOS), Hospital Day (HD) of ethics consult (EC), +/- psychology/psychiatry note, +/-chaplaincy, +/-palliative care, initiator of and stated reason for the EC.

Results
Of the 3701 patients admitted, 26 had formal EC’s (0.7%). Twelve died. Average age was 55.6 (7–85). Two patients had Calciphylaxis and four self-immolated. One EC concerned interests of fetus vs the pregnant patient. TBSA for the burned group averaged 39.7% (2–100). Average LOS was 55.6 days. Average HD of ethics consults was 20.5. For mortalities, EC was 10.8 HDs prior to death. LOS for survivors was 55.6 vs 42.33 days for non-survivors. TBSA for survivors was less than those who died (29% vs 50%). Chaplaincy was involved in 19/26 (73%), palliative care 3/26 (12%), Psychology/ psychiatry 15/26 (58%) of EC’s. The burn RNs most often characterized the ethical dilemmas as tension between beneficence and nonmaleficence while the ethicist found autonomy vs. nonmaleficence. All raters found only 1 or 2 cases involved justice. The team identified GOC tension in 20/26 cases, the ethicist, fewer than half. The burn team requested ethics consultation in all cases of self-immolation. Initiators of ethics consults were 14 burn team, 7 burn MD, 1 burn nursing, 2 chaplaincy and 2 not stated.

Conclusions
Circumstances of injury, the nature of wound and intensive care management and the association of significant injury with end of life care present challenges to the burn team. Many may be framed and addressed as ethical dilemmas. This pilot exploration of clinical utilization of medical ethics suggests patterns and questions that warrant further discussion and study. Value-driven tensions between the professional duties to do good, the duty to do no harm, and the duty to respect autonomous decisions by patients and by extension, surrogate decision makers, account for most triggers for ECs initiated by the burn team.

Applicability of Research to Practice
Directly Applicable.
28 Childhood Burn Injuries: The Uninjured Sibling Perspective
Authors: Dillard Dana R 
Published: March 2020

Abstract

Introduction
When considering burn-injured children as part of a larger family unit, it is expected their injury will stress the system; yet the focus has mainly been on the injured child and treated as incidental for the family. Though research on the family is evolving, less is known from the uninjured sibling perspective. Sibling relationships have a unique impact on development. This study aimed to understand the experience of growing up with a burn-injured sibling in childhood, with attention to how identity was shaped. Acquiring knowledge from uninjured siblings will facilitate a more integrative understanding and holistic approach to aid families. Thus, this exploratory study fills a gap by engaging the uninjured sibling’s perspective with implications for program enhancement/development.

Methods
Narrative inquiry was utilized to explicate the narratives of adults who grew up with a burn-injured sibling in childhood via semi-structured interviews (N=7). The research questions were: 1) What are the experiences, or stories, of identified adults whose sibling experienced a burn injury? 2) What do the narratives of identified adults whose sibling experienced a burn injury reveal about how their identities were shaped? 3) What are the implications for program/service development and/or enhancement elucidated by identified adults whose sibling experienced a burn injury? A purposeful criterion sampling method was used, but challenges accessing participants resulted in sequential and emergence-driven strategies. Participants’ self-identified as Caucasian (n=7), female (n=4), and male (n=3). Age ranged from 20 to 57 (M=33.14, SD=14.32) at the time of the interview and 0 to 13 (M=5.25, SD=4.25) at the time of their siblings’ injury. Interviews queried the burn incident, family relations, communication, and support received. Riessman’s thematic approach to narrative inquiry was employed for analysis.

Results
Findings supported five themes: 1) separation and alternative caregiving, 2) altered interactions and ambivalent roles, 3) (r)evolving emotional pain, 4) communication concerns, and 5) identity through autobiographical reasoning. The data suggest uninjured siblings have their own unique narratives that have failed to be acknowledged in research and practice, though identity clarity and meaning-making were articulated in their reflections. Moreover, findings support consideration of many experiences as a primary trauma.

Conclusions
The needs of uninjured siblings—specifically related to inclusion, identity, and resource acquisition—should be addressed to mitigate the impact of burn trauma. The family system remains a critical area for research and program enhancement/development.

Applicability of Research to Practice
Findings can contribute to program planning for the family with increased attention to the uninjured sibling’s experience and concern for their specific needs.
34 Family Needs of Adult & Pediatric Burn Patients
Authors: Fox Jasmine , Hsu-Chang NaiWei , Shames Stacey , Lillington Linda 
Published: March 2020

Abstract

Introduction
Family members play a significant role in recovery of the burn patient (Goyata & Rosi, 2009). A better understanding of their specific needs can greatly influence a burn patient’s rehabilitation and family adaptation during recovery. Prior research has identified family needs of critically ill patients (Hinkle 2009; Kinrade, 2009); few studies have looked at the specific needs in adult versus pediatric burn patients and whether these needs change throughout the course of hospitalization. The purpose of this study is to explore the needs of family members of burn patients to identify similarities and differences between adult and pediatric populations in order to aid nurses in prioritizing care instructions for burn families.

Methods
This IRB approved descriptive repeated measures study took place in a 12-bed burn center. 64 family members (39 adult; 25 pediatric) of burn patients participated. The 45-item Critical Care Family Needs Inventory (CCFNI) identified family member’s psychosocial needs related to assurance, information, proximity, comfort, & support on admission (ADM) and prior to discharge (DC). Descriptive statistics summarized study participant characteristics. T-test & chi-square techniques determined similarities and differences in adult and pediatric family members’ needs perceptions during the hospital stay.

Results
Majority of respondents were female (84%) often mother or spouse/significant other; age &lt; 40yrs (96% peds; 64% adults). CCFNI scores were similar in adult vs. peds family members: ADM (3.27 vs 3.37), DC (2.91 vs 3.29). Assurance needs were greatest; self-care needs were least important. Adult family member needs for information, proximity and comfort decreased significantly from ADM to DC (p 0.05) but assurance needs were unchanged. Peds family member needs for assurance, information, proximity and comfort did not change from ADM to DC. Pediatric family needs remained “important to very important” throughout the stay while adult family member needs decreased in importance.

Conclusions
Identifying needs of family members of burn victims in the Burn ICU allows for early assessment and can aid in developing specific individualized plans for successful transition upon discharge. These findings can help nurses best meet the needs of the family & promote patient & family centered care.

Applicability of Research to Practice
Findings from this study can help inform the development of approaches to better understand the particular needs of family members and develop strategies to address those needs.
45 Unravelling the Unique Burn-induced Temporal Alterations in Adipose Tissue Metabolism
Authors: Knuth Carly M , Auger Chris , Abdullahi Abdikarim , Jeschke Marc G 
Published: March 2020

Abstract

Introduction
A severe burn elicits a systemic hypermetabolic response that substantially alters the function of multiple organs and contributes to increased morbidity and mortality. A consequence of hypermetabolism is the activation of UCP1-mediated browning of white adipose tissue (WAT), which may further facilitate the hypermetabolic response. In this study, we aimed to provide comprehensive characterization of the acute and long term pathophysiological responses to burns to determine the persistence of adipose tissue browning and its potential contribution to the hypermetabolic response.

Methods
Mice were subjected to either a 30% total body surface area (TBSA) scald burn or were denoted sham. Body weight and food intake were monitored throughout the duration of the study. Cohorts were sacrificed at 6hrs, 1, 3, 5, 7, 14, 30 and 60d post-burn and adipose tissue depots were harvested. Mitochondrial respiration, protein expression, and morphology in adipose tissues were assessed.

Results
Despite consuming considerably more food, the burn group lost significantly more weight throughout the duration of the study. We also detected increases in free fatty acids and interleukin-6, markers of whole-body lipolysis and inflammation, respectively. At the tissue level, eWAT mass significantly decreased over time, suggesting that this depot provides substrate to fuel the hypermetabolic response. This was further supported by a decrease in adipocyte area and an increase in lipolytic markers which remains significant up until 60d post-burn relative to sham. There were no significant difference in iWAT mass, however we detected significant increases in the protein content of UCP1, the master regulator of adipose tissue browning, as early as day 3 which persisted until day 60. This was corroborated by the presence of UCP1+ adipocytes.

Conclusions
Consistent with previous human studies, a burn injury elicits a dynamic response that cannot be simply characterized by a single timepoint. The alterations that occur in adipose tissue are depot-specific, time-dependent, and this notion likely extends to other metabolic tissues. Further, we demonstrate that in our 30% TBSA burn murine model, the effects of the hypermetabolic response persist for up to 60 days following initial injury.

Applicability of Research to Practice
Our data indicate the hypermetabolic response persists for up to 60 days, the equivalent of approximately 7 years in humans. This underscores the severity of adipose tissue browning and potentially provides an explanation as to how the hypermetabolic response persists even after the wound has healed. Moreover, providing a comprehensive map of the time-dependent changes in a murine model gives clinicians a better indication of the metabolic effects in a burn patient and will contribute to the development of effective, targeted treatments.
64 E-cigarette and Vaporizer-related Burn Injury: Demographics and Injury Patterns
Authors: Dyamenahalli Kiran U , Wengryn Derek M , Wiktor Arek J , Kovacs Elizabeth J , Duffy Patrick , Wagner Anne L Lambert 
Published: March 2020

Abstract

Introduction
E-cigarettes and vaporizers (E-cigs) have seen a dramatic surge in popularity. The Centers for Disease Control now estimates that 1 in 4 United States (US) high school students use E-cigs. Recent recognition of E-cig-related lung injury has garnered significant attention. However, relatively little is known about E-cig-related burn injuries, which are often due to battery explosion and liquid ignition. The objective of this study was to characterize population demographics and injury patterns associated with E-cig burns.

Methods
A retrospective review of all patients presenting with E-cig-related cutaneous burn injury to a verified US burn center between January 2015 and August 2019 was performed using an institutional database. In addition, media reports covering the same mechanism of injury and date range were collected using databases for the National Electronic Injury Surveillance System, American Nonsmokers’ Rights Foundation, and international news outlets. Demographic data and injury metrics were recorded.

Results
309 international media reports and 30 institutional cases of E-cig-related burn injuries were identified. Media-reported injuries varied with respect to geographic location: US-185, United Kingdom-35, Canada-6, all other countries-8, unclear-75. Annual incidence peaked in 2016 in media reports (2019-19, 2018–61, 2017–68, 2016–106, 2015–55) and institutional records (2019-3, 2018-5, 2017-6, 2016-16, 2015-0). Injuries predominantly involved men in both media (Male 75.7%, Female 13.9%, unknown 10.4%) and institutional (Male 93.3%, Female 6.7%) datasets. Average age was 31.0 years (media) and 30.3 years (institutional). The institutional data revealed an average TBSA of 3.5% (range 1–8.5%), an average length of stay of 3.8 days (range 0–14 days), and a median number of operations of 1 (range 0–2). 90% (n=27) of patients required inpatient admission and one patient required mechanical ventilation. On admission, 58% (n=14) of patients screened positive for cannabis use. A ranking of anatomic regions by frequency of involvement was consistent between datasets: lower extremity &gt; hands &gt; head/neck &gt; torso &gt; groin. Mortality rates were also similar: 1.62% (media) and 0% (institutional).

Conclusions
E-cig-related burns are non-trivial injuries, most of which require inpatient admission, operative management, and substantial resource use. They disproportionately affect young men and burns often involve sensitive areas like the hands and face.

Applicability of Research to Practice
Combined with rising popularity, lax regulation, proliferation of counterfeit products, and associated lung injury, E-cig-related burns represent an evolving health threat. This study highlights the importance of reporting injuries to consumer product regulatory agencies and the need for further research into the causes and consequences of E-cig explosion.