bluuebunny/crossref_metadata_2025_split huggingface dataset:
800 Incorporating Medical Simulation into Nursing Burn Competencies: Adding a New Degree of Realism to the Nursing Burn Competency Experience
Authors: Decerbo Paul C , Nickerson Jillian , Coelho Elizabeth , Burton-Williams Kristen , O’Rourke Cassandra 
Published: March 2020

Abstract

Introduction
Many factors are incorporated into designing medical simulation curriculum. If the action or procedure falls into a low volume / high acuity category there is typically a focus on simulating the action or procedure in the lab with those who are responsible for performing it. The main objective is to increase knowledge and skill as well as self-efficacy (confidence) in a controlled simulation environment in order to decrease provider anxiety and medical error. Medical simulation can be moved “into the field” or in-situ to replicate the actual environment. This simple action builds muscle memory as well as increases provider awareness of tools at their disposal in their own working environments. We examined the burn competency feedback and discovered a consistent request for a more hands-on approach. Some reviews stated that nurses felt that the competencies were not relevant to their duties and tasks. Taking all of this into consideration we decided that this year the competencies will follow a single patient through every step from arrival to discharge, incorporating hands on medical simulation and realistic moulage.
The goal of this implementation of medical simulation into burn nurse competencies is to provide a more direct, hands-on, learning experience where nursing staff could follow a patient from arrival to discharge.

Methods
Our objective was to provide an effective and engaging competency curriculum while maintaining adherence to the ABA Burn Nursing Competency Domains. The main stations that were identified, ED, OR, ICU, Floor Level Care, and Discharge/Follow Up Care. We then created a pediatric track, and an adult track following the main station identification. Learners will follow the selected case, determined by the clinical background of the group, from EMS report to discharge planning. Each station will incorporate ABA Burn Nurse Competency Domain objectives. These objectives include, but are not limited to, dosing of analgesia, airway management, wound management, and providing ongoing resources for the simulated patient.

Results
The program will begin on Oct. 2nd 2019 with sessions through October and November of 2019. Data will be collected from a pre and post survey to ascertain if incorporating simulation into the burn nurse competency curriculum is an effective tool to increase knowledge, skill, and confidence of the burn team RN.

Conclusions
Upon conclusion of this years burn nurse competencies, we aim to establish a working model to incorporate relevant simulations to all future competencies in order to complete all ABA domain objectives within a three year cycle.

Applicability of Research to Practice
The program, if proven effective, will provide a framework for future burn competency curriculum and could be utilized in multiple aspects of nursing competencies throughout the entire system and beyond.
806 Hip Hip Heels Raised: A Pressure Injury Prevention Initiative
Authors: Grubbs Alicia , Mueller Jocelyn J , Kelly Jenna C 
Published: March 2020

Abstract

Introduction
Patients with dermal burns are at a greater risk of developing pressure injury secondary to critical illness and increased length of stay. Our burn center had four hospital-acquired pressure injuries, grade two or greater, in two months within our patient population. This incidence placed the burn unit in the top five units at our institution with the highest prevalence of hospital-acquired pressure injury. After discussion with nursing staff, we discovered a large variance in pressure injury prevention strategies, many of which were not focused on heel protection.

Methods
With rising prevalence, the burn team assembled a multidisciplinary team to combat the issue. The team consisted of day and night shift staff nurses, quality improvement nurse, physical therapist, and nursing management. We examined heel injury prevention evidence-based practice and then modified it for our unique patient population to develop a recommendation for best practice on our unit. The recommendations, affectionately known as the Hip Hip Heels Raised Campaign, include:

Results
To assess compliance to the new unit recommendations, patient positioning audits were completed before and after staff education. Prior to instruction and implementation of the campaign, compliance with heel elevation varied from 75–83%. With this information in mind, our goal was to achieve greater than 90% compliance during audits by January, with education beginning in mid- November. Our goal was met the week of December 27, 2018 and compliance has remained strong, averaging 92% implementation of heel elevation since campaign implementation.

Conclusions
Per the AHRQ, the average cost of a hospital acquired pressure injury averages $43,180. Our retrospective analysis for patients in our burn center discovered four pressure injuries, grade two or greater, in a two-month period prior to the campaign implementation. Over the five-month span since campaign application, only three pressure injuries have occurred in our patient population, a reduction of approximately seven pressure injuries. This reduction is the equivalence of $300,000 in patient care costs saved.

Applicability of Research to Practice
This model worked well for our unit and it is applicable to practice in the burn population because it is simple to implement and good for patient care outcomes.
826 Geographic Mapping to Target Adult Burn Prevention for an Urban Burn Center
Authors: Chandramouli Mathangi A , Rabbitts Angela , Heffernan Jamie , Chang Philip 
Published: March 2020

Abstract

Introduction
Burn prevention is one of the core missions of burn centers. Geomapping has been instrumental for police departments to target resources for crime prevention. Similarly, geomapping could assist burn specialists in identifying “hotspots” of injury. The purpose of this study is to visually identify the incidence and location of adult burn injury within the catchment area of a single tertiary urban regional burn center. Data mapping can thus then be used to target burn outreach and prevention efforts.

Methods
Demographic and deidentified clinical data was collected from a single institution over a 3 year period. 1986 burn patients were admitted between 1/2016 and 12/2018. 1360 patients were 16 years of age or greater. Geriatric patients were defined as age 60 or greater to facilitate comparison with National Burn Repository data which breaks down age by decades. The patients were mapped by their home zip code.

Results
1360 burn patients 16 years or older were admitted to this single tertiary burn center between 1/2016 and 12/2018 with an age range from 16–101.
393 patients were 60 years or older (28.9% of the adult population compared to 19.8% of the NBR population)
6 zip codes within the catchment area were identified as “hotspots” as having more than 30 inpatients listing that zip code as their home address (see figure).
The results show an unequal distribution of patients over the burn center’s catchment area with hotspots (defined by &gt; 30 burn admissions during the study period) in 6 zip codes.

Conclusions
The local demographics of this inpatient adult burn population follow national trends in etiology but differ with regards to age and race. The geomapping tool visualizes burn incidence by geography. Based on this analysis, outreach and prevention efforts should target elderly populations especially in the “hotspots.”

Applicability of Research to Practice
This research will inform targeted efforts towards burn prevention and education outreach.
833 The Importance of Trajectory Curves for the Implementation of Outcome Benchmarks in a Clinical Setting
Authors: Kelter Brian M , Wolfe Audrey E , Slavin Mary D , Kazis Lewis , Ryan Colleen M , Schneider Jeffrey C 
Published: March 2020

Abstract

Introduction
The creation of individualized treatment plans that address social participation in burn survivors requires an understanding of the expected changes over time from the original burn injury. The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a patient-reported outcome measure for social participation after burn injury. Visual representation of expected change over time of a population is achieved through the development of trajectory curves (TCs), serving as benchmarks for recovery. In order to optimize the implementation of LIBRE Profile TCs, a literature review was conducted to examine utilization of TCs in other clinical settings.

Methods
A review of studies published from 2014–2019, demonstrating TCs as growth or treatment models in clinical settings, was performed. Literature was identified by searching “trajectory curves,” “trajectory models,” and “clinic” or “clinical” in PubMed. Articles focusing on three areas of inquiry were included: 1) measuring individual patient growth; 2) comparing progress for similar patient cohorts to provide contextualized reference for personal growth; 3) predictive medicine/risk assessment for interventional care in various conditions.

Results
The initial literature review identified 141 manuscripts. A total of 107 were excluded and 34 manuscripts were reviewed and categorized based on the three areas of inquiry (Figure 1; Table 1). Positive results from TCs in all areas of inquiry were noted in 22 of the 34 the chosen studies. General trends for each area of inquiry include: an increased ability for parents and clinicians to track individual patient progress in what was primarily anthropometric studies; articles relating to comparative cohort tracking show that trajectory-driven analytical approaches offer displays of progress across similar clinical groups of recovery for given conditions. Use of TCs in predictive care or risk assessment typically relate to acute conditions such as asthma, traumatic brain injury, or degenerative conditions (neurocognitive or musculoskeletal). For the most part, these diagnoses depict a positive trend for clinicians to identify future outcomes using fitted trajectories.

Conclusions
These findings support the clinical use of trajectory curves to present patient-specific, cohort-relative, and predictive treatment for outcome-based results post-burn for burn survivors.

Applicability of Research to Practice
Future research will assess the use of LIBRE Profile recovery trajectories as benchmarks for optimization of social participation outcomes.
854 Modified Millard Forked-flap for Complete Nasal Stenosis After Smoking While on Home Oxygen
Authors: Mulay Sagar , Simpson Roger L , Nasser Ahmed , Nwaoz Basil 
Published: March 2020

Abstract

Introduction
Nasal stenosis is an uncommon burn scar deformity which can result in breathing obstruction. The reconstruction of nasal stenosis secondary to burns can be challenging due to the limitation of localized tissue, rate of recurrence, and burn injury to the surrounding areas. A vascularized composite flap of local composite tissue (forked flap) from the lip can reliably reconstruct the nasal vestibule and nasal sill diminishing the risk of recurrent nasal stenosis. We describe our use of a modified Millard forked flap, a cleft lip repair technique.

Methods
A 52-year-old female presented with complete stenosis of the right nares secondary to burn contracture of the nostril, vestibule, and upper lip. She had suffered a flash burn to her face while smoking on home oxygen requiring prolonged ventilatory support and only received topical dressings. Three months after her burn injury she was referred for the reconstruction of her contractures.
A lateral rhinotomy was performed to define the nasal floor defect. Scar release of the remaining vestibule and ala and the aesthetic units of the lip were defined. A supple unburned area of the upper lip was harvested as a vascularized composite forked flap and rotated into the vestibule defining the vestibule floor. The ala was rotated outward and full-thickness skin grafts was used to resurface the vestibular portion. The lateral aesthetic subunit of the lip was then resurfaced as a complete unit with a full-thickness skin graft. She later required fabricated nasal splint for nighttime stenting and serial daytime nostril dilatation with Hegar dilators.

Results
At nine months post-reconstruction, the patient maintains a patent nasal airway with limited vertical lip contraction, resolution of her initial symptoms of sinus congestion, and no further difficulty breathing.

Conclusions
In 1955, Ralph Millard presented the rotation-advancement technique for cleft lip repair. The Procedure was designed to create a softer, more natural-looking reconstructed lip. In the cleft lip repair, he suggested preserving the prolabial tissue lateral to the central segment as forked flaps that were rotated and banked on the nasal vestibule floor. Had that principle not been appreciated, that tissue might have been discarded in order to respect the aesthetic unit of the lip. The surgeon must utilize reliable principles to restore and retain form and function. The use of this modified forked flap incorporated composite vascularized tissue for the nostril floor reconstruction while respecting the subunit reconstruction of the lip.

Applicability of Research to Practice
Reconstruction of the injury needs to restore both functional and aesthetic deformities. Utilization of a local vascularized composite graft, taken from an area to be discarded within the upper lip subunit, provided quality tissue that significantly reduces the risk of secondary nasal contracture.
856 A Pilot Study of a Point-of-care Wound Bed Assay to Predict Graft Take
Authors: Barrios Evan L , Volland Kelly B , Thigpin Tera , Mozingo David , Schultz Gregory , Gibson Daniel J , Carson Joshua S 
Published: March 2020

Abstract

Introduction
Deciding when to graft a burn wound is instrumental in acute reconstruction. A technology capable of predicting autograft success would help optimize timing of initial debridement and grafting. In prior work, members of our team developed a point-of-care proteinase assay capable of predicting delayed wound healing in chronic wounds. In the work reported here, we seek to quantify these proteolytic enzymes in acute burn wounds in an effort to ultimately determine whether a quantitative assessment of proteinase activity in a burn wound might predict successful healing of autograft.

Methods
Eight burn patients were taken to the operating room for autografting. Tissue samples were obtained from unique sites, as well as swabs of wounds pre- and post-excision. A point-of-care proteinase assay determined initial rates of fluorescence, which correlates with the amount of proteolytic enzyme activity. Autograft sites were assessed after two weeks, with ≥50% take considered successful and &lt; 50% take deemed unsuccessful. Initial rates of fluorescence were compared. These groups were analyzed using two-sided student’s t tests, with p&lt; 0.05 identified as significant.

Results
The pre-excision group initial rate was significantly higher than the post-excision group (p=0.0006). The tissue group initial rate was also significantly higher than the post-excision group (p = 0.0028). We also compared pre-excision initial rates of enzymatic activity between successful autografts (n=10, 18.34±20.90 RFU/min) and unsuccessful autografts (n=5, 4.32±4.62 RFU/min) with p = 0.169.

Conclusions
Multiple findings indicate the potential of this assay to differentiate burn wounds based on proteinase activity. Pre-excision tissue beds contained significantly higher rates of proteinase activity compared to excised and debrided tissue beds (p = 0.0006). This is consistent with burn wound morphology, as proteolytic enzymes function to debride damaged tissue and promote angiogenesis in acute wounds. Interestingly, initial rates of proteolytic enzymatic activity in pre-excised wounds of successful autografts trended towards significance compared to unsuccessful autografts (p = 0.169), suggesting that these proteolytic enzymes reflect an overall healthy wound bed, the presence of which could portend a heightened chance for autograft success.

Applicability of Research to Practice
This pilot study confirms the presence of proteinase activity in acute burn wounds utilizing a point-of-care test. Future work will investigate whether this test can assist physicians in predicting amenability of burn wounds to autografting.
861 Analgesia After Burns: A Case Series and Development of a Multimodal Analgesic Enhanced Recovery Pathway
Authors: Mendelson Andrew m , Elkhashab Yasmin , Hughes William , Viscusi Eugene R 
Published: March 2020

Abstract

Introduction
Burn pain is grossly undertreated which may result in poorer outcomes including chronic pain, anxiety and persistent opioid use. Opioids are currently the mainstay of treatment with many burn patients receiving long term opioid management even in the context of the opioid crisis. We retrospectively reviewed the charts of burn patients admitted to our hospital to evaluate the impact of our multimodal pain management approach on overall opioid consumption.

Methods
Following IRB approval, a retrospective chart review of all patients with burn injuries over a one year period was performed. The Acute Pain Management Service was consulted for analgesic management for all patients. Patient data was collected from their electronic medical records on Epic HyperSpace and included total body surface area of burn, age and gender, length of hospital stay, amount of opioid usage throughout admission, average verbal numerical score for pain, and use of adjuvant analgesics was gathered. The amount of opioid usage was obtained from the chart and then converted to oral morphine equivalents (OME) using the CDC Prevention Conversion Chart.

Results
During the study period, eight patients met inclusion criteria. The average patient age was 42.5 years, with a mean of 26.8 % TBSA (Total body surface area) burn and mean length of stay of 23 days. Our pain pathway consisted of non-opioid analgesic adjuncts that were given around-the-clock with opioids used only on an as-needed basis. The nonopioid analgesics include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDS), gabapentin or pregabalin, and a ketamine infusion. Initial opioid consumption (on day of APMS consult) as well as median hospital day was compared to opioid consumption on day of discharge. Six out of eight patients showed a reduction in their oral morphine equivalent (OME) following APMS consult usage from day of admission with average 76 OME to 44.6 OME on day of discharge.

Conclusions
We were able to reduce patient’s opioid requirement in 6 out of 8 patients upon discharge. These findings suggest that a further more rigorous study is warranted to demonstrate the benefits of multimodal therapy in burn pain.

Applicability of Research to Practice
The multimodal approach to pain control for burn patients may possibly be able to reduce the overall opioid requirements and theoretically the opioid associated side effects.
863 Drug Addiction and Opioid Use in the Acute Burn Patient
Authors: Duraes Eliana F , Asif Mohammed , Modica Ashley , Sikorski Giulia , Hultman C Scott , Caffrey Julie 
Published: March 2020

Abstract

Introduction
In light of the opioid crisis, there is an increased interest in the acute pain management of patients with history of drug addiction. There is no consensus on pain management among different burn centers and the amount of narcotic prescription reportedly doubled over a seven year period according to Tully in 20191. Our aim was to study the association of previous drug addiction history and the treatment of acute burn patients with special interest on the daily morphine equivalent requirements.

Methods
A prospectively maintained database was queried to study acute burn patients admitted in a reference burn center from 2013 to 2018. Patients with a previous history of drug addiction (group 1) were compared to patients without it (group 2). Drug abuse was defined as patients with history of opioids abuse, heroin, cocaine, cannabis, inhalants, and alcoholism, specifically those with diagnostic codes on file. The expected mortality was calculated using the Premier® database. A p0.05 was considered significant.

Results
A total of 3046 patients were studied, 502 (16.5%) had previous history of drug abuse on file. Compared to group 2, group 1 had: more males - 343 (68.3%) vs 1456 (57.2%) p0.001; was younger - 45.7914.65 vs 52.0219.57 p0.001; required intubation at a higher rate - 100 (19.9%) vs 329 (12.9%) p0.001; longer intubation period - 2.4310.05 vs 1.377.71 p0.001; had a prolonged admission - 13.8728.82 vs 8.4816.58 p0.001; more surgeries - 1.213.30 vs 0.71.58 p=0.002, and a higher daily morphine milligram equivalent requirement - 148.34320.56 vs 56.0297.81 p0.001. The groups had similar expected mortality rates: 3.03% vs 3.56%p=0.483; which may be partly explained by the fact that the drug use history is not accounted for on the formula. No significant difference was seen on the burned area between the groups.

Conclusions
Drug addiction was associated with increased need for intubation and length of intubation, prolonged admission, increased surgery rate and a higher daily morphine equivalent usage. Further studies are necessary guide the treatment of the specific needs of these increasingly common burn patients subgroup and also to define the need of including the history of drug use on the expected mortality rate formula.

Applicability of Research to Practice
This study adds to the literature differences in the treatment of burn patients with history of drug addiction and highlights the need for specific protocols for improved care.
Relations of parameters for describing the epidemic of COVID―19 by the Kermack―McKendrick model
Authors: Tomie Toshihisa 
Published: March 2020

AbstractIn order to quantitatively characterize the epidemic of COVID-19, useful relations among parameters describing an epidemic in general are derived based on the Kermack–McKendrick model. The first relation is 1/τgrow =1/τtrans−1/τinf, where τgrow is the time constant of the exponential growth of an epidemic, τtrans is the time for a pathogen to be transmitted from one patient to uninfected person, and the infectious time τinf is the time during which the pathogen keeps its power of transmission. The second relation p(∞) ≈ 1−exp(−(R0−1)/0.60) is the relation between p(∞), the final size of the disaster defined by the ratio of the total infected people to the population of the society, and the basic reproduction number, R0, which is the number of persons infected by the transmission of the pathogen from one infected person during the infectious time. The third relation 1/τend = 1/τinf−(1−p(∞))/τtrans gives the decay time constant τend at the ending stage of the epidemic. Derived relations are applied to influenza in Japan in 2019 for characterizing the epidemic.