bluuebunny/crossref_metadata_2025_split huggingface dataset:
582 Bridging the Gap Between Inpatient and Outpatient Burn Care Compliance: Incentive Programs for Pediatric Burn Patients
Authors: Crandon Stephanie , Fleming Lenore 
Published: March 2020

Abstract

Introduction
As healthcare advances, treatment options are expanding to allow patients to be cared for in outpatient settings. To ensure quality of treatment is maintained, efforts must be made to translate resources offered during inpatient stays to the outpatient population. This is especially important for pediatric burn patients and their families whose treatment plan is contingent on maintaining critical aspects of care provided during the course of an admission. Optimal outcomes are dependent on patients complying with physical/occupational therapy activities, meeting increased nutritional standards, and performing daily dressing changes.

Methods
Incentive programs have traditionally been effective during hospital stays by rewarding children upon completion of difficult tasks, which encourages participation and provides a sense of control. In order to meet the needs of our patient population, a burn specific incentive program named “Burn Bucks” was developed with the intent to establish early patient engagement and goal setting. This program allows for a successful transition from inpatient to the home setting. Patients identify their most difficult healthcare goals and a dollar amount is assigned to that goal. Throughout their stay, staff give “bucks” for the completion of goals. As patients progress, goals are updated. Patients may use Burn Bucks earned to shop in the “Burn Bucks Store.” In preparation for discharge, home care goals are set for patients. Upon return to clinic, patients may shop in the Burn Bucks Store at the end of each appointment.

Results
Patients who participated in the Burn Bucks program returned as outpatients less fearful of the treatment room and more motivated to take an active role in their therapies. Preliminary data shows those who use burn bucks in the home setting are more likely to meet or surpass treatment goals. Additionally, parents and staff report increased participation as well as an improved overall demeanor by children who participate in the Burn Bucks program.

Conclusions
The Burn Bucks program has proven to be a successful tool to engage patients and families in their treatment plan. Early introduction during inpatient stays encourages participants to continue using Burn Bucks in the home setting. We continue to find ways to adapt the structure of the program to support various age groups and abilities, enhance coping, and individualize incentives to achieve optimal outcomes.

Applicability of Research to Practice
The success this program has brought to our patient population has prompted other teams within our hospital to adopt the Burn Bucks program to accommodate a variety of treatment plans. The ability for this particular incentive program to adapt to various treatment goals contributes to its consistent success. The principles of this program can be easily implemented in burn centers of any size.
626 Causes and Injury Patterns of Elderly Burn Patients
Authors: Miotke Sam , Romanowski Kathleen S , Palmieri Tina L , Greenhalgh David G , Sen Soman 
Published: March 2020

Abstract

Introduction
Older patients are a particularly vulnerable population with respect to burn injuries. The American Burn Association has invested resources in improving burn care and burn prevention within this age group, recognizing the difficulties in both the identification and subsequent modification of risk factors. The National Electronic Injury Surveillance System (NEISS) is maintained by the Consumer Product Safety Commission to surveil for injury trends and is populated with data from a representative group of approximately 100 emergency departments in the United States. This database could serve as a useful tool to evaluate burn injury patterns in elderly patients with an eye toward targeted prevention measures.

Methods
The NEISS was queried for patients aged 55 years and older with a diagnosis of scald, thermal, chemical, electrical, or unspecified burn injuries for the years 2008 - 2017. Each injury was classified by body part(s) burned, causative product, gender, and age group of patient (55–64, 65–74, 75–84, 85 and older). The ten most commonly burned sites as well as the ten most common causative products were determined for each gender and age group and in aggregate. Weighted estimates from the NEISS data were utilized to calculate injury numbers across the population.

Results
The most common etiology of burn injuries for all patients aged 55 and older was hot water. Men were most commonly injured by gasoline, a product which did not rank in the top ten for women in any age group. Additionally, within each age group, gasoline was among the top 4 products that was associated with burn injuries in men. Cookware was the second most common cause of burn injury among women aged 55 and older and was the sixth most common cause among men. For women, the combination of cookware and ranges/ovens was among the top 2 products associated with burn injury within each age group. The most commonly injured body part for all patients was the face. This held across most age and gender groupings except for women aged 75 to 84 (upper trunk), and women 85 and older (foot). Men were more likely to injure their hands than women.

Conclusions
The most common cause of burn injuries in older adults is hot water, and the most common body part affected is the face. Women are more likely to be injured by cookware and ranges/ovens. Men are more likely to be injured secondary to gasoline and are more likely to injure their hands.

Applicability of Research to Practice
NEISS data could be useful in the development of targeted prevention campaigns, such as focused education about the dangers of hot liquids, cooking, and accelerants.
647 Development of a Cerium (III) Nitrate-containing Electrospun Dressing for Mitigating Delayed Eschar Removal
Authors: Jockheck-Clark Angela R , Williams Cortes , Kowalczewski Christine , Roy Jahnabi , Thompson Marc A , Martinez Luis A , Christy Robert J 
Published: March 2020

Abstract

Introduction
During periods of delayed burn treatment, cells within the eschar leach toxic and immunomodulatory metabolites that can profoundly impact neighboring tissue. Therefore, to reduce the burn-related morbidities and mortalities that are the result of delayed surgical interventions, electrospinning was utilized to generate a novel cerium (III) nitrate (Ce(III)N) dressing. Previously published work has demonstrated that topical Ce(III)N application changes the eschar morphology, and that tissue beneath the treated eschar was generally healthy and had a high rate of graft acceptance.

Methods
Ce(III)N was dissolved with polyethylene oxide and spun onto a grounded rotating mandrel. The uni-axially spun mesh was compared to a co-axially electrospun dressing that contained a Ce(III)N core. Dressings were evaluated for topography/morphology, porosity and oxygen permeation using scanning electron microscopy, helium pycnometry, and a gas exchange chamber, respectively. Ce(III)N release rates were evaluated, as well as 60-day storage stability.

Results
All electrospun dressings contained functional Ce(III)N, with the co-axially spun dressing containing three times the amount of Ce(III)N as the traditionally spun dressing. Uni-axially and co-axially spun nanofibers had diameters of 1487±560 nm and 1071±147 nm, and porosities of 83.9% and 74.1%, respectively. Scaffolds released the majority of Ce(III)N within the first hour of wetting.

Conclusions
All dressings were capable of a burst of Ce(III)N release and maintained stability when stored at room temperature for 60 days.

Applicability of Research to Practice
Despite advancement in protective equipment worn by military personnel, the incidence of thermal injury is expected to rise in future conflicts. There are no burn wound dressings that can mitigate the pathophysiological processes associated with delayed burn wound treatment.
667 A Retrospective Review of Vitamin D Levels and Dosing in Burn Center Patients
Authors: Calder Sara , Quan Asia N , Osborn Suzanne , Nisbet Virginia , Richey Karen J , Bay Curt , Foster Kevin N 
Published: March 2020

Abstract

Introduction
The potential consequences of vitamin D insufficiency/deficiency (I/D) in critically ill patients include: increased ICU length of stay, organ dysfunction, infectious complications, and mortality. Burn patients, in particular, may be at increased risk of vitamin D I/D due to bleeding, systemic inflammatory response syndrome, increased utilization of vitamin D by injured tissues, compromised vascular integrity, fluid shifts, and leakage of vitamin D binding protein (VDBP) and albumin. The purpose of this study is to determine the incidence of vitamin D I/D and evaluate the institutional vitamin D dosing regimen.

Methods
A retrospective chart review was performed on all adult patients from January 1, 2018 through December 31, 2019 who received cholecalciferol and had at least one 25-hydroxy vitamin D level during their hospitalization. Vitamin D level was drawn on admission, then weekly thereafter. Patients found to be I/D were initiated on high dose vitamin D supplementation and then adjusted based on the weekly levels. The therapeutic goal for vitamin D supplementation was set at 50 ng/ml.

Results
Three hundred and sixteen patients met criteria for review. Of those patients, 293 patients (93%) were vitamin D I/D. The magnitude of vitamin D deficiency was strongly negatively correlated with increasing % total body surface area (TBSA) burn size (p&lt; 0.001). Mean time to reach therapeutic vitamin D levels following initiation of supplementation was 19 days, requiring an average of 116,125 units cholecalciferol weekly. Time to reach therapeutic levels was also positively correlated with increasing burn size (p&lt; 0.05). Many patients, however, were discharged prior to reaching therapeutic levels.

Conclusions
Vitamin D I/D is present in over 90% of burn center patients and the degree of I/D was profound. Additionally, vitamin D I/D was not easily corrected, taking almost 3 weeks to reach therapeutic levels using an aggressive supplementation regimen. Further studies documenting the consequences of vitamin D I/D and development of evidence-based supplementation dosing regimens are warranted.

Applicability of Research to Practice
This study documents common and severe vitamin D deficiency in burn patients, and difficulty in correcting this deficiency.
700 A Comparison of Pediatric Burn Injuries Based on Cultural Environment
Authors: Bennie Nicole , Belacic Heather , Bruckman David , Mondozzi Mary A , Crow John 
Published: March 2020

Abstract

Introduction
The Amish maintain cultural customs that preserve their identity minimizing assimilation into American culture and selectively use technology. Cultural beliefs and environmental situations can predispose the Amish, especially children to burn injuries. As a burn center it is important to examine demographics, incidence and causes of burn injury to bring awareness for prevention efforts. The purpose of this study was to determine if burns in Amish children are associated with greater severity when compared to non-Amish children.

Methods
A retrospective analysis of the burn registry at a verified burn center collected data on inpatient children &lt; 14 years with an acute burn injury from 2012 through 2018. Children with frostbite and non-accidental burn trauma were excluded.

Results
Of the 273 children, 16 (5.9%) Amish children were similar to the 257 (94.1%) non-Amish children in age (mean age 4.8y, SD=3.8 vs. 4.0y, SD=3.7), male gender (63% vs. 59%) and percent needing surgery (44% vs. 26%, p=0.14). However, Amish children had a greater median injury severity score (ISS) (9.0, IQR [1, 25] vs. 1.0, [1, 4], p&lt; 0.0001), median TBSA (19.5% [5.2, 52] vs. 4.0 [1.7, 7], p&lt; 0.0001), median length of stay (LOS) (10.5 days [4, 50] vs. 2.0 days [1, 8], p&lt; 0.0001), and median number of surgeries (0.5 [0, 6.5] vs. 0 [0, 1], p&lt; 0.0074). Complications of ARDS (25%), sepsis (25%), compartment syndrome (18.8%), acute renal injury/failure (12.5%) and amputation (18.8%) were more prevalent among Amish children (all p&lt; 0.0033) and non-existent in the non-Amish group. Amish children had a higher incidence of fire/flame burn (43.8% vs. 19.5%) and need for rehabilitation (37.5% vs. 0.8%).

Conclusions
In this study, Amish children had greater burn area, severity, longer LOS, more surgical interventions and complications than non-Amish children.

Applicability of Research to Practice
Culturally appropriate prevention efforts and education are needed to enhance existing care and burn or fire awareness with the Amish population.
701 Outcome Evaluation of High Dose Ascorbic Acid Infusion in Adult Burn Patients
Authors: Curry Dominick M , Smith Susan L , Hobbs Brandon , Schlosser Alexis , Smith Howard G 
Published: March 2020

Abstract

Introduction
High dose ascorbic acid (HDAA) infusion has been associated with lower resuscitation volumes following severe burn injuries. Recent data has linked the use of HDAA to an increased risk of renal failure. HDAA infusion causes an osmotic diuresis which confounds fluid titration. For these two reasons, HDAA has become controversial. The objective of this study is to examine the outcomes of adult burn patients who received HDAA infusion during acute burn resuscitation.

Methods
This study is an IRB approved retrospective chart review of all adult burn patients admitted from January 2016 through December 2018 who received HDAA for resuscitation. Patients were excluded if age &lt; 18 years, had pre-existing hemodialysis-dependent chronic kidney disease, received &lt; 16 hours of HDAA, or expired/withdrew from care within 48 hours of admission. The primary outcome was the incidence of patients receiving HDAA infusion who required renal replacement therapy (RRT) within 7 days of admission. Secondary outcomes included the incidence of abdominal compartment syndrome (ACS), duration of mechanical ventilation, actual crystalloid volume administered in the first 24 hours compared to estimated volume, ICU length of stay (LOS), and mortality.

Results
Twenty-four patients were included with a mean age of 48 (+/-16) and a mean TBSA of 49.1% (+/-17.8). The estimated fluid requirements in the 1st 24 hours were calculated using 4mL/kg/TBSA. Four patients required RRT (16.7%) and 12 patients were diagnosed with ACS (50%). The mean volume of crystalloid administered in the 1st 24 hours was 4.7 mL/kg/TBSA (+/-1.9), and the ratio of actual to estimated crystalloid in the 1st 24 hours was 1.2 (+/-0.5). Seventeen patients received albumin therapy in the 1st 24 hours. The mean urine output in 1st 24 hours was 1.7 mL/kg/hr. Mean duration of mechanical ventilation and ICU LOS was 15 and 16 days respectively. Thirteen patients died (54.2%).

Conclusions
The incidence of patients requiring RRT, along with the crystalloid volume administered and the observed to expected ratio of crystalloids in the 1st 24 hours were comparable to recent literature. The known effect of osmotic diuresis from HDAA potentially impacted fluid titration practice, increasing the risk of complications from over-resuscitation such as ACS, and mortality. Additionally, the estimation of 24-hour fluid requirements using 4mL/kg/TBSA may have contributed to the rates of ACS. Further studies comparing fluid management strategies are necessary.

Applicability of Research to Practice
This study describes the outcomes associated with HDAA during acute burn resuscitation at an adult burn center. Given the current controversy surrounding HDAA infusion, this study provides further data to help burn centers make a decision regarding their opinion of HDAA during acute burn resuscitation.
702 Acute Burn Treatment and Mechanical Ventilation
Authors: Duraes Eliana F , Slama Eliza , Modica Ashley , Asif Mohammed , Caffrey Julie , Hultman C Scott 
Published: March 2020

Abstract

Introduction
Our aim was to explore MV during the acute burn treatment and factors associated with successful extubation.

Methods
A retrospective review was performed on all burn patients that required MV in a reference burn center from December 2015 to April 2018. Patients successfully extubated or on trach collar (Group1) were compared to those that required re-intubation or died on MV (group2). The patients were also grouped depending on duration of MV, after excluding the patients that died under MV: Group A, 3 or less days; Group B, 4 or more days. A p 0.05 was considered significant.

Results
Out of a total of 104 burn patients on MV, 7 patients arrived intubated after coding on the field, were confirmed dead on the first 24 hours, and were excluded from the analysis. The mean expected mortality rate was 21.5±31%, 19 (19.5%) died during the admission. The patients remained intubated for 13±19 days, tracheostomy was performed in 20 (21%), after 26±15 days. Fifty-five (56.7%) of the patients were smokers or former smokers, 34 (35%) were illicit drug users, 16 (16.5%) had alcohol intoxication when burned. Inhalation injury was suspected in 80 (82.5%) of the patients, and confirmed in 41 (42.3%). Group 1 was younger: 48.42±18.66 vs 59.15 ± 21.38, p=0.032. Although a smaller rate of confirmed inhalation injury was seen among group1, it was not statistically significant (Group1: 25 (36.8%); group2: 16 (55.2%) (P=0.09). The TBSA burned was bigger on group 2: 18.4%±19.72 vs 34.39%±25.86, p=0.002. History of drug use was not associated with extubation success: group1: 26 (38%); group2: 8 (27.6%); (P=0.314). The expected mortality was significantly higher among group2: 10%±16.1% vs 48.54%±39.33%, p&lt; 0.001. Group1 was associated with the use of less albumin and crystalloids on the first 24h and a bigger volume of urine on Day1 (Table1). A sub-analysis of the group that required re-intubation (n=10) and the successfully extubated showed an increased rate of psychiatric illness among the group requiring re-intubation: 18 (26.5%) vs 7 (70%), p&lt; 0.001. The group that required a shorter time on the MV (GroupA) had a shorter length of stay, smaller percentage of TBSA, required fewer surgeries, and received less albumin and crystalloids on Day1 (Table2).

Conclusions
Lower expected mortality and age, and smaller %TBSA burned are associated with a successful extubation. Psychiatric illness may be associated with the need for re-intubation.

Applicability of Research to Practice
This study highlights the association of psychiatric illness and difficulty extubating the burn patient.
712 Title: Monitored Anesthesia Care (MAC) Burn Dressing Changes Even in Critically Ill Patients Is Incredibly Safe
Authors: Lozenski Jeanette , Voss Jordan , Kovac Anthony , Parks Jennifer , Northrop Kayla , Bhavsar Dhaval , Salerno Shannon 
Published: March 2020

Abstract

Introduction
Objective: Identify prevalence and factors associated with hypoxia and blood pressure changes during MAC anesthesia for inpatient burn dressing change.

Methods
Retrospective chart review on 112 adult inpatients undergoing 1 or more burn dressing changes under MAC from March 2014 to December 2017 at a single burn center.

Results
Study population was 112 burn inpatients undergoing 210 burn dressing changes under MAC. Median age was 43 years (range 18–93) with 78% male and 95% Caucasian. Average BMI was 29.7 (range 18–66). Average % total body surface area (TBSA) burn was 24% (range 1%-70%). Number of MAC dressing changes per patient was 1 to 16 with most (71.4%) undergoing 1 MAC dressing change. Among 210 MAC cases, 5 involved a hypoxemic event (defined as a % O2 saturation of &lt; 90%) and 14 involved a blood pressure changed (defined as a mean arterial pressure (MAP) of &lt; 60 mmHg) on 7 different patients Three of the hypoxic events were also associated with hypotension (1.4%) None of these events were associated with poor outcomes.

Conclusions
MAC anesthesia for dressing changes are performed on inpatients during all stages of the burn recovery. Anesthesia is involved with the initial dressing changes on the critical care individuals. The MAC anesthesia is titrated to the condition of the patient with very low frequency of hypoxia or severe hypotension.

Applicability of Research to Practice
Burn dressing changes are challenging anesthesias because of the often associated co-morbidities of the presenting patients. Other factors that are considered are the NPO status and nutritional requirements of the patients. The desire to accomplish the dressing changes with the least amount of disruption of this while caring for these ill patients can be safely accomplished with MAC dressing changes. This provides an incredibly safe environment for the patient with the rapidly titratable medications that allow the dressing changes to be completed efficiently.
746 Racial and Ethnic Disparities Among Burn Surgery Leadership
Authors: Egro Francesco M , Kettering Caroline E , Konanur Anisha , Corcos Alain C , Stofman Guy M , Ziembicki Jenny A 
Published: March 2020

Abstract

Introduction
The underrepresentation of racial and ethnic minority groups has existed and been well documented in general and plastic surgery literature but has not been described in burn surgery. The aim of this study is to evaluate current minority group representation among burn surgery leadership.

Methods
A cross-sectional study was performed in January 2019 to evaluate minority group representation among burn surgery leadership. Burn surgeons included were directors of American Burn Association (ABA)-verified burn centers in the US, past and current presidents of the ABA and International Society of Burn Injuries (ISBI), and editorial board members of five major burn journals (Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma). Surgeons were compared based on factors including age, gender, training, academic rank, and h-index.

Results
Among 71 burn center directors, 68 societal presidents, and 197 journal editors, minority ethnic groups represented 18.3, 7.4, and 34.5 percent, respectively. Among US burn center directors, the group classified collectively as non-white was significantly younger (white = 56 years, non-white = 49 years; p&lt; 0.01), graduated more recently (white = 1996, non-white = 2003; p &lt; 0.01), and had a lower h-index (white = 17.4, non-white = 9.5; p &lt; 0.05) than white colleagues. There were no significant differences in gender, type of residency training, advanced degrees obtained, and fellowships completed between white and non-white groups.The were no significant differences in the likelihood of white and non-white directors in academia to be full professor, residency or fellowship director, or chair of the department.When compared to the 2018 US National Census, burn unit directors had a 5.1 percent decrease in non-white representation. Specifically, Asians had an 8.3 percent increase in representation, while there was a decrease in both Black (12.0%) and Hispanic (15.3%) representation.

Conclusions
Disparities in representation of ethnic and racial minorities exist in burn surgery leadership. The most extreme disparities were seen with Black and Hispanic surgeons. However, because these surgeons are younger and graduated more recently, it is promising that minority representation will continue to rise in the future.

Applicability of Research to Practice
Programs should be initiated in burn surgery that address the implicit biases of burn surgeons and increase mentorship opportunities for underrepresented minorities.