bluuebunny/crossref_metadata_2025_split huggingface dataset:
708 Enteral Nutrition Initiation During Periods of Vasopressor Requirements and Elevated Lactate Levels
Authors: Shields Beth A , Pruskowski Kaitlin A , Williams Alicia M , Cancio Leopoldo C 
Published: March 2020

Abstract

Introduction
Nutrition is a core component of care for the critically ill burn patient. The Society for Critical Care Medicine recommends initiating enteral nutrition (EN) within 4–6 hours of injury for burn patients, while simultaneously recommending waiting until hemodynamic stability is achieved for critical care patients. The goal of this analysis was to evaluate tolerance of EN during periods of different pressor requirements and lactate levels.

Methods
We performed a retrospective evaluation on all burn patients admitted to our intensive care unit in 2018 who received EN. This performance improvement project was approved by our regulatory compliance division. Lactate levels and vasopressor use just prior to EN initiation, the highest EN rates and gastric residual volumes during the 24 hours after initiation, and ischemic bowel and aspiration after EN initiation were recorded. Significance was accepted at p&lt; 0.05.

Results
EN was initiated at 30 ± 20 hours after admission in 58 patients with the following characteristics: 47 ± 19 years old, 29 ± 24% TBSA burn, 13 mechanical ventilator days (IQR: 5–30), 15% mortality. The highest EN rate reached was 100 ± 49 mL/hr during the first 24 hours after initiation. Lactate levels were 1.9 mmol/L at the time of EN initiation (IQR: 1.6–2.4 mmol/L), with a maximum of 4.9 mmol/L. Lactate levels did not have a significant correlation with gastric residual volumes (p=0.532). Most (59%) patients did not have vasopressor requirements, but 21% required vasopressin only, 2% required norepinephrine only, and 19% required a combination of vasopressin and norepinephrine. Those who received norepinephrine received 3.3 ± 1.7 mcg/min, with a maximum of 7 mcg/min. There was a significant difference in gastric residual volumes between patients who had no vasopressor requirements compared to those who required vasopressors [13 mL (IQR: 0–200 mL) vs. 240 mL (IQR: 21–430 mL), p=0.014)]; however, the number of patients with gastric residual volumes over 500 mL was not significantly different (3% vs. 17%, p=0.149).
When examining patients receiving vasopressin alone, there was a significant but weak correlation between vasopressin dose and gastric residual volumes (p=0.047, R2=0.339); however, when examining only patients receiving norepinephrine, there was no correlation between norepinephrine dose and gastric residual volumes (p=0.905, R2=0.002).
There was 1 episode of aspiration and 1 episode of ischemic bowel, both of which occurred 3 days after EN initiation. EN was initiated without vasopressors running and lactate levels were normal in both cases.

Conclusions
The majority of patients tolerated EN initiation with vasopressor dosing of norepinephrine up to 7 mcg/min and lactate up to 4.9 mmol/L.

Applicability of Research to Practice
We found no indication for holding EN for lactate levels under 5 mmol/L and norepinephrine under 8 mcg/min.
743 Keeping up with Dr. Google: When Are Patients Seeking First-aid Burn Resources?
Authors: Parizh David , Effendi Maleeh , Martin Thomas L 
Published: March 2020

Abstract

Introduction
Treating burns is a relatively common occurrence in American Emergency Departments occurring an estimated 486,000 times per year. In the digital era, patients feel increasingly empowered to seek out medical resources independently. The true number of people sustaining an injury and treating themselves at home or outside of the hospital setting is difficult to quantify. However, we can see when patients were searching for first-aid burn resources on the world’s most powerful and popular search engine - Google. We hypothesized that there would be a correlation between patient’s searching for burn care resources online and burn admissions.

Methods
We used Keywords Everywhere a browser add-on for Google Chrome to cross check various phrases and words that Americans might search for to find information on how to treat a burn. “Burn treatment” was found to be the most commonly searched phrase and this was verified using Google Trends. Google Trends dose not give raw search numbers. However, it expresses the search frequency for a term relative to how frequently that term was sought out during a specified time period. We pulled search data for each successive year back till 2006 the earliest year for which complete data was available. We were then able to overlay this data on a year to year basis and thus view when information about treating burns was the most sought out.

Results
A clear increase in the frequency of searches for burn treatment can be seen around the summer months, peaking in the week surrounding the 4th of July. Further data comparing this trend to burn admissions is forthcoming as data is being solicited.

Conclusions
Americans are searching for more resources regarding burn injuries in the summer months; and especially in the days surrounding the fourth of July. We are excited to correlate this data to burn admissions. If there is an inverse relationship between admissions during the summer months and number of inquiries made via Google for acute burn care, this may suggest that many of the burns are minor. Thus, being treated through our clinics or through third-party providers. Alternatively, the patients may be treating themselves using internet resources. If this proves to be the case, there may be an opportunity to enrich online resources for our patients.

Applicability of Research to Practice
Once the data processing is complete, there will be an indication if the number of people seeking out resources via Google Search Engine correlates with out burn admissions. If not, this may be an opportunity for improvement to enrich burn first-aid resources available online.
765 The Impact of Peer Support Group Programs on Psychosocial Outcomes for Burn Survivors & Caregivers: A Review of the Literature
Authors: Bello Mariel S , Stoycos Sarah A , Carrera Brenda T , Kurakazu Dawn , Briere John , Garner Warren L , Gillenwater Justin , Yenikomshian Haig A 
Published: March 2020

Abstract

Introduction
Providing peer support group programs for burn survivors and their caregivers is an integral part of facilitating short- and long-term psychosocial recovery. Despite this, there is a lack of availability and standardization of these groups, which is partly due to a paucity of literature on this subject. The purpose of this study is to review the literature of the various types of peer support groups programs and their subsequent impact on psychosocial outcomes for burn survivors and their families.

Methods
A systematic review of the literature utilizing PubMed, PsycINFO, and Medline, was conducted for articles published between 1990 and 2018. Searches used the AND function to identify articles that crossed both a burn term (burn patient OR burn survivor OR burn care OR burn recovery) and a support group-related term (support, peer participation, aftercare, burn camp, outpatient group, inpatient group, group training). Inclusion criteria were studies in English, human subjects, peer support group programs, and studies that assessed psychosocial outcomes.

Results
Twenty articles met our inclusion criteria (7 for outpatient groups, 3 for inpatient groups, 2 for combined inpatient/outpatient groups, and 8 for burn camps). For outpatient peer support programs, all articles (n=7) demonstrated improvements in psychosocial outcomes including life satisfaction, acceptance of self, and reduced levels of isolation. For inpatient programs, all articles (n=3) reported improvements in emotional processing, concerns from caregivers, and coping strategies. The 2 articles that examined combined inpatient/outpatient programs reported substantial declines in post-traumatic stress, depression, and anxiety. Interestingly, findings were inconsistent for burn camps, 5 articles reported improvements in self-esteem, social integration, and reduced anxiety and depression while 3 articles demonstrated no significant changes.

Conclusions
Peer support group programs in various settings improve psychosocial well-being for both patients and caregivers. Inpatient/outpatient regimens were consistently beneficial while burn camps had inconsistent findings.

Applicability of Research to Practice
Peer support group programs are necessary for effective burn survivor and caregiver healing, regardless of format. Our ABA-verified burn center is currently working on a study to determine optimal inpatient/outpatient regimens of peer support.
767 Growing up with Burn Injuries - Has the Experience Changed over Time?
Authors: Rimmer Ruth B , Bay Curt , Kalil Emile T , Chacon Daniel W , Milem Mik , Esker Mark , Duke Desiree C , Wise Dustin , Foster Kevin N 
Published: March 2020

Abstract

Introduction
Growing up with disfigurement and functional limitations resulting from childhood burns can be challenging. Initial stages of care involve painful surgeries/dressing changes, strenuous physical & occupational therapy, pressure garments and time away from family/school activities. Few studies have examined the voiced issues faced by youth while maturing with burns. This study’s purpose was to determine if experiences in the post-injury phase differed between currently burn-injured youth vs. young adults burned as children.

Methods
A prior study asked Child Burn Survivors (CBS -10–16 yrs.) and Young Adults (YAs -17-25yrs.) to answer the statement: “The hardest thing about being burned is…” The most common issues included: People Staring, Getting Unwanted Questions, Being Bullied, Remembering When I Was Burned, Having Additional Surgeries and My Scars. The current study asked participants to rate items on a 4-point scale from (1) Not at all to (4) Really a lot. The YAs were asked to consider issues they encountered maturing with burns.

Results
Child Survivors (CBS, n=147) mean age 13.4 years, male (n=46%) female (n=54%), and YA Survivors (YA, n = 81) male(n=39%) female (n=61%) mean age =19.1 yrs., and were predominately racial/ethnic minorities (CBS=67%; YA = 58%). No differences existed for age burned (CBS=6 yrs. vs. YA = 6.4 yrs.) hidden & visible scars (CBS=55% vs. YA=68%) and TBSA ≥ 50% (CBS=19% vs. YA =20%). Top mean scores for CBS’s included: Remembering the Burn (2.05) & Getting Unwanted Questions (2.0). The YA group’s top mean scores included Being Bullied (2.10) & People Staring (2.0). The CBS group reported that Getting Unwanted Questions was more problematic than the YA Group (p =003). YAs shared that Being Bullied was their biggest problem vs. CVS, significantly more so (p=.01).

Conclusions
Bullying appears to be less of a problem for current child burn survivors than those previously burned. The difference may be due to a recent emphasis placed on anti-bullying in US schools. Findings highlight an ongoing need to address the psycho/social issues related to burns. Teaching interventions like the Phoenix Society’s Rehearse Your Response can help youth address unwanted questions and staring. Providing children an opportunity to process the injury event may also improve their ability to cope with burn stressors.

Applicability of Research to Practice
This research has clinical implications as issues shared by participants can be addressed by burn healthcare providers and therapists. Results endorse the delivery of supportive strategies which complement surgical/medical treatment and should help improve their social interactions/quality of life.
768 Young Adults Burn Survivors - Key Challenges They Faced While Growing Up
Authors: Rimmer Ruth B , Bay Curt , Rutter Cindy , Chacon Daniel W , Wise Dustin , Duke Desiree C , Milem Mik , Foster Kevin N 
Published: March 2020

Abstract

Introduction
There is a paucity of research regarding the challenges faced by young adults (YA) who matured with burns. It is well documented that acute burn care is laden with painful surgeries/dressing changes, gruesome physical/occupational therapies, anxiety and time away from family & friends. However, the specific issues young adults burned as children find most challenging remain largely unknown. This study sought to provide YA survivors with an opportunity to describe the difficult issues they endured.

Methods
Burn surviving youth responded to the open-ended statement “The hardest thing about being burned is…” Seven themes were derived from their responses: People Staring at Me, Being Bullied, Remembering When I was Burned, Having Additional Surgeries, My Scars, Getting Questions About My Burns,& the Pain & Itching, Young adult survivors were asked to rate each item on a 4-point scale from (1) Not at all to (4) Really a lot.

Results
Participants were YA survivors (n=64) mean age 19.1 years, female (62%) male (38%), average age at burn of 6.4 yrs. Sixty-eight percent reported both visible & hidden scars; 25% had a TBSA &gt; 50%. Sixty-six percent were minority race/ethnicity. More than half of respondents reported issues with My Scars (65%), Remembering the Burn (52%) and Pain & Itching (50%). People Staring and Bullying has been bothersome for over 70%, 72% reported Being Bullied and 71% noted People Staring. The highest 5 means among YA subgroups included: Participants with hand scars- Being Bullied (2.6), those with visible scars - My Scars (2.6). Those reporting both facial & hand scars endorsed People Staring (2.4), youth with a TBSA ≥ 50% - Being Bullied (2.4) and with visible scars - Remembering the Burn – (2.4). Girls were bothered significantly more by My Scars (p=.02). Youth with both facial & hand scars had greater issues with Pain/Itch (p=.03).

Conclusions
This study provides insight into problems encountered by maturing burn survivors and discloses the more challenging issues they endured. These data can assist burn centers, camps, and psychotherapists in discussing potential survivor issues and suggest interventions to help burn-injured youth respond to challenges. Special consideration should be given to girls, those with facial/hand scars, large TBSAs and visible scarring.

Applicability of Research to Practice
This research can help burn care professionals better understand the major difficulties burn-injured youth experience. Supportive strategies should be developed to augment surgical/medical treatment with constructive psycho/social interventions. Providing survivors with constructive coping strategies can help to improve their social interactions and quality of life.
782 Central Line Associated Blood Stream Infection Reduction Utilizing a Business Improvement Model: The Four Disciplines of Execution
Authors: Dale Elizabeth , Schmits Grace , Allard Karen 
Published: March 2020

Abstract

Introduction
In July of 2018, the Burn ICU had very high Central Line Associated Blood Stream Infection (CLABSI) rate, more than double national rates. Due to the high cost and mortality associated with CLABSI, the unit leadership initiated a quality improvement project to decrease CLABSI rates.

Methods
The process implemented is called the “Four Disciplines of Execution” (4DX) based on a book by Sean Covey. Those methods are as follows:

Results
The 4DX Process allowed identification of areas for all team members (MDs and RNs) to improve their practice. Over time, consistency of practice with lead measures became 100% and new lead measures had to be developed. CLABSI improvement rate exceeded expectations; in June the rate dropped to 2.29 infections per 1000 patient line days (only 1 CLABSI during intervention period).

Conclusions
This process allowed engagement of the whole team, allowed for MD and RN problem solving and accountability, and resulted in dramatic improvement in HAI rates in the Burn ICU.

Applicability of Research to Practice
This method was unique compared to typical healthcare improvement models. In addition to being effective, it helped improve overall morale and performance on the unit.
795 Factors Associated with Time to Initial Debridement in a Pediatric Burn Center
Authors: Giles Sheila , Wheeler Krista K , Fabia Renata , Lever Kimberly , Shi Junxin , Thakkar Rajan 
Published: March 2020

Abstract

Introduction
There is sparse literature addressing the time of initial burn debridement. The purpose of this study was to describe factors associated with time to initial debridement in one American Burn Association (ABA) verified pediatric burn center.

Methods
Quality improvement data was prospectively collected for pediatric burn patients admitted from July 2018 through June 2019. The data included sedation method, total body surface area (TBSA) burn, mechanism of injury, and time to burn wound debridement. Adverse outcomes were also recorded. Nonparametric methods were used to evaluate associations. Medians are presented with interquartile ranges (IQR).

Results
There were 137 patients included in this study. The median time to initial debridement was 261 minutes (IQR: 166–321). Most patients (80%) received conscious sedation for their first debridement. The median time to debridement was significantly lower for patients receiving sedation as opposed to those without sedation, 240 minutes (IQR: 163–308) vs 338 minutes (IQR: 257–442), p=0.0004. Patients with TBSA burn &gt; 5% (n=46) also had a significant earlier time to debridement as compared with patients with smaller burns, 183 minutes (IQR: 150–277) vs 283 minutes (IQR: 197–360), p&lt; 0.0001. There was a significant difference in time to initial debridement based on mechanism of injury, p=0.0213. The median time to debridement for flame burns was 173 minutes (IQR: 149–308) as compared with scald burns with a median of 247 (IQR: 157–298) and contact burns, median 286 (IQR: 197–389). There were no adverse outcomes observed during the study period.

Conclusions
In an ABA verified pediatric burn center, conscious sedation, larger TBSA burn, and flame burns appeared to contribute to earlier time to debridement, with no adverse outcomes. Further analysis are ongoing as to whether pain scores differed for these initial burn dressings and if conscious sedation had any effects on subsequent dressings.

Applicability of Research to Practice
This study adds to the sparse literature regarding time to initial debridement and identifies factors associated with an earlier time to debridement. This study also raises further opportunities for investigation regarding the relationship between initial sedated debridement procedures and pain scores during subsequent dressing changes.
804 Successful Implementation of Acupuncture for Hospitalized Burn Patients
Authors: Thomas Mini , Joe Victor C , Nunez Molly , Nourani Bobby , Chin Theresa L , Burton Kimberly , Rychlock Rachel , Li Sheng , Horie Mariko 
Published: March 2020

Abstract

Introduction
There is evidence that acupuncture is beneficial for burn patients, resulting in improved pain control, decreased stress, and improved wound healing. Nevertheless, a limited number of hospitals have adopted acupuncture for inpatients. The purpose of this project was to incorporate acupuncture as an adjunct modality for pain control and other symptomatology for inpatients on the burn service.

Methods
In April 2019, the hospital initiated acupuncture services for inpatients through the Integrative Health (IH) program and hired three licensed acupuncturists and a medical director. The burn team collaborated with IH to develop care delivery guidelines. Referral for acupuncture services are initiated with a consult transmitted by the burn team physician via the electronic medical record. Acupuncture services are provided Monday to Friday, 8 to 5 pm. Acupuncturists attend weekly inter-disciplinary team rounds to answer questions and discuss potential treatment indications. Traditional Chinese Medicine evaluation is performed, with history and physical, including tongue inspection and pulse assessment. After verbal consent, practitioners treat using either single-use filiform acupuncture needles or blunt needles. Following treatment, the patient is evaluated for pain and satisfaction. About 3–5 treatment sessions are offered weekly. An online survey was conducted to evaluate healthcare workers’ attitude towards acupuncture in the inpatient setting.

Results
Since April 2019, 20% of hospitalized patients on the burn service received acupuncture referral and the number of patients utilizing acupuncture is increasing. A total of 191 sessions were provided for 22 patients. Common reasons for patients not to receive treatment include lack of consent, unavailability due to other scheduled treatments, and lack of appropriate intact skin for needling. The attitude survey was completed by 166 health care workers including physicians, nurses, therapists, and social workers. Overwhelmingly positive opinions were reported as shown in the table.

Conclusions
The project demonstrated successful implementation of acupuncture as an adjunct therapeutic modality for the burn inpatient service. It was met with patient satisfaction and acceptance by the healthcare team. Plans are in process to mature the provision of acupuncture services and follow outcomes such as pain control, sleep, and stress.

Applicability of Research to Practice
Currently, acupuncture for hospitalized patients is not billed which may be a major barrier in promoting this therapy. However, increased patient satisfaction and symptom relief could potentially offset costs. Future studies should also examine potential impact on wound healing and length of stay of burn patients.