bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization of Klebsiella pneumoniae isolates from a mother–child cohort in Madagascar
Authors: Rakotondrasoa Andriniaina , Passet Virginie , Herindrainy Perlinot , Garin Benoit , Kermorvant-Duchemin Elsa , Delarocque-Astagneau Elisabeth , Guillemot Didier , Huynh Bich-Tram , Brisse Sylvain , Collard Jean-Marc 
Published: March 2020

AbstractObjectivesTo define characteristics of Klebsiella pneumoniae isolated from carriage and infections in mothers and their neonates belonging to a paediatric cohort in Madagascar.MethodsA total of 2000 mothers and their 2001 neonates were included. For each mother, vaginal and stool samples were collected at the birth. Additionally, upon suspicion of infection, samples were collected from suspected infected body sites in 121 neonates. Genomic sequences of all isolated K. pneumoniae were used for phylogenetic analyses and to investigate the genomic content of antimicrobial resistance genes, virulence genes and plasmid replicon types.ResultsFive percent (n = 101) of mothers were K. pneumoniae positive. Of 251 collected K. pneumoniae isolates, 102 (40.6%) were from mothers and 149 (59.3%) were from neonates. A total of 49 (19.5%; all from infants except 1) isolates were from infected body sites. MLST identified 108 different STs distributed over the six K. pneumoniae phylogroups Kp1 to Kp6. We found 65 (25.8%) ESBL producers and a total of 101 (40.2%) MDR isolates. The most common ESBL gene was blaCTX-M-15 (in 99.3% of isolates expressing ESBL). One isolate co-harboured blaCTX-M-15 and blaNDM-1 genes. Three isolates from infected body sites belonged to hypervirulent-associated ST23 (n = 1) and ST25 (n = 2). We observed two cases of mother-to-child transmission and sustained K. pneumoniae carriage was identified in 10 neonates, with identical isolates observed longitudinally over the course of 18 to 115 days.ConclusionsThis study revealed substantial genetic diversity and a high rate of antimicrobial resistance among K. pneumoniae isolated from both carriage and infections in Madagascar.
77 Functional Outcomes in Patients with Hand Burns Receiving Long Term Hand Therapy
Authors: Choi Katherine J , Pham Christopher H , Collier Zachary J , Carney John , Kurakazu Dawn , Yenikomshian Haig A , Gillenwater Justin 
Published: March 2020

Abstract

Introduction
Sparse data exists on functional outcomes of patients receiving outpatient therapy after admission with hand burns. The purpose of our study is to evaluate the effectiveness of long-term outpatient occupational therapy (OT) on hand joint range of motion (ROM), activities of daily living (ADL) status, and pain after burn injury.

Methods
All patients with hand burns admitted to a single ABA verified burn center from January 2015 to May 2016 with properly documented outpatient OT follow up were included. Demographics (TBSA, hand dominance, mechanism), interventions (time-to-surgery, procedures), and long-term outcomes (further procedures, pain, ROM, contractures, scars, ADL) were evaluated. The effect of patient demographics and interventions on outcomes were evaluated with descriptive statistics and multivariate logistic regression.

Results
Of 61 patients with hand burns, 43 were referred for outpatient therapy, but only 31% (n=19) consistently presented for follow up. Mean age was 37±14 years, 74% (n=14) were male, and mean TBSA was 12%±17. Surgical management was required in 63% (n=12), and the mean time-to-surgery was 16±37 days from injury. Contractures occurred in 16% (n=3), 11% (n=2) had hypertrophic scarring, and 21% (n=4) developed both contractures and hypertrophic scarring. Of these patients, 21% (n=4) required further surgical intervention, including 3 contracture releases and 1 triamcinolone injection.
Mean OT follow up was 16±14 weeks. As of the last OT note, 84% (n=16) had independent ADL function, 16% (n=3) required assistance, and none were poorly functioning. Likewise, 47% (n=9) had normal ROM, 53% (n=10) were within functional limits, and none had poor ROM. 79% (n=15) demonstrated improvement of ADL function, and 84% (n=16) had improvement of ROM. At OT intake, 68% (n=13) reported pain as a major limitation, but by end of therapy, only 21% (n=4) were limited by pain. Those with contractures or hypertrophic scars were 9.9 times less likely to have improvement in ADL status (p=.03, RR 9.9, CI 1.3–67).

Conclusions
Most patients referred for hand therapy after burn injury return to functional independence and have functional ROM.

Applicability of Research to Practice
Referral to and compliance with dedicated long-term hand therapy leads to improvements to ADL and ROM in patients admitted with hand burn injuries.
94 Bioimpedance Spectroscopy Is a Valid and Reliable Measure of Edema in Hand Burn Injury
Authors: Edwick Dale O , Hince Dana A , Rawlins Jeremy M , Wood Fiona M , Edgar Dale W 
Published: March 2020

Abstract

Introduction
The assessment of swelling following burn injury is complicated by the presence of wounds and dressings, particularly as the patient cohort experience significant pain, impaired movement, and may require medications that result in modified behavior. Further, traditional measures of volume, such as water displacement volumetry (WDV) or circumferential limb measures may pose increased infection risk and pain due to contact with open wounds. Clinically, edema is most often assessed by noting loss of skin creases, palpation of areas of visible swelling, and loss of function, as there remains a lack of sensitive objective measures for edema in patients with hand burn injury. Bioimpedance spectroscopy (BIS) is a measure of body composition that has been demonstrated by our group to be reliable for measuring whole body and limb edema during resuscitation, and to be sensitive to local edema changes within healing wounds. The aim of this study was to determine the reliability and validity of BIS as a measure of edema following hand burn injury.

Methods
One hundred patients presenting with hand burn injury were recruited to this trial. Repeated volume measures of the hand were recorded using a novel application of BIS, and repeated using WDV. The results were analysed using multi-level mixed effects regressions. The use of BIS electrodes on the dorsum of the middle finger at the DIP and MCPJ levels, and dorsum of the wrist and forearm have been previously described for measuring lymphedema.

Results
Paired repeated measures were obtained for 195 hands. Alternate electrode positions on the palm of the middle finger and hand, and volar wrist and forearm, and a combination of palmar hand / dorsal forearm were assessed. There was no evidence of a significant difference between these electrode configurations and the previously described dorsal hand / forearm configuration (position x distance interaction, p=0.608–0.802). Dorsal hand / volar forearm configuration was significantly different (position x distance interaction, p=0.006) from the standard electrode position described. Comparison with WDV demonstrated a strong correlation (r=0.79; limits of agreement 198-460mL; bias 329mL). Reliability of BIS was determined by ICC: 0.9978–0.9999 (CI 0.9967–0.9999).

Conclusions
Compared to WDV, BIS is a valid and reliable measure of edema following acute hand burn injury. This study also confirmed the interchangeability of multiple BIS electrode positions.

Applicability of Research to Practice
BIS offers a real time measure of fluid (change) within the extracellular space, and therefore edema in patients with hand burn injury, while minimizing the risk of infection and increased pain in burns patients. The interchangeability of electrode positions provides clinicians with a number of flexible options to accommodate locations of hand burn wounds, thus allowing between patient comparisons.
104 Comorbidity Does Not Predict Outcomes After Burn Injury in the Elderly
Authors: Bernal Isabel , Paine Rosemary , Carter Damien W , Falank Carolyne 
Published: March 2020

Abstract

Introduction
As the population ages; burn centers, especially those with a large rural catchment, will be expected to care for older adults with complex medical co-morbidities. Recent work has shown that %TBSA at which 50% of patients would be expected to die (LD50) for elderly patients is up to 20% lower than non-elderly patients. However, the factors contributing to mortality are unclear. We undertook this study to characterize our experience with elderly burn patients in our rural state and to understand how mortality is affected by comorbid disease.

Methods
We performed a retrospective review of all burn patients ≥50 years old admitted to our burn center over a 5 year period between January 2014 and December 2018. We collected demographic and injury data including %TBSA, mechanism, inhalation injury status, discharge disposition, length of stay as well as complications including pneumonia, kidney injury, wound infection and graft loss. We calculated the modified Baux score, Charlson Comorbidity Index (CCI) and overall mortality for each patient. The %TBSA and CCI were correlated with complications and mortality using the Pearson correlation coefficient analysis.

Results
There were 243 patients (35%) who met inclusion criteria out of total of 688 burn admissions during that period. The median age was 60 years (mean 62.2, range: 50–95) and 72.4% were male. The median TBSA was 4% (mean: 8.2%, range: 0.5% - 55%). We found weak correlations between CCI and both pneumonia (R=0.177, p=0.005) and mortality (R=0.1297, p=0.0434). There was also a weak correlation between %TBSA and pneumonia (R=0.3302, p &lt; 0.001), kidney injury (R=0.205, p=0.001), wound infection (R=0.1295, p=0.045) and graft loss (R=0.2616, p&lt; 0.001). Interestingly, in the subgroup with &gt; 15% TBSA burns (n=35), there was no significant correlation with increased complications. For the entire cohort, the predicted mortality based on the mean modified Baux score was 16%. The actual observed mortality was 4.1%.

Conclusions
Our findings suggest that, in our center, CCI is not predictive of burn related complications or mortality and %TBSA is not predictive of complications or death. The observed to expected mortality ratio was remarkably low.

Applicability of Research to Practice
As we treat older burn patients, it is important to identify the individual patient factors and hospital specific burn care factors that may improve outcomes in the elderly population.
117 Light or Dark Pigmentation of Engineered Skin Substitutes Containing Melanocytes Protects Against UV-Induced DNA Damage in Vivo
Authors: Supp Dorothy M , Hahn Jennifer M , Lloyd Christopher M , Combs Kelly A , Swope Viki B , Abdel-Malek Zalfa , Boyce Steven T 
Published: March 2020

Abstract

Introduction
Engineered skin substitutes (ESS) were developed to meet the need for prompt wound closure in patients with large full thickness burns. ESS containing autologous fibroblasts and keratinocytes were shown to provide stable wound closure in burn patients, but are limited by hypopigmentation. DNA damage caused by ultraviolet (UV) radiation is a known risk factor for development of skin cancer. In normal human skin, epidermal melanocytes provide pigmentation, helping to shield skin from UV-induced DNA damage. The current study investigated inclusion of human melanocytes (hM) and their role in the response of ESS to UV light in vivo.

Methods
Primary cells were isolated from skin of healthy de-identified human donors with IRB approval. Three groups of ESS were prepared with fibroblasts and keratinocytes, +/- hM, and were grafted orthotopically to immunodeficient mice: ESS without hM; ESS with light skin-derived (Caucasian) hM (ESS+hML); and ESS with dark skin-derived (African American) hM (ESS+hMD). After 8 weeks in vivo, grafts were irradiated with 135 mJ/cm2 UV, and mice were euthanized after 2 or 24 hours; non-UV treated mice served as controls. Pigmentation and erythema were measured with a Mexameter. Melanocytes and cyclobutane pyrimidine dimers (CPDs) were quantified by immunostaining with anti-TYRP1 and anti-CPD antibodies, respectively, followed by image analysis (Nikon Elements). Statistical analyses (SigmaPlot) utilized t-test or one-way ANOVA; P&lt; 0.05 was considered significant.

Results
At 8 weeks post-grafting, mean hM density in ESS+hML and ESS+hMD was not significantly different from normal human skin samples. Pigmentation (in Mexameter units) before UV irradiation was significantly different among groups (ESS+hMD &gt; ESS+hML &gt; ESS no hM). UV irradiation did not increase erythema in any group, but resulted in significantly increased pigmentation in ESS+hML and ESS+hMD at 2 hours, but not 24 hours, post-UV. CPDs, the most prevalent form of UV-induced DNA damage, were significantly elevated 24 hours post-UV in ESS without hM. DNA damage was significantly lower 24 hours post-UV in ESS+hML and ESS+hMD compared with ESS without hM. No differences in DNA damage were observed between ESS+hML and ESS+hMD.

Conclusions
Pigmentation of ESS+hML and ESS+hMD in vivo varied according to the skin phototype of the hM donor, with no difference in melanocyte density, which was similar to normal human skin. Inclusion of either light or dark hM decreased UV-induced DNA damage, suggesting that hM in ESS play a photoprotective role, as in normal human skin.

Applicability of Research to Practice
Protection against UV-induced DNA damage may reduce the risk of skin cancer in patients grafted with ESS containing melanocytes.
127 Does Socioeconomic Status Impact Opioid Requirements in Burn Injured Patients with Methamphetamine Abuse?
Authors: Tejiram Shawn , Solomon Eve A , Greenhalgh David G , Palmieri Tina L , Sen Soman , Romanowski Kathleen S 
Published: March 2020

Abstract

Introduction
Methamphetamine (MA) abuse among burn injured patients is associated with lower socioeconomic status, larger burn injuries, and longer lengths of stay. While overlap among MA and opioid abuse has risen, studies examining the impact of MA abuse and socioeconomic status on opioid requirements in burn injured patients remain limited. The aim of this work was to examine the impact of MA abuse and socioeconomic status on discharge opioid requirements in burn injured patients.

Methods
Records on burn injured patients admitted to an ABA verified burn center were retrospectively reviewed from January 2016 to December 2017. Demographics, burn size (TBSA), admission toxicity screening, discharge pain scores, length of stay (LOS), adjuvant pain medications, and opioid equivalents (OE) within 24 hours of discharge were reviewed. OEs were determined by conversion of narcotics to oral morphine equivalents. Patients were grouped into methamphetamine positive (MPOS) or negative groups (MNEG) for comparison purposes.

Results
Of 690 patients who met inclusion criteria, 451 admission toxicity screening exams were performed that identified 170 patients positive for methamphetamine abuse. MNEG patients had significantly higher OE (p=0.03) requirements than MPOS patients. No significant differences were noted between gender (p=0.22), TBSA (p=0.70), benzodiazepine use (p=0.87), or clonidine use (p = 0.88) between groups. MPOS patients were less likely to receive gabapentin (p=0.03). OE and OE/TBSA requirements correlated with discharge pain score (p &lt; 0.001) and LOS (p &lt; 0.001). A significantly higher level of poverty was seen in MPOS patients (p &lt; 0.0001), but poverty itself was not a predictor of OE (p = 0.66), OE/TBSA (p = 0.90), pain score (p = 0.28), or LOS (0.49). Multivariate linear regression found MNEG status (p=0.003), TBSA (p&lt; 0.0001), and pain score (p&lt; 0.0001) were independently associated with OE.

Conclusions
Though lower socioeconomic status was seen more in patients with MA abuse, it was not associated with opioid use or pain scores. While it is generally believed that MPOS patients require more pain medication, this was not the case in our current study population. Additional work will be necessary to determine techniques to improve pain control.

Applicability of Research to Practice
Given the opioid crisis, it is critical to understand factors that determine pain medication usage in this patient population to decrease the use of narcotics while improving pain control.
503 Cardiac Arrhythmias and Dysfunction in Pediatric Burns
Authors: Wilmot Ivan , Chang Philip , Nelson Judith , Fowler Laura , Warner Petra 
Published: March 2020

Abstract

Introduction
Long term cardiac dysfunction and reversible cardiomyopathy can develop in large burns. In addition, cardiac arrhythmias can occur with any burn size. The incidence of cardiac arrhythmias and dysfunction in pediatric burns is unclear. Therefore, the objective of this prospective study was to evaluate the incidence of arrhythmias and cardiac dysfunction in pediatric burns and assess if early recognition improves clinical outcomes.

Methods
Pediatric burn patients ages 0 - 18 with TBSA injuries greater than 30% or those with cardiac dysfunction/ arrhythmia were enrolled after obtaining IRB approval. Exclusion criteria included pre-existing cardiac disease, desquamative skin disorders and electrical injury. For patients with burns greater than 30%, echocardiograms (Echo) were obtained on admission and then monthly. Echo exams were discontinued after three negative exams or upon discharge. All patients with arrhythmias had electrocardiograms (EKGs) and electrolyte panels obtained.

Results
Of the 130 acute burn patients admitted during 2017–2018, 10 patients were enrolled. The average age was 5 years (0.8 to 10 yrs), 70% were males and 90% sustained flame injuries. Average TBSA was 45% (24–70%) with average full thickness burns of 33% (0–67%). 20 Echos and 21 EKGs were obtained.
Only three patients experienced cardiac symptoms, reflecting an incidence rate of 2%. One patient had sustained bradycardia with EKG reading anterior wall myocardial infarction: however troponins, ECHO and clinical evaluation were not consistent with this reading. A severe medication side effect was found to be the inciting cause. Another patient demonstrated bradycardia with sleep, requiring no intervention. The final symptomatic patient, with a 25% TBSA burn, experienced four bradycardic arrests, caused by PEA arrest at the referring hospital after aspiration and receipt of multiple pain medications. Responding to epinephrine, the bradycardia resolved. Admission Echo demonstrated an ejection fraction of 25% with a normal EKG. Repeat ECHOs demonstrated full cardiac recovery.
The remaining patients did not exhibit any abnormalities on ECHO examinations aside from trivial tricuspid regurgitation. In addition, electrolytes panels did not demonstrate any findings contributing to cardiac arrhythmias.
Given these negative findings and the cost involved with ECHO examination, it was elected to discontinue the prospective study.

Conclusions
Although cardiac dysfunction and arrhythmias can impact patient care, the incidence of cardiac disease in pediatric burns is low. Elective Echos in large burns demonstrated no abnormal findings. Use of ECHOs is best performed with symptomatic disease.

Applicability of Research to Practice
Incidence of cardiac disease is low in pediatric burns. Use of echocardiograms are best used in patients with symptomatic disease.
540 Healthcare Resource Utilization and Costs of Care Among Pediatric Patients with Thermal Burns Undergoing Inpatient Autografting in a Managed Care Population
Authors: Teng Chia-Chen , Tan Hiangkiat 
Published: March 2020

Abstract

Introduction
Autograft is considered the standard of care for severe burns; however, data on the economic outcomes in the pediatric population are sparse. This study assessed the healthcare resource utilization (HCRU) and costs of care among pediatric patients undergoing autografting for thermal burns.

Methods
The HealthCore Integrated Research Database was used to identify patients &lt; 18 years old with thermal burns receiving the first inpatient autograft between 1/1/2011 and 6/30/2016. The first admission date was assigned as the index date; 12-month pre- and 24-month post-index-date continuous enrollment were required. Patient demographics, clinical characteristics, HCRU, and total costs were assessed.

Results
Of 65 identified patients, mean age was 7.2 years (standard deviation, SD=5.19), 46.2% were &lt; 6 years old, and 69.2% were male. The majority of burn sites were in upper limbs (64.6%) and lower limbs (52.3%), followed by trunk (41.5%) and eye, face, head, and neck (24.6%). Over 80.0% of patients had third or deep third degree burns; 60% had total body surface area (TBSA) &lt; 10% of any degree burn, and only a few patients (≤ 10) had TBSA ≥ 30%. The mean total all-cause cost in the one-year pre-index period was $14,359 (SD=$27,393), and $9,274 (SD=$25,694) of that cost were burn-related. The average length of stay of the index hospitalization was 10.9 days (SD=10.72), with mean total cost of $94,652 (SD=$162,176). The first-year post-index mean total cost was $111,536 (SD=$174,616) and 93.5% (including index hospitalization) were burn-related. On average, the index hospitalization accounted for 84.9% of the first-year costs. The second-year mean total cost was $10,734 (SD=$40,185), with 5.9% burn-related. Very few (≤ 10) patients had a burn-related hospitalization in the first year after discharge from the index hospitalization, and none had any burn-related inpatient stay in the second year.

Conclusions
The first-year economic burden after burn injury in this pediatric population was substantial, driven by the initial hospitalization for those undergoing autografting. Burn-related HCRU and cost reduced considerably in the second year post-index.

Applicability of Research to Practice
This study provided insights on the economic burden of pediatric patients with thermal burns who underwent inpatient autografting. Although autograft is part of the standard of care for severe burns, healthy skin availability and morbidity associated with skin harvest for autograft are major concerns among this vulnerable population. Innovations in burn care are warranted to ensure improved clinical and economic outcomes among patients with thermal burns.