bluuebunny/crossref_metadata_2025_split huggingface dataset:
635 Compression Garments with Silicone Improve Hypertrophic Scars Compared to Compression Garments Alone: A Retrospective Study
Authors: Hartman Brett , Robertson Karen , Spera Leigh J , Hinton Michael 
Published: March 2020

Abstract

Introduction
The management of hypertrophic scars is one of the major challenges facing healthcare providers in the treatment of burn patients. Two of the mainstay noninvasive clinical practices for hypertrophic scars is the utilization of pressure garments and garments with Silicone gel sheeting. Here, we present a comparison of the effectiveness of compression garments alone and garments with silicone in the treatment of a large pediatric patient population with hypertrophic scars.

Methods
A retrospective study was performed to compare the effectiveness of compression garments with silicone versus compression garments without silicone in the treatment of pediatric hypertrophic scars. Included in this study were patients who received at least 12 months of follow-up treatment with silicone or non-silicone compression garments between 2013 and 2018. Modified Vancouver Scar Scale (VSS) scores were analyzed 1, 3, 6, 9, and 12 months post-injury/surgery for each scar. Descriptive statistics and t tests were used to summarize and compare the total VSS scores between the two groups. In addition, descriptive and ANOVA statistics were performed to compare the effectiveness of silicone compression treatment for scars located on different regions of the body.

Results
In total, the compression garment with silicone group included 99 scars of 70 different patients and the non-silicone group included 28 scars of 19 different patients. Before-after total VSS scores for silicone group decreased from 4.11 (SD, 1.522) to 1.47 (SD, 1.268) compared to a decrease from 3.27 (SD, 1.117) to 1.80 (SD, 1.380) for compression group after 12 months of treatment (P&lt; 0.05). ANOVA analysis revealed no statistically significant difference between silicone’s effectiveness on scars located in different regions of the body based on total VSS score after 12 months of treatment (F(4, 99)=1.47, p&lt; 0.05).

Conclusions
Compression garments with silicone are more effective in treating hypertrophic scars than garments without silicone. The effectiveness of silicone is independent of the scar location assuming sufficient contact and coverage.

Applicability of Research to Practice
This retrospective study supports the use Silicone compression garments for hypertrophic scars in pediatric patients and is completely applicable to medical practice.
652 Topical Delivery of Fidgetin-Like 2 siRNA to Enhance Cell Migration for Burn Wound Healing in a Swine Model
Authors: Kowalczewski Christine , Michelle Holik , Larson David A , Shaffer Lucy , Christy Robert J 
Published: March 2020

Abstract

Introduction
Donor site skin is a precious commodity for burn wounds and graft-sparing procedures are critical for larger total body surface area burns. Currently, large ratio skin grafts have been found to preserve donor skin but at the expense of delayed reepithelialization and increased scar formation at the recipient site. In this study, we propose to utilize a topical gene therapy treatment as an adjunct to higher meshing ratio (4:1) split thickness skin grafts (mSTSG) to improve re-epithelialization and reduce donor skin requirements. Administration of small interfering RNA (siRNA) to suppress the expression of one microtubule regulatory protein, Fidgetin-Like 2 (FL2), has been shown to increase cell migration rate both in vitro and in vivo. We hypothesize that topical application of nanoparticle (NP) encapsulated FL2 siRNA will increase cell migration resulting in expedited reepithelialization in large mesh ratio mSTSG in a full-thickness porcine burn model. A pilot study was conducted to down-select siRNA dose by measuring the rate of reepithelialization of full-thickness grafted burns.

Methods
Ten full-thickness (FT) 5x5cm burn wounds were created on the dorsum of anesthetized Yorkshire pigs. Four days later, the wounds were surgically debrided to a bleeding wound bed and grafted using a 4:1 mSTSG. Treatments groups (n= 2 per pig) consisted of vehicle control (PBS), scrambled sequence NP siRNA (non-targeting siRNA; negative control), and either 5, 10, or 20uM concentration of NP FL2 siRNA were applied topically to the mSTSG. Rechecks were performed twice a week for four week during which time digital images, non-invasive measurements, punch biopsies were acquired, and treatment was reapplied. Quantitative measurements include rate of reepithelialization and laser speckle imaging. Histopathology was assessed by a blinded pathologist.

Results
All wounds reepithelialized within 28 days post-grafting without infection. There was a positive trend with increasing concentration of NP FL2 siRNA on the burn wound healing. LSI data showed no statistical differences to vehicle control. Pathology analysis is ongoing.

Conclusions
Topical application of NP FL2 siRNA did increase the rate of reepithelialization of large ratio mSTSG treated full-thickness injuries. Additional pilot animals are currently ongoing to down-select siRNA dose for future studies comparing the experimental treatment to the current clinical gold standard 1:1.5 mesh ratio.

Applicability of Research to Practice
A topical gene therapy treatment combined with a higher meshing ratio to improve current treatment modalities by increasing reepithelialization and decreasing multiple donor site harvesting.
653 Capillary Suction Device-a Novel Approach to Negative Pressure Wound Therapy
Authors: Babcock George F , Chatterjee Ranjit , Riddle Tara 
Published: March 2020

Abstract

Introduction
Negative Pressure Wound Therapy (NPWT) is a well-established procedure used for non-healing wounds including burn wounds. In NPWT, a special sealed dressing of large cell foam (&gt;400 µm) or gauze is connected to a pump. The sealed dressing acts as a conduit to pressure transfer and aids in the passive flow of fluid. Most commonly, negative pressures between -10 and -125 millimeters of mercury (mm Hg) are used. The mechanism of healing is unknown but maybe due to removal of the exudate and bacteria, and the stimulation of tissue repair through micro deformation. Reticulated foams with micron-size open cells (100 to 5µm) exerts capillary suction between 10 and 60 mm of Hg with a multilayered foam dressing. The negative pressures produced are within the range of suction by mechanical pumps. Therefore, the long-term goal our research is to examine effectiveness of Capillary Suction Devices (CSD) as a topical device in both preventing and healing complicated wounds, burn and donor site wounds. Our hypothesis is that CSD is an effective, safe and lower cost alternative to vacuum-assisted NPWT.

Methods
Yorkshire pigs received 4 surgical posterior excision wounds, measuring 2 in. by 2 in. The wounds were covered with a NPWT dressing (110 mm Hg negative pressure by a pump), CSD with capillary suctions of 30 mm Hg (CSD-30) and 60+ mm Hg (CSD-60), and a conventional gauze dressing. The wounds were measured on 2 day and then every 4 to 5 days until wounds closed. We also measured and compared the total fluids collected with each dressing.

Results
By post-wound day 20, the wounds treated with CSD-60 and NPWT were 100% closed while the wounds treated with CSD-30 and gauze were 65 and 45%, respectively. This indicated comparable wound closure efficacies for CSD-60 and NPWT. The CSD-30 product was superior to gauze, but less efficacious than the tested NPWT protocol. The average total fluid uptake measured in grams dry weight were similar for CSD-60 and NPWT, 36 and 38g., respectively while the values were 24g for CSD-30 and 12g for gauze. However, the maximum fluid uptake observed at day 2 indicated that CSD-60 and CSD 30, 24 and 14g respectively, were superior to NPWT and gauze 12 and 7g respectively.

Conclusions
This data indicates comparable wound closure efficacies for CSD-60 capillary suction and NPWT. The CSD product with 30 mmHg suction was superior to gauze, but less efficacious than NPWT or CSD-60 protocol. The study results provide impetus for further research on the use of high suction CSD for replacement of pump mediated NPWT and the moderate suction CSD for preventing progression of high-risk wounds to an ulcerous stage.

Applicability of Research to Practice
This small study suggests that CSD maybe alternative in to NPWT. CSD provides a significant cost and weight advantage to the patient, as well is allowing for increased mobility.
662 Clinical Outcomes from Prospective Randomized Trials on the Proportion of Carbohydrates versus Fat in Enteral Nutrition for Burn Patients
Authors: Shields Beth A , Pruskowski Kaitlin A , Aden James K , Basel Anthony , Britton Garrett W , Cancio Leopoldo C 
Published: March 2020

Abstract

Introduction
Multiple organizations have developed guidelines for nutritional support following burn trauma. These guidelines are based on low levels of evidence and largely on expert opinion. We sought to compile randomized controlled trials (RCTs) evaluating clinical outcomes from carbohydrate versus fat in enteral nutrition (EN) for burn patients and then analyze outcomes via meta-analysis and compare these outcomes to current available guidelines.

Methods
We performed a literature search to identify RCTs evaluating outcomes of burn patients with different proportions of carbohydrate versus fat interventions. Meta-analyses were conducted on outcomes reported by more than one RCT with the DerSimonian and Laird random effects model. Statistical significance was established at α less than 0.05. Meta-analysis results were then evaluated alongside the available guidelines from American Society for Parenteral and Enteral Nutrition (ASPEN) and Society of Critical Care Medicine (SCCM), the European Society for Parenteral and Enteral Nutrition (ESPEN), and the International Society for Burn Injury (ISBI).

Results
We identified 3 studies meeting our inclusion criteria for RCTs. Meta-analysis showed lower fat, higher carbohydrate EN to be associated with lower incidence of pneumonia (p=0.0005) as well as a reduction in mortality (p=0.04). The ASPEN/SCCM and ISBI guidelines do not specifically address this topic. ESPEN recommends less than 60% carbohydrates and less than 35% fat. However, this is not in accordance with the 46–65% carbohydrate and 12–27% fat with favorable outcomes studied in the 3 identified RCTs.

Conclusions
As current guidelines are often not based on high levels of evidence, it was important to collect and evaluate all of the available RCTs. Our meta-analysis results of these RCTs demonstrated mortality benefits with lower fat, higher carbohydrate EN in burn patients. Additionally, we found lower rates of pneumonia with lower fat, higher carbohydrate EN.

Applicability of Research to Practice
Consideration should be made for 12–27% fat, 46–65% carbohydrate EN in burn patients; however, multicentered trials are required before strong recommendations can be made.
664 Risk Factors for the Development of Transaminitis in Pediatric Burn Patients Treated with Oxandrolone
Authors: Pape Kate , Zavala Sarah , Gayed Rita , Reger Melissa , Jones Kendrea , Kiracofe Brittany 
Published: March 2020

Abstract

Introduction
Oxandrolone is an anabolic steroid that is the standard of care for burn patients experiencing hypermetabolism. Previous studies have demonstrated the benefits of oxandrolone, including increased body mass and improved wound healing. One of the common side effects of oxandrolone is transaminitis, occurring in 5–15% of patients, but little is known about associated risk factors with the development of transaminitis. A recent multicenter study in adults found that younger age and those receiving concurrent intravenous vasopressors or amiodarone were more likely to develop transaminitis while on oxandrolone. The purpose of this study was to determine the incidence and identify risk factors for the development of transaminitis in pediatric burn patients receiving oxandrolone therapy.

Methods
This was a multicenter, retrospective risk factor analysis that included pediatric patients with thermal burn injury (total body surface area [TBSA] &gt; 10%) who received oxandrolone over a 5-year time period. The primary outcome of the study was the development of transaminitis while on oxandrolone therapy, which was defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) &gt;100 mg/dL. Secondary outcomes included mortality, length of stay, and change from baseline ALT/AST.

Results
A total of 55 pediatric patients from 5 burn centers met inclusion criteria. Of those, 13 (23.6%) developed transaminitis, and the mean time to development of transaminitis was 17 days. Patients who developed transaminitis were older (12 vs 6.4 years, p = 0.01) and had a larger mean %TBSA (45.9 vs 34.1, p = 0.03). The odds of developing transaminitis increased by 23% for each 1 year increase in age (OR 1.23, CI 1.06–1.44). The use of other concurrent medications was not associated with an increased risk of developing transaminitis. Renal function and hepatic function was not associated with the development of transaminitis. There was no significant difference in length of stay and mortality.

Conclusions
Transaminitis occurred in 23.6% of our study population and was associated with patients who were older and had a larger mean %TBSA burn. Older pediatric patients with larger burns who are receiving oxandrolone should be closely monitored for the development of transaminitis.

Applicability of Research to Practice
Future research is needed to identify appropriate monitoring and management of transaminitis in oxandrolone-treated pediatric burn patients.
668 Early Enteral Nutrition in Geriatric Burn Patients: Is There a Benefit?
Authors: Castanon Lourdes , Hanna Kamil , Asmar Samer , Ditillo Michael F , Gries Lynn , Bible Letitia , Douglas Molly , Joseph Bellal 
Published: March 2020

Abstract

Introduction
Nutrition is a critical component of acute burn care and wound healing. There is no consensus over the appropriate timing of initiating enteral nutrition (EN) in geriatric burn patients. The aim of our study was to assess the impact of early EN on outcomes in geriatric burn patients. We hypothesized that early EN is associated with improved outcomes.

Methods
We performed a 2-year (2015–2016) analysis of the ACS-TQIP and included all older adult (age ≥65years) burn patients who received EN. Patients were stratified into two groups based on timing of initiation of EN: Early-EN (&lt; 24 hrs) vs. Late-EN (≥ 24 hrs). We performed propensity score matching (1:2 ratio) to control for possible confounding variables including demographics, comorbidities, injury parameters, height and body weight. Outcome measures were in-hospital; complications, hospital and ICU length of stay, and mortality.

Results
A total of 593,818 trauma patients were analyzed, of which 447 patients were matched (Early-EN: 159 vs Late-EN: 318). Mean age was 44±22, 75% were males, and median ISS was 29 [26–36] and mean total body burn surface area (TBSA) was 15±5%. There was no significant difference between the two groups in terms of age (p=0.99), gender (p=0.60), race (p=0.91), ISS (p=0.43), GCS (p=0.85), TBSA (p=0.51), height (p=0.71), and weight (p=0.61). Overall, the complications rate was 40%, median hospital LOS was 25 [15–36] days, median ICU LOS was 15 [8–26] days and mortality rate was 16%. Patients in the early ED group had significantly lower rate of complications and mortality Table 1. At the same time, patients in the early group had lower hospital length of stay (23[12–36] vs. 26[16–38], p=0.013) and ICU length of stay (12[8–24] vs. 16[8–26], p=0.025).

Conclusions
In our propensity matched cohort of geriatric burn patients, early EN was associated with improvement in outcomes. The cumulative benefits observed may warrant incorporating early EN as part of intensive care protocols.

Applicability of Research to Practice
Geriatric patients are a special subset of the population that require additional considerations. Our research highlights the impact of early enteral nutrition on different in hospital outcomes. This is an area of constant debate, our study shows that early enteral nutrition in geriatric burn patients is associated with improved outcome. We found this applicable in most of our patients and thus it might warrant further incorporation in ICU burn protocols.
756 Homeless and Burned – A Retrospective Analysis of an Especially Challenged Patient Population
Authors: Chandramouli Mathangi A , Heffernan Jamie , Rabbitts Angela , Chang Philip 
Published: March 2020

Abstract

Introduction
The undomiciled burned patient presents more challenges to the burn team with regards to safe disposition. Discharge planning is complicated by the lack of a safe, clean environment to perform requisite wound care, thus prolonging hospital stays. The purpose of our study was to analyze the homeless patients admitted to a major urban burn center. This data would then better help identify trends and characteristics that could inform development of support services for this unfortunate population.

Methods
Demographic and clinical data from inpatients was collected from a single urban ABA verified burn center over a 3 year period between 1/2016 and 12/2018. Simple descriptive statistical analysis was performed.

Results
1985 patients were admitted over the 3 year period. 48 homeless patients were identified (2.4%). The average age of this population was 39.8±16.8 years (range 3 months to 63 years old). There were 5 children (10.4% of the homeless cohort) in this population (ranging from 3 months to 4 years of age). Only 2 homeless burn inpatients were greater than 60 years of age (2% of the homeless cohort).
There were 15 females (31%) and 33 males (69%).
The mean TBSA was 5.8±9.9%. The average length of hospital stay was 21.9±29 days. 27 of the 48 patients (56%) required operative treatment. The 3 most common etiologies of skin injury were flame burns (29%), scald burns (25%), and cold injury (19%). The vast number of patients (39 out of 48, 81%) were discharged back to “their previous condition” (i.e. homeless shelter or the streets). There was 1 mortality in this group.

Conclusions
Contrary to widespread assumptions about the homeless being overwhelmingly male and adult, a significant percentage of the homeless burn patients were female with a percentage of patients being pediatric as well. The length of stay was significantly longer for most patients given the relatively small average size of burn injury. Cold injury was more significant etiology in this population compared to the overall burn population.

Applicability of Research to Practice
This analysis of the undomiciled burn inpatient at a single urban burn center will help better describe this especially challenging population and help focus social support and discharge planning resources for this group.
776 A New Outcome Metric for Young Children with Burns: Item Pool Development for the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Computer Adaptive Test (CAT) Profile
Authors: Grant Gabrielle G , Brady Keri , Stoddard Frederick , Meyer Walter , Romanowski Kathleen S , Chang Philip , Painting Lynda E , Fowler Laura , Nelson Judith , Sheridan Robert , Warner Petra , Palmieri Tina L , Schneider Jeffrey C , Kazis Lewis , Ryan Colleen M 
Published: March 2020

Abstract

Introduction
The assessment of recovery from burn injury is critical to improving pediatric health. However, there is a lack of brief, burn-specific measures to assess preschool-aged burn survivors’ health outcomes. We developed items pools for a new, parent-reported computer adaptive test based assessment of preschool-aged children’s burn outcomes.

Methods
Initial item pools were informed by the Preschool LIBRE Conceptual Model based on the International Classification for Children (ICF) and the Burn Outcomes Questionnaires (BOQ 0–5) and generated from a review of existing instruments assessing health and developmental outcomes in children 1–5 years. Candidate items underwent a review process to bin items together based on the underlying construct they assessed. Items were then winnowed down and further refined based on clinical expert consensus meetings. The winnowing process focused on ensuring items assessed abilities and behaviors that could be reliably determined by parent report, were age-relevant, and focused on health and developmental concepts that are important in the assessment of children’s burn recovery. To ensure item quality, we conducted parent cognitive interviews. In final reviews, we standardized item recall periods, response options, verb tense, and literacy demands.

Results
A total of 9,509 items were identified and extracted. Four item pool domains were established: communication and language development (42 items), physical functioning (53 items), psychological functioning (56 items), and social functioning (37 items). The respective item pools aim to assess: children’s ability to receive meaning and produce language; children’s gross and fine motor abilities; children’s emotions and behavior (internalizing and externalizing behaviors, dysregulation, toileting, response to trauma and resilience); and children’s social participation and abilities. Recall period and response options were refined for consistency for all 188 final items.

Conclusions
Four item pools were developed assessing four domains 1) communication and language development, 2) physical functioning, 3) psychological functioning and 4) social functioning for preschool-aged children. The item pools are currently being field-tested for the calibration and validation of the Preschool LIBRE CAT Profile.

Applicability of Research to Practice
This work is relevant to researchers and practitioners evaluating the effects of burn injury on preschool-aged children’s health and developmental outcomes.