bluuebunny/crossref_metadata_2025_split huggingface dataset:
514 Post-burn Malnutrition and Associated Cardiomyopathy
Authors: McQuitty Alexis L , Brown Frances , Talon Mark , Martinez Robert 
Published: March 2020

Abstract

Introduction
It is known that systolic dysfunction (dilated cardiomyopathy) may occur in a high percentage of patients with large TBSA burns. The reversible myocardial depression may be due to many factors: thermal injury, sepsis, severe malnutrition. Malnutrition and delayed wound healing may occur with a combination of primary and secondary protein-energy undernutrition.

Methods
Serial transthoracic and transesophageal echocardiographic parameters were measured during perioperative care (ejection fraction, fractional shortening, pericardial fluid) in 8 patients with evidence of malnutrition (low BMI, low albumin and prealbumin, muscle wasting) and a delayed presentation to the hospital. Initial echocardiography was performed post-injury day 30 -142; follow-up exams were performed in some patients at 2 years post-injury. Acutely-injured patients or those with sepsis were excluded.

Results
From 2015–2017, echocardiographic measurements were obtained in 8 patients, ages 7–21. The presenting TBSA ranged from 30–82% and included flame injury, electrical burns, and 1 case of pemphigus vulgaris. The initial ejection fraction ranged from 12–45% in patients with a BMI range of 10–25. The mean initial albumin was 2g/dL; the mean prealbumin was 9.5mg/dL. Two patients had mild to moderate pericardial effusions, which resolved after 1 month of proper nutrition. Selenium deficiency was noted in 1 patient. Four patients required perioperative short-term dobutamine.

Conclusions
Patients presenting with malnutrition and impaired wound healing all had evidence of cardiomyopathy; however, the degrees of systolic dysfunction varied significantly. BMI, albumin, and prealbumin all had a strong correlation with the degree of myocardial depression. Despite the lower ejection fractions, many patients maintained an adequate cardiac index and did not require inotropic medications. With time and adequate nutrition, cardiac function improved, although many remained with mild dysfunction in the first year.

Applicability of Research to Practice
This case series demonstrates the continued need for early recognition of malnutrition and cardiomyopathy in this patient population and the need for early intervention. Echocardiographic diagnosis may improve acute perioperative care. In addition, future studies are needed to determine the chronic cardiac effects of reversible dilated cardiomyopathy. Nutrition, refeeding, and perioperative management require a multidisciplinary team.
522 Skin Graft Donor-site Morbidity: A Systematic Literature Review
Authors: Asuku Malachy , Yan Qi , Yu Tzy-Chyi , Boing Elaine A , Hahn Helen , Hovland Sara , Donelan Matthias B 
Published: March 2020

Abstract

Introduction
Although split-thickness skin grafts (STSGs) are part of standard treatment for burn, traumatic, and chronic wounds, the harvesting of STSGs creates iatrogenic injuries at the donor sites. This review summarizes the scientific literature on morbidity associated with STSG donor sites.

Methods
A systematic literature search from 2014 to 2019 was performed in MEDLINE, Embase, and Chemical Abstracts to identify English-language articles reporting on the clinical-study findings, complications, management, financial burden, and patient-reported outcomes pertaining to STSG donor sites.

Results
Of 1426 articles identified, 44 met eligibility criteria and were included in the analysis. Most studies (n=31; randomized controlled trials [RCTs], n=26; observational studies, n=5) compared the outcomes of donor-site wounds that were treated with different dressings. Several studies (n=9; RCTs, n=5; observational studies, n=4) evaluated new agents or methods to improve donor-site outcomes. Only 3 studies focused on patient- or physician-reported outcomes. No studies reported on the length of hospital stay or the financial burden associated with donor-site wounds. Among the studies that indicated donor site location (n=34), the thigh was the most common. The most frequently reported donor-site outcome was the mean time to wound healing (n=21), which was 4.7±0.2 to 28.2±5.6 days. In some studies (n=13), the pain score assessed by visual analog scale (0–10 scoring, 0 being no pain and 10 being extreme pain) was 1.46 to 10.0 on postoperative day (POD) 1 and was 0.2 to 8.0 between POD 10 and 12. In a few studies (n=5), donor-site scar assessment using the Vancouver Scar Scale (0–13 scoring, 0 being normal skin and 13 being the worst scar) showed scores ranged from 0 to 10.9 at postoperative year 1. One study reported a 48.3% incidence of donor-site scar hypertrophy at 8 years. Infection rates were generally low but ranged from 0%-50%. Less frequently reported outcomes included pruritus, stiffness, and patient esthetic dissatisfaction.

Conclusions
This systemic literature search revealed a wide range of healing variation noted in STSG donor-site outcomes. Despite optimal wound care, donor sites required days to heal and were frequently associated with morbidities, including pain and scarring. Less frequently, donor sites were linked with severe morbidities, such as wound infection. Since majority of articles were RCTs with short follow-up, more research is warranted to assess the long-term outcome of hypertrophic scarring, another serious complication. These negative outcomes impose a substantial burden on patients and may impact their quality of life.

Applicability of Research to Practice
The elimination or reduction of STSG donor sites and their associated morbidity have long been identified by patients and providers as an unmet need deserving urgent attention.
548 The Economics of Burn Injuries Among Children Aged 0–4 Years
Authors: Beaulieu Emilie , Zheng Alex , Rajabali Fahra , MacDougall Frances J , Pike Ian 
Published: March 2020

Abstract

Introduction
Children under the age of five years are particularly vulnerable to scalds and contact burns and have the highest rate of hospitalization and mortality from burns. Studies of costs associated with pediatric burns have included a limited number of patients and focused on inpatient and complication costs, limiting our understanding of the full economic burden of pediatric burns, including costs incurred through outpatient care and caregivers’ productivity loss. This study aimed to develop a societal costing model for burn injuries among children aged 0 to 4 years.

Methods
Children aged 0 to 4 years identified through the local Burn Registry with a burn injury between January 1, 2014 and March 15, 2018 were included in this study. Patients with inhalation injury, electrical, chemical and friction burns were excluded. An incidence-based cost-of-illness analysis with a human capital approach was used to quantify the cost of partial and full-thickness burns according to the percentage of total body surface area (%TBSA) involved. The cost of a burn injury was assessed from a societal perspective through the following cost categories: emergency department visits, inpatient, outpatient dressing changes, outpatient burnbaths, day surgeries, clinic visits and caregiver productivity losses. A list of resource items for each category were extracted from patient chart review, the local Burn Registry, and the local Hospital Finance Database, and assigned unit prices. Costs were discounted to a present value in 2017 dollars at 1.5% per annum.

Results
Burn injuries were observed for 342 children, of which 249 (73%) had their burn severity classified (%TBSA and partial/full thickness) and were included in this study. Burn severity categories (1–5%, 6–10%, 11–20%, and &gt;20%) were developed based on the differential distribution of the costs allocated to each burn incident. The majority of children (60.8%) suffered from a 1–5% burn. A 1–5%, 6–10%, 11–20%, and &gt;20% burn respectively cost an average of $2,229, $8,653, $13,663, and $98,634 to society. Costs incurred by the 1–5% burns were related mostly to emergency department visits and dressing changes, while costs incurred by the &gt;20% were related mostly to inpatient and clinic visits (garments) costs.

Conclusions
This costing approach raises awareness about the important, yet preventable economic burden that pediatric burn injuries place on society.

Applicability of Research to Practice
This evidence may persuade policymakers and clinicians to invest in pediatric burns prevention programs in order to decrease pediatric burns costs allowing for the allocation of funds towards other clinical initiatives. This costing model may also facilitate cost-effectiveness analyses of burn prevention programs in the coming years.
550 Real World Treatment Trends for Patients TBSA ≤ 20%: Evaluating Important Shifts in Care and Budget Impact of ASCS Adoption
Authors: Holmes James H , Kowal Stacey , Ferrufino Cheryl P 
Published: March 2020

Abstract

Introduction
Treatment pathways in burn care are typically determined based on burn center (BC) and patient characteristics, although decisions may be influenced by anecdotal experience, personal preference, and hospital policies/purchasing decisions. Health economic (HE) evaluations can support improved decision-making, identifying the most cost-effective interventions for tailored care. A novel burn care model (BEACON) was developed with burn surgeons over several years and validated through numerous publications, including an assessment of the HE impacts of autologous skin cell suspension (ASCS) use for definitive burn closure. To ensure that BEACON accurately represents the current state of care, it is vital to update data that underpins model projections. This study collected real world data on practice patterns and patient outcomes for the most commonly seen burns (TBSA ≤ 20%) to update the current understanding of standard of care (SOC) costs and outcomes and to refine estimates on the impact of ASCS use in TBSA ≤ 20% patients.

Methods
Data was collected from a 10% sample of BCs, including: BC and patient characteristics, resource use, inpatient costs, and length of stay (LOS). NBR based inputs in BEACON were updated to reflect survey data for patients with TBSA ≤ 20%, with the ability to view data as a national aggregate sample and across BC characteristics. BEACON estimates patient and BC costs and outcomes across a spectrum of patient profiles (age, gender, inhalation injury, comorbidity status, burn depth, TBSA) and combines information on each patient profile to understand annual budget impact. Key outcomes were compared across the survey sample and published NBR trends. Using the updated BEACON, the BC budget impact of ASCS in burns TBSA ≤ 20% was assessed.

Results
The survey was collected from 16+ BCs, focusing on inpatient encounters in 2018. LOS was lower than NBR estimates, with some centers reporting LOS per %TBSA far below 1 d/%TBSA. Using the detailed bottom-up estimation of cost from BEACON with survey data, trends suggest total hospital costs for SOC are lower than published NBR charges given shorter LOS and updated cost and resource use assumption.

Conclusions
Compared to NBR 8.0, contemporary data suggests that fewer small TBSA burns are being treated in the inpatient setting; those treated have a LOS below NBR estimates. When using real world data, the impact of ASCS use in burns TBSA ≤ 20% was still calculated to be cost saving to a BC overall, given reductions in LOS and number of definitive closure procedures. Incorporating ASCS into appropriate TBSA ≤ 20% procedures can still result in a positive financial impact for BCs.

Applicability of Research to Practice
566 Representation and Consequences of Guilt in Parents of Young Children with Unintentional Burns
Authors: Lin Yuting , Lewis Frances M , Kantrowitz-Gordon Ira , Carrougher Gretchen J , Qiao Liang , Whitney JoAnne (Joie) 
Published: March 2020

Abstract

Introduction
The incidence of unintentional burn injuries provides a natural condition that induces guilt and other emotions, such as blame, in the parents of the inflicted child. Empirical evidence generated has suggested that the consequences of guilt include both prosocial behaviors and antisocial behaviors. Therefore, the effects of guilt on parental behavioral and emotional outcomes have long-term implication. The purposes of this study were to examine guilt and its representation in parental responses to a child’s burn, and to look for the immediate consequences that guilt for parents.

Methods
Semi-structured interviews were conducted with 20 parents or caregivers in the hospital during their child’s clinical visit in a regional burn center in eastern China. We used a combination of deductive and inductive content analysis to analyze the interview data.

Results
Parents expressed feelings of guilt using both the word “guilt” or sentences that conveyed the manifest meaning, which reflected the definition of guilt. Analysis of the data produced three conceptual domains of the consequence of guilt. Reappraisal of guilt toward the self included eight categories: regret, blaming myself, thinking about why, not wanting to talk, wanting to be punished, blaming others, having trouble sleeping and feeling irresponsible. Motivational reactions toward the child were sorted into four categories: paying more attention to prevent injuries, feeling sorry for the child, providing the best care, and placating the child. Other reported accompanying emotions included upset, anger and heartache.

Conclusions
Guilt and its consequences are correlated but have distinct semantic representation.
However, guilt and its related emotions were often expressed within one parent’s account of his or her emotional experience. Blaming has been a significant reaction among parents and family caregivers, including self-blaming and blaming others. The results of this study suggest that guilt appears to promote both prosocial and antisocial emotions and behaviors in parents.

Applicability of Research to Practice
This paper’s findings help to extend our theoretical understanding of the guilt and its effects on the development and persistence of emotional distress in parents facing their child’s unintentional burn injury. What’s more, these results have practical implications for professionals caring for parents or family caregivers who are in greater need of professional mental health support and interventions, given the long-term recovery period in children with moderate to severe burn injury and the meaning and visibility associated with the burn scars. Further research is needed to elucidate the role of guilt in the development and persistence of emotional distress in parents facing their child’s unintentional burn injury.
568 Appearance Related Concerns Among Pediatric Burn Patients
Authors: Cloonan Taya Z , O’Donnell Ellen , Lydon Martha , Prelack Kathrina 
Published: March 2020

Abstract

Introduction
A primary outcome goal for pediatric burn patients is to regain social functioning and achieve developmental social milestones. Research regarding appearance related concerns and their relevance to social development is still lacking. The purpose of this study is to evaluate how appearance-related concerns affect social and academic functioning for children with visible scars. The overall aim of this project is to develop a screening process to identify patients at risk so that appropriate supportive interventions can be implemented.

Methods
A secondary analysis of data collected using Burn Outcomes Questionnaire (BOQ) and the Pediatric Symptom Checklist (PSC) which measures psychosocial well-being, was conducted in a pediatric burn center. These questionnaires were administered to patients aged 11–18 years who were admitted to our hospital between 2000 and 2017. Using these validated tools, the relationship between scores on the BOQ and PSC specifically associated with appearance related concerns and their implication on social and academic functioning were compared. Subscales for externalizing psychiatric symptoms (hyperactivity, aggression) or internalizing psychiatric symptoms (anxiety, depression) were compared to appearance related scores using Pearson’s correlation.

Results
Data on 36 patients was obtained and analyzed. Results are shown in Table 1.
There was a moderate correlation between appearance-related concerns and internalizing symptoms (R = 0.55; p &lt; .001). There was no relationship between externalizing symptoms and appearance related concerns.

Conclusions
Appearance related concerns are significantly associated with internalizing psychiatric symptoms that include anxiety and depression. Additional research is needed to identify demographic factors such as gender as well as cultural moderators that can be used to identify patients at risk.

Applicability of Research to Practice
Results of this study have determined that there is a need for greater screening of internalizing psychiatric symptoms among our patient population. Once identified, patients can be offered appropriate interventions.
571 Perspectives on Research Participation Feedback: Results from Burn Survivor Focus Groups
Authors: Amtmann Dagmar , McMullen Kara , Bamer Alyssa M , Gibran Nicole S , Holavanahalli Radha K , Schneider Jeffrey C , Wolfe Audrey E , Sanchez Adriana 
Published: March 2020

Abstract

Introduction
Research participants often receive little to no feedback after participating in a research study. We sought to better understand what information burn survivors might want to receive based on their participation in research, and what formats might be most useful. Participant preferences will be used to develop summary reports based on their responses to survey questions and can inform patient information dissemination in burn clinics.

Methods
Adult burn survivors and caregivers/partners participated in focus groups. Multiple formats of reports on health domains, such as pain, depression and itch were discussed. All participants were asked whether they would be interested in receiving a summary of the responses they provided, even if their answers suggested problems (e.g., high depressive symptoms). Understandability of the information, preferred format (graph, table, list), and opinions about the formats were discussed. Audio recordings were transcribed, anonymized and summarized.
Results: A total of 11 burn survivors and 4 caregivers/partners participated in three focus groups at different locations in the U.S. Average age of the survivors at the time of the focus groups was 49 years, 62% were male and 71% were white. Mean burn size was 50% and 75% of participants had a fire/flame etiology of injury. Burn survivors and their partners unanimously wanted to receive reports about their health after study participation, regardless of whether the feedback was positive or negative. Longitudinal graphs were too complex and tables were more understandable. The preferred format listed the health domains in which the burn survivor was doing well and the areas of concern, with optional links to more details. Burn survivors found the links to online resources helpful and suggested that information about drugs, alcohol, and PTSD be provided to all regardless of a problem in these domains. Most survivors were not concerned about the potential negative impact of reports indicating continued health problems but suggested that any negative feedback should be provided no sooner than 1-year post injury.
Conclusions: Burn survivors are very interested in receiving summary reports of their responses to research surveys. Most would share the results with their caregivers and only a few would share it with care providers. Simple displays and messaging are essential for the reports to be useful. More research is needed to evaluate whether the reports can aid burn survivors in their recovery and to develop strategies for reaching out to survivors in distress.

Applicability of Research to Practice
Results help clinicians and researchers provide understandable health information to patients and encourage patient/family member engagement in clinical care or research.
574 Assessment of the Relationship Between Mental Illness and Inpatient Length of Stay
Authors: Collins Carolyn , Dao Sylvia , Lorico Jeremiah 
Published: March 2020

Abstract

Introduction
Mental illness and burn injury requiring hospitalization are uniquely intertwined. While literature has shown that burn patients are more likely to experience acute stress disorder, post-traumatic stress disorder, and depression, the impact of pre-existing mental illness on the duration of inpatient hospitalization for burn patients is unclear. We aim to assess the impact of acute mental illness requiring treatment by a psychiatrist during admission to a burn unit on patient length of stay (LOS).

Methods
A retrospective analysis was conducted using burn registry data to evaluate patients age 18 to 65 admitted between January 1, 2017 and December 31, 2018. Patients admitted with burns, inhalation injury, frostbite and Steven Johnsons Syndrome were included. Patient age, total body surface area (TBSA), LOS, and psychiatry consult (PC) incidences were collected. Patients were separated into psychiatric (P) and non-psychiatric (NP) groups to compare the impact of PC on LOS. Multiple linear regression analysis was conducted in both groups to evaluate the impact of TBSA and age on LOS. Two-sample t-test assuming unequal variances was conducted to compare age, TBSA, and LOS in both groups.

Results
Multiple regression in the P (n=71) group indicated both age and TBSA explained 48.4% of the variance of LOS (R²= 0.48, F(2,68)= 31.96, p&lt; 0.005). TBSA significantly predicted LOS (β= 275.9, p&lt; 0.005), but age was insignificant (β= 0.177, p=0.4). Multiple Regression in the NP (n=617) group found that both age and TBSA explained 11% of the variance of LOS (R²= 0.11, F(2,613)=39.9, p&lt; .005). TBSA and age significantly predicted LOS (β = 59.9, p&lt; .005), (β = 0.09, p= 0.05), respectively. T-test assuming unequal variance found there was no significant difference in age for NP group (m= 41.73, SD= 14.02) and P group (m= 43.77, SD= 13.53; t(87)= 1.98, p = 0.11). TBSA held no significant difference between both P (m=0.05, SD= 0.08) and NP (m=0.05, SD= 0.09; t(93)= 1.98, p= 0.94). However, LOS was significantly different for P (m=26.20, SD= ±32.92) than NP (m=9.58, SD= ±17.57; t(75)= 1.99, p &lt; 0.005)

Conclusions
It is an expected finding that TBSA had a significant impact on LOS, and age did not. Since the TBSA and age between N and NP are not significantly different, the impact of this correlation cannot account for the difference between LOS in the two groups. The correlation between PC and increased LOS may be used to more effectively estimate duration of inpatient admission for burn patients with psychiatric illness.

Applicability of Research to Practice
Directly applicable to practice.