bluuebunny/crossref_metadata_2025_split huggingface dataset:
620 Impacting Teen Parents with Early Education for Burn and Fire Prevention
Authors: Henry Shana M , Kopari Nicole M 
Published: March 2020

Abstract

Introduction
Unintentional fire or burn injuries are the 5th leading cause of injury deaths in the United States for children age 1–4 and the 3rd for those age 5–9. 24% of all burn injuries occur in children under the age of 15. Preparation and education are key elements in preventing fire tragedies in children. We recognized a trend in children of teen pregnancies presenting to our outpatient burn clinic with burn injuries and identified an opportunity to incorporate burn and fire prevention education into a pre-existing teen parenting program within local schools.

Methods
We utilized an established relationship with the local school district, which offers an elective course focusing on teen parenting in high schools with credit granted toward high school graduation. This course offers parenting classes and life skills training on a variety of topics including car seat safety, water safety, bike and pedestrian safely, and poison and first aid education. The Burn Prevention Coordinator partnered with the Fire Department Injury Prevention Specialist to teach a one hour lecture on burn and fire safety. Upon completion, the teen parents were provided with water testers to prevent scald burns, outlet protectors to prevent electrical injuries, temperature sensitive spoons for safe feeding, travel mugs, smoke alarms, and “First Aid for Burns” refrigerator magnets.

Results
We have taught 16 classes over the past 2 years and reached 600–800 teen parents per year. Teen parents received education regarding scald and contact burn prevention, home escape planning, smoke alarm education including contact information to have smoke alarms installed into their homes, and education regarding first aid and when to seek medical attention in regard to burn injuries. Post-lecture feedback forms have shown positive results. On average, each teen parent learned two new fire and burn prevention techniques for their child.

Conclusions
We identified a high risk population and partnered with a well-established teen parenting course to educate teen parents on burn and fire prevention. We provided teen parents with tools to assist them in creating a safer environment for their children.

Applicability of Research to Practice
Partnering with established community programs we were able to immediately make an impact focusing on burn and fire prevention.
622 Seasonal Impact on Burn Admissions in a Desert Burn Unit
Authors: Saquib Syed F , Chestovich Paul J , Carroll Joseph T 
Published: March 2020

Abstract

Introduction
In much of the US and the world, burn injuries are more common in the winter season. However, to our knowledge there has not been any study reviewing the seasonal variation of burn injuries in a desert climate. This study examines the seasonal impact of admissions, acuity, mortality and resource utilization at an accredited burn center located in a desert climate.

Methods
This is a retrospective analysis of all patients admitted from March 1, 2014 to February 28, 2019 for acute burns at our specialized burn center located in a desert climate. Patients were categorized in four groups according to each season based on their date of admission. The seasonal breakdown was the following: Spring (March/April/May), Summer (June/July/August), Fall (September/October/November), and Winter (December/January/February). Demographics include age, gender, etiology, and TBSA. Outcome measures included are total admissions for each season, average daily inpatient census, mortality, ICU-free and hospital-free days (30 days). Statistical analysis was completed with STATA.

Results
A total of 1519 patients were included in this study. 1016 were male (66.9%) with an average age 39.6 years (IQR 20–59). Most admissions came during the Summer (35%), followed by Winter (23%), Spring (21%) and Fall (21%). Figure 1 displays the burn admissions per month throughout the year separated by etiology. Most common mechanisms are flame/flash (677, 44.6%), scald (414, 27.3%) and pavement (194, 12.8%). 169 (87.1%) of 194 pavement burn admissions occurred during the Summer. Average TBSA was 12.8%, and was highest for flash/flame (16.8%), electrical (10.6%) and pavement (9.5%). Average hospital free days was 19.9, lowest for pavement (16.2 days), flash/flame (18.0 days) and contact (21.8 days). Average ICU free days were lowest for flash/flame (24.4 days), followed by pavement (26.4 days) and electrical (27.9 days). Overall 1437 patients (94.6%) survived to hospital discharge. Average daily inpatient census was highest in Summer (14.1), followed by Winter (9.8), Spring (8.7) and Fall (7.1).

Conclusions
In a desert climate, the summer months are the peak season for burn admissions and average daily inpatient census in large part due to pavement burns. As these burns have a longer length of stay, it leads to increase in resource utilization compared to the other mechanisms.

Applicability of Research to Practice
The results of this study justify the need for continued community education focused on prevention of pavement burns. It highlights the need to increase hospital resources such as nursing staff, residents, fellows and mid-level providers during the Summer season.
624 Car Seat Heater Burns: A Case Report Intended to Raise Awareness
Authors: Richman Evan H , Brown Parker , Richman Owen , Reilly Debra A 
Published: March 2020

Abstract

Introduction
Today it is estimated that approximately 30–40% of the cars in U.S have seat warmers, with the demand increasing. Unfortunately, these seat warmers do not have any established guideline of safety, leading some warmers to stay on for extended periods of time and reach temperatures that far exceed the human skin tolerance levels. Magunia et al. first described a patient with full-thickness burns in 2003, however in the time since this publishing, minimal factory standards have been instituted. We report a unique case of a neurologically impaired patient who suffered posterior thigh full-thickness burns secondary to a car seat heater. A delay in her treatment led to the need for surgical intervention. We also tested car models 2014 and newer to establish whether modern cars still present a danger to vulnerable populations.

Methods
Testing of 10 cars, models 2014 or newer, with a contact surface temperature thermometer independently calibrated. Testing in 21°C ambient air. Four tests, average and highest temperature both recorded.

Results
Maximum seat temperatures range from 35°C - 53°C. Average seat temperatures range from 34°C - 49°C.

Conclusions
This case illustrates the dangers and risks presented with car seat heaters. Cases such as this, still happening after the voluntary NHTSA mandate, emphasize the need for heightened physician awareness and mandatory factory standards. In agreement with the National Highway Traffic Safety Administration (NHTSA) statement, under no circumstances should a seat heater top 43°C. We tested 10 cars and found 7 of these cars exceeded the 43°C. In addition, all seat heaters should include self-timers. In our unique case, the patient had no awareness the seat heater was on, suggesting the need for a clearer alert on the dashboard. Health-care providers should also help educate patients about the potential dangers of seat warmers, especially in vulnerable populations.

Applicability of Research to Practice
This research highlights the potential dangers car seat heaters present to consumers. Mounting evidence, including lawsuit and case reports, show car seat heaters far exceed voluntary standards set by NHTSA. These temperatures put patrons at increased risk of life-altering burns. Furthermore, these are not “faulty” heaters, these heaters are functioning as the manufacturers fabricated them. We also report seat heaters have not followed suggestions outlined by Manguina et al in 2003, such as dash alerts, automatic turn off timer, and other safety features. The first step is raising awareness to healthcare workers so proper warnings can be made to patients, especially those who are neurologically impaired.
630 Fear Avoidance Beliefs and Behaviours of Burn Survivors: A Mixed Methods Approach
Authors: Shashoua Danielle , Vincent-Toskin Sacha , Langlois Jade , de Vilhena Bernardo S , Duchesne Philippe , Calva Valerie , Oliveira Ana de , Nedelec Bernadette 
Published: March 2020

Abstract

Introduction
The Fear-Avoidance (FA) Model describes a cascade of events after pain that is perceived as threatening, which may lead to avoidance of valued and meaningful life activities and greater disability. Literature examining burn survivors (BS) suggests they may experience FA, however, the evaluation tool that has been used is four items extracted from the Tampa Scale of Kinesiophobia that were modified for BS, but never formally validated with this population. Therefore, the aim of this study was to explore the lived-experience of BS with respect to FA and determine whether the questionnaire reflects and accurately measures their lived-experience.

Methods
A mixed methods approach was used with quantitative data collected using the modified questionnaire followed by individual interviews to gather qualitative data about the participants’ opinion and perceived relevance of the questionnaire using cognitive debriefing as well as their lived-experience of FA. Participants were recruited using purposeful sampling so that a range of FA beliefs and behaviors were explored. The inclusion criteria were adults BS who required hospitalization and skin grafting whose burn injury occurred within the past 3 years.

Results
17 participants (9 ♂, 8 ♀, mean age = 51, mean TBSA burned = 22%, mean days post-burn = 458). The overall mean score of the questionnaire was 1.63 where &gt;1 is considered FA. Five major themes emerged from the thematic analysis of the interviews: perceived vulnerability to re-injury; others as fear influencers; difficulties & hardships during recovery; engagement in activity, and active thoughts. The questionnaire results identified 12 FA participants vs 9 based on the interviews. Only one of the questions was able to discriminate FA participants from non FA participants and none of the current questions clearly resonated with BS.

Conclusions
This study demonstrated that the modified questionnaire did not demonstrate the ability to quantify or reflect the BS lived-experience of FA. However, this remains an important issue since more than half of the participants reported avoiding engagement in valued life activities due to fear of pain or injury even months or years after their injury. Further research should focus on protective factors that may aid patients in reducing or preventing FA.

Applicability of Research to Practice
FA should be evaluated and addressed with BS using an assessment tool that has been specifically validated with this population.
633 ‘Living Well’ After Burn Injury: Using Case Report Mapping to Illustrate Life Changing Contributions from the Burn Model System Research Program
Authors: Carrougher Gretchen J , Bamer Alyssa M , Amtmann Dagmar , Wolfe Audrey E , Schneider Jeffrey C , Holavanahalli Radha K , Kowalske Karen J , Gibran Nicole S 
Published: March 2020

Abstract

Introduction
The Burn Model System (BMS) program of research has been funded since 1994. The overarching aim of this program is to improve outcomes and quality of life for people with disabilities in the areas of: 1) health and function, 2) employment, and 3) community living and participation. This review reports BMS contributions that have positively impacted lives of individuals with a significant burn injury using case report mapping to relate contributions to the recovery of a burn survivor.

Methods
Peer-reviewed publications derived from BMS data were reviewed in July 2019 for significant contributions as identified by current grantees.

Results
With 25 years of funding, many unique contributions (see Table) with direct benefit to patient recovery were identified and categorized into one of the following areas: Treatment, Assessment measures, Sequelae, Peer support, Employment, and Long-term functional outcomes. A second review for significant results of BMS research that add to the understanding of burn injury, pathophysiology and recovery research were identified and categorized as Injury and recovery research.

Conclusions
The knowledge generation and clinical innovation that this program has contributed to our collective understanding of recovery after burn injury is considerable. Using a case study story board, impact of these findings will be illustrated.

Applicability of Research to Practice
Past contributions help inform future research, particularly in the arena of rehabilitation research.
634 Use and Benefits of Using Acrylic Splints Inside the Pressotherapy Glove in Pediatric Burned Hands, Six Years Retrospective Review
Authors: Montanez Ginna A Parra , Adema Sarlos Siri , Gutiérrez Hannia Pacheco 
Published: March 2020

Abstract

Introduction
Burns children’s hands in special care areas. This report describes 1. how to handle using acrylic splints burned hands in pressotherapy gloves and 2. how to make splints using cuts and remaining parts of the face acrylic splints. The hand splints offer comfort, long-lasting, and full fit and produce full passive stretching of the scar During the maturation period. This splints are easy to be handled by parents.

Methods
We developed splints were to be placed inside gloves. For this process and given the selected material, it was agreed with the seamstress that the glove as appropriate, We have developed an alternative method of using the material. The splints are constructed as follows: 1. It′s purchase in sheets, although the cuts or parts that are face masks with acrylic reused.2.To copy the mold wax pencil is required. 3. To mold hot air gun is required. 4. It is easy to wash and sand to the finish.

Results
A pilot trial of 40 splints was undertaken and once it was deemed safe to use it became our practice. Over the last 6 years, 486 acrylic splints have been fabricated and utilized in over 210 surgical cases to address splint needs for the hand. This technique with acrylic is used as a material available for making face masks which minimizes costs. The use of splints inside the glove allows full adjustment over the scar counteracting the forces of retraction of these scars and also at a palmar and digital level. With the use of splints parents said there is a best period of adaptation of children and they do not remove them.

Conclusions
Acrylic with silicone is lightweight and flexible, being comfortable for children to use inside the glove. It is used especially in evening hours, but can also be used in the day, in any case accompany the use of the splint with a strengthening program, tactile desensitization and manual stretching to prevent muscle atrophy and deconditioning. For molding the acrylic, gloves and hot air gun are needed to cut more easily and thus give the required angulation required in each case. Care should be taken strictly using acrylic splints to prevent compressive neuropathies. It should be checked rigorously usage time of the splints during the first week review possible areas of pressure on edges, inside the glove, to prevent secondary complications.

Applicability of Research to Practice
656 Inter- and Intra-user Reliability of Skin Graft Thickness as a Function of Instrument
Authors: Powell Heather M , Baumann Molly E , Bailey John Kevin 
Published: March 2020

Abstract

Introduction
The most popular powered dermatomes (both electric and pneumatic) have a linear blade which oscillates at high speeds. Though the thickness of skin graft being elevated can be controlled by the depth-adjustment dial on the side of the instrument, factors, such as applied pressure, angle between the instrument and the surface, and curvature of the harvest site, can cause deviations from the target depth. As a result, the same depth setting can result in significantly different thicknesses of excised tissue among operators. A newer, powered dermatome has been developed which pneumatically rotates a circular blade at a fixed angle to the surface of the skin and does not require additional downward pressure. The goal of this study was to assess inter- and intra-user uniformity of graft thickness using conventional and newly designed dermatomes and assess the accuracy of the excised thickness.

Methods
Split thickness skin grafts were collected from the dorsum of Yorkshire pigs using a conventional dermatome and a newly designed test dermatome. Three different users collected three 2-inch wide by 4-inch long strips of skin using both instruments. Skin thickness at the center and edges of each strip were measured using a digital micrometer. Additionally, grafts were laser scanned to create a map of thickness for the entire piece of tissue. Reliability of the harvest was assessed using inter- and intra-class correlation coefficient.

Results
Both instruments were set to collect grafts 0.012” thick. Grafts harvested using the conventional dermatome ranged from 0.020–0.038” thick while grafts harvested with the test instrument ranged from 0.008–0.016” thick. On average, the conventional dermatome harvested grafts that were 2.16-fold thicker than the instrument setting while the test instrument collected grafts 0.91-fold the target thickness. Intra-user reliability was similar between instruments with greater reliability observed when users has substantial prior experience. Additionally, inter-user reliability was significantly increased with the test instrument.

Conclusions
Many factors control the uniformity and overall thickness of a skin graft including applied pressure and angle of attack, and how much tension is applied to the elevated graft. Using a conventional dermatome, variability in thickness was observed with greater average measured thickness versus depth setting. Grafts harvested using the newly designed instrument were on average closer to the desired thickness and more reproducible among users.

Applicability of Research to Practice
New instruments for skin harvesting may enhance uniformity of skin grafts.
665 Reliability of Resting Energy Expenditure in Major Burns: Comparison Between Measured and Predictive Equations
Authors: Hur Jun , Kym Dohern 
Published: March 2020

Abstract

Introduction
Poor outcomes can result from inadequate energy intake. We aimed to investigate the reliability of resting energy expenditure (REE) measured by indirect calorimetry (IC) with REE calculated using predictive equations for nutritional support in patients with major burns.

Methods
REE was measured using IC and compared with predictive equations in 215 adult severe burns patients from Jan 2011 to Jun 2015. Agreement between IC and predictive equations was assessed using Bland-Altman methods.

Results
All predictive equations were compared with REE measured using IC. The mean measured REE was 1712 kcal/d. Bland-Altman analysis showed that 1.2 times HBE, Thumb 25, and Ireton-Jones equations had higher accuracy and reliability. The concordance correlation coefficient was higher (0.49) in the Ireton-Jones equation, and root mean square error (RMSE) was lowest (471.5) in the Thumb 25 equation. The proportion of patients with predicted REE within ±10% of measured REE was highest with Thumb 25 (52.5%). Other equations for burns patients had higher mean bias and overestimated REE when compared with IC results.

Conclusions
This study suggests that Thumb 25 can be used as an alternative method for estimating energy requirements of patients with major burns when IC is not available or applicable.

Applicability of Research to Practice
Harrison-Benedict known as standard equation failed to show superiority to others in burns. Burn-specific equations are tend to overestimate ebergy requirements.
705 Evaluation of Burn Resuscitation Practices at a Large Burn Center
Authors: Gayed Rita , Tran Tu-Trinh , Tidwell Ansley , Hodge Juvonda , Ingram Walter L 
Published: March 2020

Abstract

Introduction
Large burns cause a systemic inflammatory response in the entire body leading to profound capillary leak, tissue edema and hemodynamic instability, a condition known as burn shock. If not managed appropriately, the patient can go into cardiac collapse and multi-organ failure. Adequate and timely burn resuscitation is a cornerstone in burn care. Different formulas have been studied to estimate fluid needs during the first 24hrs.
The purpose of this study was to retrospectively evaluate burn resuscitation practices of large burns (20% TBSA and greater) and their associated outcomes at a large urban burn center.

Methods
This was a retrospective chart review of adult patients admitted to the burn center with burns of 20% TBSA or greater who survived the first 48hrs of admission. Primary outcome was evaluating the percentage of patients who received resuscitation according to predetermined volume ranges (&lt; or equal to 4ml/kg/% TBSA vs &gt;4ml/kg/%TBSA). Secondary outcomes included the use of adjuncts (colloids and ascorbic acid), markers of over- and under-resuscitation, the use of perfusion markers to guide resuscitation, and ICU and hospital length of stay.

Results
One hundred and fifty one adults with burns of 30–50% TBSA were included. Fifty nine per cent of them received a median of 2.9ml/kg/%TBSA (low volume- LV group) compared to 41% that received 5.1ml/kg/%TBSA (high volume-HV group). The HV group received more adjuncts in form of colloids (73% vs 61%) and ascorbic acid infusion (55% vs 37% of patients). Majority of patients in both groups had an adequate urine output and showed an improved base deficit at 24hrs from admission which were used as resuscitation markers; lactate levels were trended infrequently. The most common over-resuscitation complication was pulmonary edema, found in both groups in ~ 30% of patients. Only 6% of patients in both groups required renal replacement therapy initiation at 96hrs from admission. Patients in the LV group had a shorter ICU and hospital length of stay (16 vs 36 days, and 27 vs 39 days, respectively, p value &lt; 0.05).

Conclusions
Patients who received median resuscitation volumes of ~ 3ml/kg/%TBSA had better outcomes compared to patients who received higher volumes. Protocolized monitoring of resuscitation markers is key to tailoring resuscitation efforts to patient’s individual response. The effect of the different adjunct therapies (colloids, ascorbic acid) should be further investigated.

Applicability of Research to Practice
Burn resuscitation is a cornerstone of specialized critical burn care. Additional data regarding the amount and type of resuscitation volume used and its associated outcomes can advance practice to guide successful resuscitation and decrease early set backs that may further complicate the patient’s clinical course.