bluuebunny/crossref_metadata_2025_split huggingface dataset:
40 Implementation of a Nursing-driven Volume-based Enteral Feeding Protocol
Authors: Moore Kristin , Cooper Cheryl , Fagert Kayleigh , Cochran Amalia , Thomas Sheela S , Coffey Rebecca 
Published: March 2020

Abstract

Introduction
Nutrition in the burn patient is vital to proper wound healing and graft take, counteracting the hypermetabolic response, and improving patient outcomes. Studies support early, aggressive enteral nutrition for burn patients. Enteral nutrition is often interrupted during hospitalization, causing patients to fail to achieve their nutritional goals. To maximize nutritional support for burn patients, our institution implemented a nurse-driven, volume-based enteral infusion protocol (VBP). The goal of this quality improvement project was to compare clinical outcomes and volume of enteral nutrition received by the burn patient pre- and post-VBP.

Methods
A single-center retrospective analysis was conducted at one adult burn center comparing pre- and post-implementation of a VBP. Patients aged 18–89 years admitted to the SICU for initial management of burn injury between November 2014 – May 2015 (pre-VBP) and June 2015 – January 2016 (post-VBP) were included; for stepdown patients the time period ranged from June 2017 – December 2017 (pre-VBP) and February 2018 – September 2018 (post-VBP). Pertinent demographic and burn-related data were collected. Clinical outcomes included length of stay (LOS), complications as defined by National Burn Repository, duration of mechanical ventilation, percent weight gain or loss, and percent of enteral volume received.

Results
In the SICU, there were 10 patients pre-protocol and 12 patients post-protocol. When comparing pre-VBP to post-VBP demographics, mean TBSA was 19.6% (1–40.5) vs 24.83% (2–61.5%), with a mean age of 64.4 vs 60.7 years. For clinical outcomes, mean number of complications was 1.6 vs 2, with mean ventilator days of 16.2 vs 16.4, SICU mean length of stay/TBSA 1.99 vs 2.23 days, and hospital mean LOS/TBSA 3.83 vs 2.54 days. Overall prescribed amount of enteral nutrition received pre-VBP was 105% vs post-VBP amount received at 95% (p=0.09). For the step-down unit, there were 8 patients pre-protocol and 6 patients post-protocol. Overall prescribed amount of enteral nutrition received pre-VBP was 83% vs post-VBP amount received at 89% (p=0.3815).

Conclusions
While clinical outcomes remain unchanged during the evaluation period, our patients met their prescribed enteral nutrition volume requirements when a nurse-driven VBP was initiated. In addition, for non-ICU patients, a trend was seen towards increased tube feeds with VBP.

Applicability of Research to Practice
Nurse-driven VBPs allow for RNs to adjust the rate of enteral nutrition by “catching up” for interruptions in feeding to meet the patient’s nutritional goals for the day.
61 Tap Water: Still Burning After All These Years
Authors: Lee Christina , Bessey Palmer Q 
Published: March 2020

Abstract

Introduction
Hot tap water has long been recognized as a cause of burns, especially for children. Standards for appliance manufacture and building codes were established several decades ago to avoid excessively high hot water temperature at the tap in order to reduce the incidence of these injuries. The purpose of this study was to determine the prevalence and impact of tap water scalds (TWS) seen at burn centers in a recent time period.

Methods
We reviewed the National Burn Repository (NBR) for the years 2015–2017. We identified all scald burn injuries from the primary ICD10 code (former ECodes in ICD9, now External Cause Codes in ICD10). The codes for the cause of burns include X00 – X19. The X11 series identifies TWS. The data fields were analyzed using SAS 9.4 (Cary, NC). Data are expressed as Mean ± SEM or Mean (95% CI). Differences in continuous variable means were tested with TTest and categorical variables with Chi square and Fisher’s Exact Test. Logistic regression analysis was used to test differences between groups and identify risk factors for death.

Results
There were 16,318 patients included in the two-year data set. Of those, 5,014 (30.7 ± 0.4 %) had scald burns identified by the Primary ICD10 code, and 1,029 (20.5 ± 0.6 %) of those were due to hot tap water. The prevalence of TWS among children &lt; 5 with scald injuries was 21.8% (15.9–23.8); among children 5–14, 19.4% (15.9–22.8); among young adults 15–44, 14.7% (12.8–16.5); those 45-64 24.1% (21.3–26.8); and those 65 and older 27.9% (23.7–32.2). Burn size for those 45–64 tended to be larger with TWS than other scald injuries (3.3 ± 0.7 % TBSA vs 2.0 ± 0.2, p=0.08), and was significantly larger in those 65 and older (3.8 ± 0.9 % vs 1.2 ± 0.3, p&lt; 0.01). Case fatality for all TWS was greater than that for all other scalds (1.4 ± 0.4 % vs 0.3 ± 0.1, p&lt; 0.01). No patient less than 45 died following TWS. Case fatality for those 45–64 tended to be greater for TWS than other scalds (0.9 ± 0.6 % vs 0, p=0.06.), and it was substantially higher for 65 and older (10.0 ± 2.8 % vs 2.3 ± 0.8, p&lt; 0.01). Among patients 65 and older, those with TWS were slightly older than those with other scalds (76.3 ± 0.7 years vs 74.6 ± 0.4, p&lt; 0.05).

Conclusions
TWS burns still account for a substantial proportion of scald burns across the country, despite the wide application of building codes and manufacturing standards designed to prevent these injuries. They are most prevalent among children and older adults. In older patients they are more extensive than other scalds and result in an appreciable case fatality. Hot tap water continues to be a clear and potentially deadly hazard, especially for the elderly. Additional strategies to prevent these injuries should be sought.

Applicability of Research to Practice
Directly Applicable.
63 Assessing the Quality and Reliability of Patient Information Regarding First-aid Burn Care on Youtube
Authors: Parizh David , Effendi Maleeh , Martin Thomas L 
Published: March 2020

Abstract

Introduction
Social media has increasingly become the first point of reference for patients regarding medical information. This study assesses the quality and reliability of patient information available on YouTube regarding First-Aid for Burn Care.

Methods
Using Google Trends, “burn treatment” was identified as the most common term to likely be used to seek out information regarding first-aid treatment of burns. The terms “burn treatment” was searched on YouTube within Internet Explorer on September 18, 2019. Results were filtered by view count and the first 6 pages of results, top 120 videos were reviewed, excluding duplicates, non-English language videos, and videos unrelated to first-aid burn care. Videos were analyzed by two independent reviewers and descriptive statistics. Videos were also rated for information reliability and quality using both the Modified DISCERN (MD) tool (1 = low, 5 = high) and the Global Quality Scale (GQS) (1 = poor, 5 = excellent).

Results
Overall 67% of the videos were classified as informative with 15% constituting personal experience, the remainder of which were misleading. The physicians had a lower number of mean views per video at 140k compared to 210k from non experts. Physician group constituted 20.6% of all speakers in the video, with NP/PA constituting 2.9%. The GQS mean was 2, with physicians scoring slightly higher at 2.3, NP/PA scoring 3, and the remainder of the speakers scoring lowest at 1.8. The Modified discern score mean was 2.0.

Conclusions
Overall the burn care professionals inclusion physician, nursing and physician assistants constituted a minority of the speakers present. 76% were by other professionals who don’t deliver care inside the hospital setting. The physicians had lower number of views when compared to non experts. However, burn care professionals scored higher on the modified discern and the GQS compared to non-experts. The overall quality of all videos was low across the board with a modified discern of 2 out of 5. There is an opportunity to improve resources available to our patients from the burn care professional stand point to increase online presence.

Applicability of Research to Practice
The quality of videos reviewed was poor, and demonstrated an opportunity for improvement of resources available to our patients online.
74 The Effectiveness of Serial Casting in Obtaining Maximum Range in Burn Scar Contracted Joints
Authors: Purushothaman Prabhu , Schetzsle Stephanie , Chiang Wei , Lin Weber , Tredget Edward , Kwan Peter 
Published: March 2020

Abstract

Introduction
Recovery from burn scar contracture demands significant time and resources from patients and healthcare providers. Few studies have explored how serial casting improves recovery. The aim is to present preliminary data illustrating the benefits of serial casting in burn scar contracture rehabilitation.

Methods
Six burn patients (8 joints) that did not respond to traditional conservative therapy were included. Joints were x-rayed to rule out heterotopic ossification/joint abnormality before casting. Patients were casted 5x, 3x or 1x/week. Initial session consisted of measuring baseline range of motion (ROM) prior to physiotherapy intervention (PTI) (heat, active ROM with end range overpressure, joint glides, and progressive resistive exercises) and plaster cast application by Occupational Therapy. Following sessions involved measuring ROM post cast removal, and before PTI and new cast application. Scar contractures were photographed weekly and assessed using the Modified Vancouver Scar Scale (MVSS).

Results
On average, casting started 93.67±20.31 days post burn injury and lasted 8.90±1.23 days. Mean time between cast changes was 2.30±0.25 days; on average, each joint was casted 4.30±0.65 times. MVSS score (pre/post serial casting:9.70±0.47 / 4.70±0.42, p&lt; 0.0001) and ROM as a percentage of total (pre/post serial casting:56.30±5.12% / 96.40±0.90%, p&lt; 0.0001) showed improvements from pre to post casting. Post casting, average ROM gained was 43.70±6.60 degrees and average percentage of ROM regained was 96.38±0.87%. Each joint consumed a mean of 6.56±1.22 therapy hours and $45.13±12.15 in materials.

Conclusions
Serial casting produced rapid gains in ROM to near full ROM in burn scar contracted joints. Correspondingly scar pliability, height, and pigmentation improved. Serial casting can be effective and initiated early in scar maturation.

Applicability of Research to Practice
Serial casting can be a standard technique in rehabilitation of burn scar contracture. It is easy to adopt due to low material cost, easy therapist training, and low time demands from patients and therapists. It can delay or prevent the need for contracture release surgery (in the case of 3 patients). Based on therapist observations, it can lead to increased treatment compliance due to rapid effectiveness.
78 Optimising Compression for the Management of Acute Hand Burn Edema
Authors: Edwick Dale O , Hince Dana A , Rawlins Jeremy M , Wood Fiona M , Edgar Dale W 
Published: March 2020

Abstract

Introduction
Compression, a common treatment of choice for the management of edema, is one intervention which is applied with little objective understanding of the optimal parameters of application or efficacy in a patient with an acute burn wound. The aim of this study was to determine the effectiveness of different methods of compression for the management of hand edema following burn injury. The hypothesis tested was: in alert acute hand burn injury patients, application of cohesive bandage will reduce edema faster than an off the shelf compression glove.

Methods
A randomized control study of 100 patients presenting with hand burn injury. Compression was randomized to one of three methods of application - 1) spiral application of cohesive bandage to fingers, figure of eight to hand and wrist; 2) pinch application or cohesive bandage to fingers, spiral application to hand and wrist; or 3) an off-the-shelf compression glove (control condition). Repeated volume measures of the hand were recorded using water displacement volumetry. The results were analysed using multi-level mixed effects regressions. Outcome measures were hand and wrist active range of movement, pain VAS and QuickDASH. ROM measures were collected with and without compression in situ. Patients were provided with a home exercise program including standardized exercises to optimize venous and lymphatic outflow, and exercises tailored depending on the location of the patients’ injury. Standard instruction to patients was to continue using their hand with the compression in situ, and to elevate at rest and overnight.

Results
One hundred patients (68 males) demonstrated significant reductions in hand volumes, using all compression methods (10.0–14.5mL, p&lt; 0.001). There was no evidence of difference between methods of compression for managing edema. All ROM measures improved, with significant improvement in hand composite finger flexion (p=0.001), hand span (p=0.022) and wrist flexion (p=0.022). QuickDASH decreased between sessions (p&lt; 0.001) indicating reduced upper limb disability. There was no evidence of differences in ROM measures between compression methods.

Conclusions
There is no evidence of difference between these methods of compression for managing acute hand burn edema. ROM improves with reductions in hand burn edema.

Applicability of Research to Practice
For the management of acute edema following hand burn injury, this study demonstrates that compression can be applied by therapists of different experience, using methods they are familiar with, to positively influence edema following hand burn injury.
111 Predicting Restoration of Joint Function in the Contracted Burned Hand: The Benefit of the Soft Tissue to Skeletal Ratio
Authors: Simpson Roger L , Mulay Sagar , Nasser Ahmed , Ibrahim Ahmed 
Published: March 2020

Abstract

Introduction
Long-standing burn contractures of the hand produce marked soft tissue deficits across mobile joint surfaces. Optimum functional reconstruction requires attention to the ratio of soft tissue contracture to skeletal length. Maturation of burn scar and anticipated growth in children play a role in selecting procedures that maximize function and range.

Methods
Burn contractures of the hand show functional loss of motion by flexion/extension deformities of the fingers and wrist. Analysis of soft tissue shortening (contraction), measured against existing skeletal length was used to customize procedures to restore maximum function. Twenty six patients, aged 3 to 57 years underwent post burn reconstruction to maximize hand function. Each procedure selected was based on the ratio of existing soft tissue to skeletal length.

Results
Flexion/extension at all joints requires a balanced glide of soft tissue over existing bone length defining a 1:1 ratio between soft tissue and skeletal length. Burn contracture shortens soft tissue and restricts motion over joints. An objective ratio was applied to each joint contracture. A comparison of soft tissue quality to skeletal length (including growth in children) was used to determine the procedure for reconstruction associated with the best prognosis for maximum outcome with the least recurrence.
Abnormalities included post burn boutonniere deformities, webspace contractures, flexion and extension contracture deformities of the hand, and digits. Burn scar hypertrophy and induration worsened the ratio. Eight patients with a soft tissue to skeletal ratio of 0.4:1 or less required bone shortening in the form of either joint arthrodesis, trapeziectomy, or wrist fusion. Twelve patients with a ratio of 0.7:1 or better were managed with skin grafts and/or adjacent tissue rearrangement. In the remaining group, four patients required a combination of procedures including composite soft tissue and tendon expansion restoring length of all soft tissue relative to bony length precluding the need for flap reconstruction and tendon lengthening. Two patients underwent bone shortening with prosthetic joint replacement. All patients restored to a 0.8:1 ratio or better regained optimum position of joint position and function. No secondary procedures were required for deterioration of function at two years.

Conclusions
A balanced dynamic soft tissue to skeletal ratio is essential in restoring maximum function to the burned hand. Understanding soft tissue contraction compared to existing bone length will permit the objective design of a reconstructive hand/finger procedure that will predict outcome and maximize hand function.

Applicability of Research to Practice
Predicable outcomes of functional hand reconstruction are possible based on the relationship of burn scar contracture to measurable skeletal length.
120 Terahertz Spectral Imaging for Burn Depth Determination in an in Vivo Porcine Scald Model
Authors: Arbab M Hassan , Osman Omar , Zhou Juin , Khani Mahmoud E , Harris Zachery B , Singer Adam 
Published: March 2020

Abstract

Introduction
Clinical evaluation of burns results in about 50–70% accuracy in predicting the final burn progression and healing outcome in partial thickness burns. Early and accurate assessment of burn wounds is critical for determining the course of clinical management. Terahertz (THz) spectral imaging is a promising biomedical imaging modality that has been used to quantitatively determine burn severity in acute rodent models. Here, we hypothesized that the new THz modality can determine burn depth and predict the wound healing outcome of injuries using a standardized porcine model. We developed a handheld THz instrument to obtain diagnostic images from large animal burns with varying severities. The results showed that the THz imaging can differentiate between different burn groups defined by injury depth on days 1–5 post-burn, and predict their ultimate outcome defined by reepithelialization during a 28-day study period (1-way ANOVA, p&lt; 0.05).

Methods
Multiple 1 inch diameter standardized cutaneous burns were created (n = 20–24 per pig) in 3 anesthetized female domestic pigs (~32kg) using a circulating heated water in replicates. The temperatures were controlled and kept constant at 95 C degrees using thermosensors, while the duration of exposure was varied between 5, 15, or 25 seconds. Burns were covered with a topical antibiotic ointment and frequent dressing changes were performed for 4 weeks. Daily THz scans were obtained from each burn during the first week, corresponding to the peak of the anti-inflammatory response of the burns. After the initial 5 days, weekly scans were obtained until the ultimate healing outcome was determined by an experienced surgeon and a blinded histopathologist. Periodic punch biopsies were taken to determine burn depth, percentage burns reepithelialized within 21 days, and depth of scar at 28 days.

Results
Attached figures show representative daily visual and THz images of burns with the associated ROI. Bar plots show mean and standard deviation of spectral amplitude (SA) and spectral slope (SS). Low severity burns showed decreasing SA and increasing SS over time, whereas SS from 25 second burns remained negative and SA increased by day 4. Variation in SS suggests changes in density of skin structure as a result of scattering and changes in SA suggests variations in water content. Detailed statistical analysis is in attached table.

Conclusions
Using the novel handheld THz scanner, analysis of the spectral slopes signal showed the ability of the new Terahertz imaging modality in differentiating between different burn severities (p &lt; 0.05) and evaluating burn progression.

Applicability of Research to Practice
THz modality can result in improvement in the accuracy of burn triage, which in turn can lead to better wound healing outcomes, reduction in length of hospital stay and improvement in overall recovery of the patients.
122 Prevalence and Associated Predictors for Patients Developing Chronic, Neuropathic Pain Following Burns
Authors: Klifto Kevin M , Hultman C Scott 
Published: March 2020

Abstract

Introduction
Chronic pain, unrelated to the burn itself, can manifest as a long-term complication in patients sustaining burn injuries. The purpose of this study was to determine the prevalence and compare burn characteristics between burn patients who developed chronic neuropathic pain (CNP) and burn patients without CNP treated at a Burn Center.

Methods
A single-center, retrospective analysis of 1880 patients admitted to the adult Burn Center was performed from January 1, 2014 through January 1, 2019. Patients included were over the age of fifteen years, sustained a burn injury and were admitted to the Burn Unit. CNP was diagnosed clinically following burn injury. Patients were excluded from the definition of CNP if their pain was due to an underlying medical illness or medication. Comparisons between patients admitted to the Burn Unit with no pain and patients admitted to the Burn Unit who developed CNP were performed.

Results
One hundred thirteen (n=113) of the 1880 burn patients developed CNP as a direct result of burn injury over five years with a prevalence of 6%. Patients who developed CNP were a significantly older median age [54 vs. 46, p=0.002], abused alcohol [29% vs. 8.5%, p&lt; 0.001], abused substances [31% vs. 9%, p&lt; 0.001], were current everyday smokers [73% vs. 34%, p&lt; 0.001], suffered more full-thickness burns [58% vs. 43%, p&lt; 0.001], greater median %TBSA burns [6 vs. 3.5, p&lt; 0.001], were more often intubated on mechanical ventilation [33% vs. 14%, p&lt; 0.001], greater median number of surgeries [2 vs. 0, p&lt; 0.001] and longer median hospital length of stay (LOS) [10 vs. 3 days, p&lt; 0.001], compared to those who did not develop CNP, respectively. Median patient follow-up was 27 months.

Conclusions
The prevalence of CNP over five years was 6% in the Burn Center. Older ages, alcohol abuse, substance abuse, current everyday smoking, greater %TBSA burns, third degree burns, being intubated on mechanical ventilation, having more surgeries and longer hospital LOS were associated with developing CNP following burn injury.

Applicability of Research to Practice
The largest study to date assessing the prevalence of chronic nerve pain following burns. Identified new independent predictors for chronic neuropathic pain following burn injury, not previously assessed in the literature.