bluuebunny/crossref_metadata_2025_split huggingface dataset:
585 Preventing Occipital Pressure Injuries in Patients Admitted to the Burn ICU
Authors: Kammin Vitina M , Eckert Kristine , Alem Paula , Dimler Margaret A , Kammin Vitina M , Marano Michael 
Published: March 2020

Abstract

Introduction
Occipital pressure injuries (OPI) are categorized as pressure injuries on the occipital bone caused by pressure, shearing, or friction. Patients with significant burns are at a greater risk of developing these types of injuries due to increased fluid volume from resuscitation, decreased tissue perfusion, immobility, edema and length of stay. The rate of OPI in the BICU was 4.3 in 2016; this led to a comprehensive program to reduce/eliminate these injuries.

Methods
Early identification of at-risk patients and implementation of prevention strategies was conducted. Best practices were reviewed and the following interventions were put into place: on admission, all patients with facial burns, (intubated or not), were given a small size fluidized positioner pillow. The pillow was to be positioned with a defined divot in the center and not flattened (which is the way they were currently being utilized). The fluidized pillow must go into the hydrotherapy room with the patient and the patient’s head turned and repositioned every 2 hours. The use of a moisture-wicking fabric was utilized over the fluidized positioner pillow to prevent maceration. Nursing staff and burn technicians were educated as to practice changes; wound care nurses were available for educational support. In addition, in 2017, the Burn ICU instituted a 2 RN skin check daily for all patients in the hydrotherapy room once all dressings were removed. This tank room “time out” was instituted for early identification of areas of potential skin breakdown.

Results
Implementation of these protocols has significantly decreased the occurrence of OPI in the BICU. Since implementation, the rate of OPI in 2017, 2018 and Q1 and Q2 of 2019 has been 0%. The application of the fluidized positioner pillow, tank room “time-out” and staff education has greatly decreased the occurrence of OPI in the BICU.

Conclusions
Patients sustaining large surface area burns and/or full-thickness burns to the head and neck are susceptible to the development of OPI. The utilization of a fluidized positioner pillow in conjunction with improved assessment and identification using a 2 RN “time out” skin assessment daily, has led to a decrease in OPI in our BICU.

Applicability of Research to Practice
The utilization of the fluidized positioner pillow in conjunction with the described interventions can lead to a decrease in occipital HAPI and improve patient outcomes.
595 Mapping the Literature of Burns and Ethics
Authors: DeRosa Antonio , Gibbons Linda , Stribling Judy C 
Published: March 2020

Abstract

Introduction
Burn clinicians commonly experience ethical dilemmas as a direct result of a patient’s burn injury, yet literature on ethics in burns are scarce. A bibliometric analysis of literature on burn patients and ethics is necessary to support decision-making of burn-injured patients and their families. By identifying core journals, analyzing cited references, categorizing journals into Zones, and estimating database coverage, the results of this study informs burn specialists of the most relevant journals related to discussions about ethical issues in treating burn patients.

Methods
This study examined references during a three-year period (2016–2018) from a sample core of journals using the mapping protocol from the Nursing and Allied Health Resources Section (NAHRS) of the Medical Library Association (MLA). Following the prescribed steps in the NAHRS protocol, the investigators polled experts from the burn unit in a U.S. urban academic medical center inquiring about resources they believe contain the highest amount of content related to burns and ethics.
Using the following search strategy, the investigators queried Scopus, a subscription-based discovery portal, to retrieve references from the source journals published during the years 2016–2018.

Results
Based on professional responses, analysis of journal impact factors from the Journal Citation Reports (JCR) provided by Clarivate Analytics and a search of burns and ethics articles in MEDLINE, three journals informed the source titles for this study: Burns, BMC Medical Ethics, and Journal of Medical Ethics. There were 225 cited references pulled from the bibliographies of source journal publications: 183 references were from journal articles; 99 of these published in Burns. The years 2009–2013 accounted for the highest number of references inclusive of all publication types (n=61), followed by 2014–2018 (n=52). According to Bradford’s Law of Scattering, the n for this study was 4.4 (49 journals in Zone 2 divided by the 11 journals in Zone 1). Each zone makes up approximately 33% of the total number of cited references in all journals.

Conclusions
Results of this mapping study reveal there is a need for further published research on burns and ethics. Advancing burn clinicians’ understanding of ethics and burns will improve the overall care of burn-injured patients and supports the clinician in meeting their own professional ethical obligations.

Applicability of Research to Practice
Directly applicable to practice.
600 Nursing Standard of Practice: Assessment & Assistance with Bedside Escharotomy
Authors: Adkinson Lyndsay , Theis Mary , Witmer Malorie 
Published: March 2020

Abstract

Introduction
An escharotomy is an emergent procedure to treat circumferential, full-thickness burns. If left untreated, distal ischemia, compartment syndrome, respiratory failure, tissue necrosis, or death may occur. This procedure involves an incision through areas of eschar to release pressure within the affected compartment. An escharotomy may be performed at the bedside under sterile conditions by an experienced provider with the assistance of the nursing staff. The assisting nurse must have knowledge of the technique, purpose, and associated complications of the procedure. Nursing responsibilities may include pre-/post-procedure care, assessment, assistance with required equipment, patient teaching, & documentation.

Methods
Extensive literature review was conducted to identify the existence of nursing standards of practice regarding assessment and assistance with bedside escharotomy. A 20-question survey was sent to burn center nursing staff to evaluate inconsistencies in nursing knowledge and practice during bedside escharotomy.

Results
Information gathered via literature review revealed no consensus among U.S. burn centers in nursing standard of practice for a bedside escharotomy. Survey results further demonstrated inconsistencies in nursing knowledge and practice. Notable results from the survey included variance in post-procedure assessments, provider presence and skill level, dressing intervention, & obtaining informed consent prior to procedure.

Conclusions
A procedure was developed to standardize nursing practice during bedside escharotomy. This procedure outlines required supplies and preparation of equipment, implementation of nursing assessment and assistance, special considerations & complications, patient teaching, and required documentation. Images were included in the procedure for reference. Nursing staff received education regarding the purpose and utilization of the procedure. The procedure is available electronically to all health system employees. Future plans include reevaluation of staff knowledge and utilization of the procedure.

Applicability of Research to Practice
Development of a standard bedside escharotomy nursing procedure has the potential to improve level of knowledge, consistency in practice, and patient outcomes. Continued utilization and evaluation of this standard of practice supports the need for a consensus among U.S. burn centers.
613 Thriving During Development of a Large, Advanced Burn and Wound Clinic - The Realization of Successful Change Management
Authors: Prestifilippo Kathleen M , Webb Emily , Mullins Robert F , Fagan Shawn , Hassan Zaheed , Homsombath Bounthavy , Craft-Coffman Beretta , Currington Cynthia , Whalen Meganjoy 
Published: March 2020

Abstract

Introduction
Our center had an existing advanced burn and wound clinic, established more than 10years ago. Over the past several years, the need for expansion has been evident and in the past year, this expansion has been realized and the clinic doubled in size. With growth of any kind comes change. Change in healthcare is most often met with resistance. A multidisciplinary approach to planning and building a new healthcare environment is crucial to its success.

Methods
Review of admission and turnover rates.

Results
Several variables can be attributed to this overall accomplishment:

Conclusions

Applicability of Research to Practice
Sharing experiences related to staffing and growth with other clinicians helps foster support and leads to development of newer and better ways to do everyday work in clinical settings.
631 Mobilization of Patient with Inhalation Burn Injury Requiring VV ECMO: A Case Study
Authors: Berenbaum Karina J , Gottlieb Lawrence , O’Connor Annemarie , Teele Megan , Esbrook Cheryl , Jessica Fortin , Song Tae H 
Published: March 2020

Abstract

Introduction
As extracorporeal membrane oxygenation (ECMO) becomes more popular, there is increasing evidence supporting the safety and feasibility of early physical and occupational therapy (PT, OT) and mobility with patients on ECMO. However, there is limited evidence to support mobilizing burn ECMO patients. This case discusses safety and feasibility and explains how to successfully mobilize a burn patient on ECMO.

Methods
The patient is a 56-year old male admitted after sustaining 16% total body surface area partial and full thickness burns to his face, neck, forearms, and hands following an explosion at work. He sustained an inhalational injury and was intubated upon admission. Progression of his inhalation injury led to respiratory failure despite maximal ventilatory support. To maintain appropriate oxygenation, he underwent placement of left femoral-left internal jugular veno-venous ECMO (VV-ECMO). The patient received PT and OT throughout his stay in the Burn ICU. After starting ECMO, the patient resumed therapy with a sitting restriction to &lt; 45 degrees of left hip flexion. The critical care, burn, OT, PT, and cardiothoracic surgery teams discussed factors impacting his ability to participate in therapy, e.g., managing sedation to maximize wakefulness and titrating medications due to hypertension. Modifications to therapy treatments were made based on medical changes and the patient’s ability to participate. The patient was seen daily for mobilization by a PT, OT, nurse, and ECMO specialist team. Clinicians had extensive training and experience working with patients with acute mechanical circulatory support. Safety considerations were followed during all therapy sessions, including careful monitoring of ECMO flows, vitals signs, and securement of medical devices.

Results
While on ECMO for 11 days, the patient was engaged in daily therapy consisting of active exercise, bed mobility, transfers and standing balance activities. ECMO flows were maintained and no adverse events occurred during mobilization. From the first session on ECMO to day of discharge, the patient exhibited a 14-point increase in his Boston University Activity Measure for Post-Acute Care functional outcome score and progressed to ambulating 300 feet.

Conclusions
Burn patients on VV-ECMO with femoral cannulation can safely and effectively engage in therapy and early mobilization, which yield positive functional outcomes. A well-coordinated inter-disciplinary team and highly skilled staff is essential to provide safe and effective intervention.

Applicability of Research to Practice
Early mobilization of burn patients on ECMO is feasible and can ameliorate the effects of immobility. Burn therapists are an integral part of the inter-disciplinary team and should be trained to be skilled at providing care for patients on mechanical circulatory support.
643 The Use of Topical Exogenous Nutrient Supplementation to Improve Graft Take on an Avascular Wound Bed
Authors: Cooper Laura , Bohan Phillip Kemp , Carlsson Anders H , Chan Rodney K , Everett Tyler 
Published: March 2020

Abstract

Introduction
Skin graft survival relies on imbibition, inosculation, and revascularization from the wound bed. When a wound bed is poorly vascularized, as in the case of exposed fascia, tendon or bone, skin grafting may be delayed until the wound bed improves. We propose that topical nutrient supplementation may be able to increase take of skin grafts applied over an avascular wound bed.

Methods
Twenty full-thickness 5cm-diameter wounds were created on the dorsum of anesthetized swine and a dermal substitute (0.4mm, 0.8mm, 1.2mm, or 1.6mm thick) was placed on each wound. Negative pressure therapy with and without intermittent (3x per day) saline instillation was applied. Wounds were analyzed using a non-contact 3D camera at day 7 and day 14.

Results
Dermal substitutes of 0.8mm, 1.2mm, and 1.6mm thicknesses inhibited graft take significantly (p&lt; 0.01, p=0.02, p&lt; 0.01, respectively) for all wounds treated with wound vac alone. Addition of the normal saline instill showed a significant improvement in graft take (p=0.03) over wound vac alone for the wounds treated with the 0.8mm dermal substitute. Wounds covered with 1.2mm and 1.6mm dermal substitute continued to show significantly decreased graft take (p=0.03 and p=0.02, respectively). Wounds with 0.4mm dermal substitute showed similar graft take to control for both the wound vac and wound vac + instill treatments.

Conclusions
Dermal substitutes ≥0.8mm create a successful model of an avascular wound bed. Vac + instill treatment overcame the impedance of an avascular wound bed only for the 0.8mm dermal substitute thickness. This thickness of dermal substitute creates an ideal avascular wound bed model from which to conduct further studies incorporating topical nutrients instilled directly onto skin grafts placed onto avascular wound beds.

Applicability of Research to Practice
Single-stage skin grafting procedures onto avascular wound beds may become feasible with topical nutrient supplementation providing the environment to maintain graft survival until the wound bed is able to support the skin graft.
644 Enzymatic Debridement of Porcine Burn Wounds via a Novel Protease, SN514
Authors: Stone Randolph , Jockheck-Clark Angela R , Larson David A , Wall John , Michelle Holik , Shaffer Lucy , Natesan Shanmugasundaram , Tetens Shannon , Roche Eric , Shi Lei , Christy Robert J 
Published: March 2020

Abstract

Introduction
The future multi-domain battlefield will require prolonged care in theater with evacuation delays of up to seven days. This creates a great risk of infection by not removing any necrotic tissue from burns in a timely manner. Products that can provide non-surgical debridement (NSD) prior to definitive care are essential. The purpose of this study was to evaluate a novel protease (SN514) as a potential NSD agent on deep partial (DPT) and full thickness (FT) burn wounds in a pig and on discarded human skin.

Methods
On day -4, twenty DPT and FT 3 cm diameter burn wounds were created on the dorsum of 8 anesthetized Yorkshire pigs using appropriate pain control methods. Burns were treated daily from day 0 to day 4 with one of five treatment groups: 1) no treatment, 2) collagenase, 3) 0.5% SN514, 4) 1.0% SN514, or 5) hydrogel vehicle. The wounds were assessed every day, rinsed with 4% chlorohexidine and sterile water, digital and laser speckle images (LSI) were acquired, the treatments reapplied, and then rebandaged. Biopsy strips were harvested across the middle of wounds on day 3 or 4. Samples were paraffin embedded, sectioned, stained with H&E and Masson’s trichrome, and imaged. For the human skin cohort, an abdominoplasty sample was burned to create FT burns. Burned and unburned samples were treated daily with SN514 for up to 4 days.

Results
During the daily assessment, SN514 treated wounds appeared more debrided than controls. No bleeding, infection, inflammation, or redness were observed. LSI detected significant increases in the perfusion status of SN514 treated wounds for the DPT burns on day 4. Histological analysis indicated a greater debridement of the porcine burn wounds for SN514. Treatment of human burned tissue with SN514 resulted in an 80% weight reduction compared to untreated samples.

Conclusions
SN514 treatment removed significant amounts of necrotic tissue from DPT and FT burns. SN514 achieved this in the absence of blood loss, without harming adjacent normal skin, and may have potentiated the wounds to allow healing to begin. The observed increase in perfusion after treatments suggests that the wound bed was optimal for spontaneous healing or a temporary covering. Application of SN514 on the burned human tissue successfully debrided both the dermis and hypodermis.

Applicability of Research to Practice
The ultimate aim is to identify NSD products for prolonged care scenarios that are easy to use, safe, and may improve healing of burns without the need for surgical debridement.
660 Prevalence, Risk Factors, and Clinical Consequence of Enteral Feeding Intolerance in the Critically Ill: An Analysis of a Multicenter, Multi-year Database
Authors: Heyland Daren , Ortiz Luis A , Day Andrew G 
Published: March 2020

Abstract

Introduction
We aimed to determine the incidence of enteral feed intolerance (EFI), factors associated with intolerance, and to assess the influence of intolerance on key nutritional and clinical outcomes in critically ill patients.

Methods
We used data from The International Nutrition Survey database collected from 2007–2014. Included patients were mechanically ventilated critically ill adults who remained in the Intensive Care Unit for at least 72 hours and received some enteral nutrition during the first 12 days of their ICU stay. Data collected included nutritional prescription, adequacy, and clinical otucomes. We defined EFI as feeding is interrupted due to one of the following reasons: high gastric residual volumes (GRV), increased abdominal girth or abdominal distension, vomiting/emesis, diarrhea or subjective discomfort. Logistic regression controlling for covariates (year, region, sex, APACHE II score, admission type by primary diagnosis, BMI and baseline caloric and protein prescriptions) was used to determine risk factors for intolerance and its clinical significance.

Results
The current analysis included 15, 918 patients from 775 ICUs. Of these, 4, 036 (25.4%) had at least one episode of EFI. The rate rose from just below 1% on day 1 to a peak of 6% on day 4 and 5 and declined daily thereafter (See Figure). Factors predictive of EFI are shown in Table 1. Admission diagnosis was significantly predictive of EFI with patients with burn injuries showing the highest incidence. After controlling for the covariates,patients who had EFI received about 10% less EN adequacycompared to patients without of EFI (see Table 2). The mortality rate in EFI patients was 31% vs. 24% among patients who did not have EFI (OR=1.5 [95% CI, 1.4–1.6] p&lt; 0.0001). Patients who had EFI had fewer ventilator free days, longer ICU lengths of stay, and longer time to discharge alive (all p&lt; 0.0001) (See Table 2).

Conclusions
Intolerance occurs frequently during enteral nutrition in the critically ill and is associated with poorer nutritional and clinical outcomes. The identification, prevention, and optimal management in burn injured patients may improve nutrition delivery and clinical outcomes in this important “at risk” population.

Applicability of Research to Practice
To improve the nutrition therapy in burns patients.
669 The Validation of a Novel Outcome Measure in Severe Burns- the Persistent Organ Dysfunction (POD)+Death: Results from a Multicentre Evaluation
Authors: Heyland Daren , Stoppe Christian , Ortiz Luis A , Day Andrew G 
Published: March 2020

Abstract

Introduction
Very few burn care interventions have been rigorously evaluated with adequately powered randomized clinical trials (RCTs) focusing on long-term clinically relevant outcomes. There is a need to improve the efficiency of RCTs in burn care so that more definitive high quality RCTs can be completed with the available resources. Persistent Organ Dysfunction (POD) plus death is a novel endpoint that has been previously validated in general ICU patients. The objective of this study was to validate and demonstrate the utility of POD+death for clinical trials of burn patients.

Methods
We performed a secondary analysis of a dataset from a RCT of enteral glutamine (the RE-ENERGIZE Trial) involving 60 Intensive Care Units (ICUs) around the world. Enrolled patients were followed for 6 months documenting hospital and 6 months outcomes including quality of life. For the purposes of this analysis, we restricted inclusion to patients with &gt;20% burn size. We define POD as requiring supportive technologies during critical illness and is present when a patient has ongoing requirement for vasopressors, dialysis, or mechanical ventilation at the outcome assessments time points. We evaluated the data for the prevalence of POD and its association with outcome. We hypothesized that patients alive with POD, compared to those alive without POD, would have worse clinical outcomes and that by combining POD+death, we would gain statistical efficiencies.

Results
Five hundred thirty-nine patients were involved in this analysis. At 28 days, 4.6% of patients were estimated to have circulatory failure, 6.3% had renal failure, 17.1% had respiratory failure, and 8.9% had died, for an overall prevalence of POD+death=27%. Of survivors at day 28, those with POD, compared to those without POD, had a higher mortality rate in the follow up period, had longer ICU and hospital stays, and a reduced quality of life on many of the domains at 6 months (see Tables). Using our observed 28 day rates, to achieve 80% power at a two-sided alpha=0.05 to determine a 25% RRR in mortality, we would require 2246 patient per group to detect a 25% RRR in mortality from 9% to 6.75%, but only 573 patients per group to detect a 25% RRR in mortality+POD from 27% to 20%

Conclusions
POD+death may be a valid composite outcome measure and compared to historically used endpoints, POD may reduce the sample size requirements of clinical trials of severe burns patients. Further validation in larger clinical trials is required.

Applicability of Research to Practice
To improve the efficiency of RCTs in burn settings.