bluuebunny/crossref_metadata_2025_split huggingface dataset:
46 Inhibition of Lipolysis with Acipimox Targets Post-burn White Adipose Browning by Altering Macrophage Polarity
Authors: Barayan Dalia , Vinaik Roohi , Jeschke Marc G 
Published: March 2020

Abstract

Introduction
Severe burns are accompanied by a detrimental hypermetabolic stress response that can persist for years post-injury. Our previous work revealed that, under prolonged stress, white adipose tissue (WAT) adopts brown adipose-like traits in a process termed ‘browning’. This switch, characterized by the presence of uncoupling protein 1 (UCP1), is driven by the polarization of macrophages towards an M2 phenotype. Recently, we demonstrated that inhibiting lipolysis with the clinically approved drug, Acipimox, represses the burn-induced thermogenic activation of WAT. These findings raise the possibility that elevated rates of lipolysis may play a role in regulating the macrophage polarization state after major burn. However, the interconnection between post-burn lipolysis and inflammation remains unclear. In the present study, we investigated the mechanism underlying Acipimox’s inhibitory effects on burn-induced browning. Using a mouse model of thermal injury, we determine the metabolic effects of reducing WAT lipolysis on burn-induced macrophage recruitment and M2-polarization.

Methods
Adult C57BL/6 mice received a 30% total body surface area scald burn. Mice were then given daily intraperitoneal injections of APX (50 mg/Kg). On day 7 post-burn, the inguinal adipose tissue depot (iWAT) was harvested for histological analyses. Flow cytometry and F4/80 staining were used to assess adipose macrophage distribution and profile, and gene expression was analyzed via qPCR.

Results
APX administration significantly increased mitochondrial coupling, reflected by the decrease in UCP-1 (p&lt; 0.05) and PGC-1a (p&lt; 0.01) levels relative to the iWAT of untreated burn mice. F4/80 immunostaining of iWAT demonstrated decreased macrophage recruitment in Acipimox treated mice (p&lt; 0.05). Flow cytometric analysis indicated decreased macrophage infiltration at 7 days in Acipimox treated mice (p&lt; 0.05). Furthermore, iWAT from Acipimox treated mice demonstrated a pro-inflammatory profile, indicated by a greater distribution of TLR4 positive macrophages (p&lt; 0.05).

Conclusions
Previously, we showed that the administration of Acipimox effectively suppressed PKA-mediated lipolysis and improved mitochondrial coupling in adipose tissue post-burn. Here, we elucidate the mechanism underlying these metabolic changes. Importantly, we show Acipimox exerts its inhibitory effects on burn-induced WAT browning by directly modulating macrophage recruitment and the M2-polarization state.

Applicability of Research to Practice
Our study highlights the critical role of lipolysis in mediating the key post-burn metabolic phenomena browning and inflammation. The data presented herein validate the pharmacological inhibition of lipolysis as a potentially powerful therapeutic strategy to counteract the detrimental metabolic effects induced by burn.
124 Virtual Reality for Reducing Pain and Perioperative Anxiety in Pediatric Burn Patients
Authors: Schwartz Heather J , Fagan Shawn , Craft-Coffman Beretta , Truelove Christopher A , Mullins Robert F 
Published: March 2020

Abstract

Introduction
One of the most traumatizing and frightening experiences a child can experience is to sustain a burn injury. As a result, the child may experience excruciating pain and anxiety. The objective of this quality improvement project is use virtual reality as a nonpharmacologic intervention for pain and anxiety control and compare to traditional distractions methods.

Methods
There were 46 subjects ages 4 to 20 enrolled in a sample of convenience. Participants were given either virtual reality or distraction for dressing changes or minor surgical procedures. Before and after the surgical procedure or dressing change, the participants, their parent and nursing staff completed a Modified Yale Perioperative Anxiety Scale (mYPAS, Faces, Legs, Activity, Cry, and Consolability (FLACC) scale or Numeric Rating System (NRS).

Results
There was no significant difference in FLACC, NRS, and mYPAS scale scores pre-treatment. The post treatment NRS scores were significantly different between distraction and virtual reality (p= 0.031). FLACC scores for the distraction group increased 3.5-fold, while the virtual reality group scores decreased (p.0.0008). Mean mYPAS scores decreased again showing a significant difference between distraction and virtual reality with p= 0.004. The score increased with distraction and decreased with virtual reality with a difference of 12. In all cases virtual reality was better than distraction, when measuring pain and anxiety.

Conclusions
This QI project demonstrates that VR was more effective in reducing both pain and anxiety in burned pediatric patients as opposed to traditional distraction post treatment. Traditional distraction unfortunately was shown to increase both pain and anxiety post treatment. These conclusions suggest that VR may be utilized as a non-pharmacologic treatment option in conjunction with standard treatment to help decrease pain and anxiety in acutely burned children.

Applicability of Research to Practice
This study increases the knowledge base and advances the evidence-based practice of advanced practice registered nurses in the specialty of burn care. It suggests that a non-pharmacologic intervention such as virtual reality can be used to effectively reduce pain and anxiety in children who are undergoing treatment for their burn injury.
126 Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients
Authors: Lee Jin A , Wright Michael 
Published: March 2020

Abstract

Introduction
Analgesia in burn patients is significantly challenging given the complexity of burn pain. Opioids are a mainstay of therapy, but studies demonstrate varying outcomes with respect to the efficacy of adjunctive non-opioid agents in the treatment of burn pain. The need for analgesia extends beyond hospital admission—given the known risks of opioids, the impact of multimodal analgesia on opioid requirements post-discharge needs to be further elucidated in this population.

Methods
In this retrospective, single-center cohort study, adult burn patients who were consecutively admitted to the burn ICU service and subsequently followed in the burn clinic between 2/2015 and 9/2018 were evaluated up to 6 months post-discharge. The subjects were divided into two cohorts based on discharge pain regimens: multimodal vs non-multimodal. Individuals taking long-acting opioids prior to admission were excluded. The primary outcome was the change in oral morphine equivalents (OME) between discharge and follow up occurring between 2 - 6 weeks post-discharge. Secondary outcomes included the number of multimodal agents utilized and a comparison of OME between the last 24 hours of admission and discharge.

Results
A total of 152 patients were included for analysis (n= 76 per cohort). The multimodal cohort demonstrated increased total body surface area burned (23.9% ± 15.4 vs 16.6% ± 7.1; p &lt; 0.001) and prolonged number of days spent in the ICU (22.7 ± 23.1 vs 10.7 ± 8.9; p &lt; 0.001). The change in OME from discharge to first follow up was -106.6 mg in the multimodal vs -75.4 mg in the non-multimodal cohort (p = 0.039; figure 1). In each cohort, discharge OME did not statistically differ from last 24 hour OME (multimodal: p = 0.067; non-multimodal: p = 0.537). The most common non-opioid agents utilized were acetaminophen and gabapentin.

Conclusions
Despite extended ICU length of stay and larger TBSA, burn patients discharged with multimodal pain regimens demonstrated a statistically significant reduction in oral morphine equivalents from discharge to first follow up compared to those discharged on opioid-only regimens.

Applicability of Research to Practice
This study demonstrates promising results with respect to lowering discharge opioid requirements by utilizing a multimodal analgesic approach in the management of burn pain.
505 Burn Sepsis: Does the Initial Vitamin C Level Matter?
Authors: Williams Jeffrey W , Craig Christopher K , Saraswat Anju , Holmes James H 
Published: March 2020

Abstract

Introduction
After the first 24 hours, the principle cause of death in burn patients is multiple organ dysfunction/failure syndrome. It is preceded by infection in 83% of burn patients, with reported septic mortality up to 65%. In a recent journal article involving septic medical ICU patients, Marik et al. reports that all initial Vitamin C levels were below the normal range (0.4–2.0 mg/dL) prior to any intervention. Independent of each other, both early recognition and treatment of infection and vitamin C have been shown to be beneficial in sepsis. We monitored Vitamin C levels as part of our “Burn Code Sepsis” algorithm to obtain a baseline understanding of Vitamin C levels in infected adult burn patients.

Methods
Adult (≥18 yo) admissions between 7/1/2018 – 6/30/2019 were identified from our Burn Registry and all sepsis screens were evaluated in the EMR. Patients were screened clinically at least BID and were considered a “positive” screen if MAP &lt; 65 mmHg (SBP&lt; 90 mmHg) or if 2 of the 3 occurred: Temp &gt;102.2F; HR &gt;120; RR &gt;28 (or RR &gt;10% of ventilator set rate if set rate is &gt;24 bpm). A positive screen prompted lab work to include CBC, BMP, procalcitonin (PCT), lactic acid (LA) and Vitamin C (VC), per protocol. If PCT &gt;3.0 ng/ml or LA &gt;2.0 mmol/L, or both thrombocytopenia and hyperglycemia were present, a “Burn Code Sepsis” was initiated and included cultures, a CXR, and empiric antibiotics. If the cultures were positive or the CXR demonstrated an infectious process, a patient was considered “septic”. All burn injured patients with greater than or equal to 20% TBSA burns receive Vitamin C supplementation as part of our standard of care.

Results
There were 286 admissions during the 12-month period, with 38 positive initial sepsis screens (mean TBSA = 35%) that have an associated VC level. Of these positive screens, 26 (65%) were infected and 12 (35%) were not infected. ROC Curve analysis of VC levels and its ability to diagnose septic patients yields an AUC = 0.60 (p = 0.37). The mean VC level of infected patients at the time of initial screening was 1.9 +/- 1.4 mg/dL, and the mean VC level of non-infected patients at initial screening was 1.5 +/- 1.0 mg/dL.

Conclusions
Our results contrast with the previously published article on Vitamin C levels in a septic, non-burn injured population. Only 1 of 26 infected patients possessed a Vitamin C level below the normal range (0.4–2.0 mg/dL). Infected patients possessed higher Vitamin C levels than the non-infected patients, though not statistically significant (p = 0.35). AUC analysis indicates Vitamin C level is a poor prognostic test for sepsis.

Applicability of Research to Practice
Further research on Vitamin C levels and Its role in sepsis in the burn injured population is warranted.
570 Who Benefits the Most from Burn Camps?
Authors: Radics-Johnson Jennifer B , Chacon Daniel W , Zhang Li 
Published: March 2020

Abstract

Introduction
Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child.

Methods
A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were describes as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value&lt; 0.5.

Results
Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32).
There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confident in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?”

Conclusions
In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.

Applicability of Research to Practice
Research shows that burn camps have a positive effect on burn survivors including improving self-esteem, self-confidence and social skills. This study shows that burn camp is beneficial to burn survivors of varying gender, age, TBSA or ethnicity.
581 Basecamp: Burn Efficiency Care Pathway
Authors: Blayney Carolyn B , Gibran Nicole S 
Published: March 2020

Abstract

Introduction
Standardizing care has shown in the literature to be a means to improving the culture of safety in any field. Aligning burn surgeons, staff and ancillary services in the Burn ICU, Burn Acute Care floor, Burn Clinic who all have varying ideas, and plans of care creates toxic variation and communication challenges for bedside staff. While attending a medical center leadership development session, Burn Center Leadership collaborated on a project regarding burn center standardization.

Methods
A multidisciplinary Burn Center retreat in September 2017, launched the effort with a special emphasis on patient and family participation.We elicited feedback on what we did well and areas we could improve on. Using crowdsourcing methodology, the group selected 5 core QI/PI areas: resuscitation, wound care, pain/anxiety/delirium, physical mobility and psychosocial needs.Each multidisciplinary group, led by a non-physician chair and a Physician liaison established assigned tasks, rules of engagement and time frames. Work groups met weekly and reported progress to the Burn center QI committee.The project concluded with dissemination of the work products to staff. Patients and families were updated on the progress made to ensure we were still in alignment with our original goals.

Results
Burn Center orientation materials, standard operating practice documents and a Burn Center Standard of Care packet was developed. Documents were uploaded to a commonly accessible Burn Center Sharepoint website so there was one central source of information. The final BasECamP output was a daily checklist packet started on all BICU admits, that addressed key QI indicators and directives for care goals; 24 hr resuscitation guidelines, time to TF vs PO within 4 hrs of admit, daily weights, IV vs PO medication for wound care, time to first active mobility and a review of ICU and Hospital LOS per %TBSA.
71 adult burn patients &gt;18 years admitted to the BICU between November 2018 and May 2019 were started on the pathway. Of the 71, 58 were admitted with a burn injury, 4 with TEN, 6 were burn post-ops and there were 3 deaths. The 58 new burn admits are reviewed below.

Conclusions
The BaSeCamP packet is turned in and reviewed with the team. Data shows significant improvement in knowledge of standard operating procedures, expectations and resource availability. With improved communication across the burn team, staff more clearly understand patient-specific expectations in burn care and are more easily able to educate patients and families about the plan.

Applicability of Research to Practice
This Process improvement project responds to patient and family feedback that burn teams must coordinate communication and eliminate variability in delivery of care.
596 ICU Sedation Practices for Mechanically Ventilated Burn Patients Following Guideline Implementation
Authors: Anderson Jeffrey H , Mandell Samuel P 
Published: March 2020

Abstract

Introduction
Our American Burn Association verified regional burn center has approximately 700 admissions for burn injury per year, 200 of which are admitted to the burn intensive care unit (BICU). Sedation practices during acute burn resuscitations remain variable. In order to standardize our sedation practices, we developed a Background Pain and Anxiety Decision Tree for Mechanically Intubated Adults in March 2017. Concern over hypotension led to the removal of propofol as the sedative of choice. The new protocol made midazolam the primary choice and recommended the use of adjunct analgesics, including acetaminophen, for background pain. It uses the Richmond Agitation Sedation Scale (RASS) to determine whether patients were oversedated (RASS&lt; 0) or anxious (RASS &gt;1+).

Methods
We conducted a single center retrospective chart review on intubated patients admitted to the BICU from November 2017 through November 2018. Data collection focused primarily on sedation practices during this time to determine whether our protocol had the desired effects. Highest and lowest RASS were collected, and the difference between the two (delta RASS) was used to determine changes in patient agitation and sedation.

Results
Thirty three adult patients requiring mechanical ventilation were admitted to the BICU between November 2017 and November 2018. Of these patients, 21 (66%) received propofol on hospital day one, and 12 (38%) received propofol on hospital day two. Eleven patients received both propofol and midazolam on hospital day one. Of these patients, the average propofol dose was 511 micrograms per day and the average midazolam dose was 13.3mg per day (p=0.02). Eighteen (56%) and twenty five (78%) patients received acetaminophen on hospital days one and two, respectively. Twenty four patients had a RASS recorded during their first hospital day. The average highest RASS recorded was 1.3 and the average lowest recorded RASS was -3.2. Patients who received both propofol and midazolam had a higher peak RASS (2.4) and a lower minimum RASS (3.4), creating a larger delta RASS for this group.

Conclusions
Despite eliminating propofol from our sedation guidelines, its use remains the predominant mode of sedation for burn patients throughout the first forty eight hours of hospitalization. There is also room for improvement for administration of non-opioid analgesics, including acetaminophen. Finally, our ventilated patients tend to be more oversedated than undersedated, and a combination of midazolam and propofol creates the largest swings in patients’ sedation and agitation status.

Applicability of Research to Practice
Changing sedation and pain management practices in the ICU is a multifactorial process that requires more than ICU guideline implementation. The use of two sedatives during the first hospital day can result in larger swings in RASS as opposed to use of a single agent.
614 Staff Nurse Retention in a Growing Advanced Burn and Wound Clinic Through Implementing a Hiring Best Practice: Peer Interview as a Successful Change Process Managerial Approach
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
In recent decades, healthcare administrators and nurse managers have been challenged with identifying qualified candidates for patient care positions, and then to retain these personnel. The entire process of onboarding the right candidate requires time, money and resources on various levels. When the approach is from a top-down managerial style, it is not always accepted and therefore, is not always successful. Peer interviewing has been identified as a hiring best practice and can contribute to lowering the cost of recruitment, decreasing loss of time to screen and interview and contributes to higher employee morale. To distribute resources and thus save money and time, we adopted this approach to hiring during a critical time of growth and development of a large advanced burn and wound center.

Methods

Results

Conclusions

Applicability of Research to Practice
Sharing best practices and outcomes with other clinicians helps foster standardization and validation of care among peers.
617 Changing Onboarding to Increase Retention
Authors: Ladwig Melanie R 
Published: March 2020

Abstract

Introduction
Faced with some failed orientations and an increase in turnover, the Burn unit decided to change our orientation plan. There were 4 RNs who left or failed orientation in a period of a few months. The help of our practice council and feedback from preceptors was enlisted. In addition, the ABA Nursing Competencies were incorporated to revamp the orientation program. Most RNs onboarding to burn are not critical care RNs upon hire and therefore required an improved pathway to orient them to the burn care as well as critical care management.

Methods
Typical orientation started in the ICU. However, feedback following our traditional path led to specific changes based on the need to emphasize a sense of community as well as integrate specific time management skills particular to burn care. Orienting burn nurses now spend 12 shifts in the burn unit, 24–30 in the ICU, and then another 12–18 in the Burn unit. In addition, the staff taught Burn Care Principles course was restructured by practice council members and educators to focus on a case study-based learning style to emphasize important aspects of burn care. An in-situ simulation component to the Burn Care principles course was added to further solidify their learning. The competency tools used in orientation were changed to incorporate the American Burn Association Nurse competencies.

Results
Turnover was decreased from 33% (2017–2018) to 7.7% (2019). Preceptors and new RNs state they felt much more competent to begin their journey as a burn RNs the potential cost savings related to decreasing turnover would be well over $75,000.

Conclusions
The interventions made were staff driven by the orientees and preceptors, the practice council, and staff on the unit. the change in orientation allowed for less extensions and more successes. Burn RNs were more confident and less overwhelmed during their orientation. The team morale improved with their involvement with the process which was an added win.

Applicability of Research to Practice
This process needs to be followed so be able to ascertain if there will be lasting effects to retention.