bluuebunny/crossref_metadata_2025_split huggingface dataset:
648 Direct Comparison of Fractional Carbon Dioxide Lasers Systems: Ablative Well Properties and Healing
Authors: Powell Heather M , Baumann Molly E , McFarland Kevin L , Zuccaro Jennifer , Blackstone Britani N , Bailey John Kevin , Supp Dorothy M , Fish Joel 
Published: March 2020

Abstract

Introduction
Ablative lasers are a common tool for burn scar remodeling with numerous commercially available systems, each with varying capabilities. Among fractional CO2 (FXCO2) laser systems, the same nomenclature is utilized to describe properties of the laser including beam fluence and fractional coverage. Despite identical laser settings for these properties, the outcomes in two patient cohorts utilizing two different FXCO2 laser systems were notably different. As a result, a direct comparison of ablative wells, fractional coverage and healing between the two systems was conducted using ex-vivo and porcine models.

Methods
An ex-vivo study comparing fractional coverage settings (1%, 3%, and 5%) between the two different FXCO2 laser systems was first carried out (all measurements were obtained by a blinded rater using a high-powered microscope to quantify ablative area). Porcine skin was then treated with the two systems at 10–70 mJ. To compare ablative well properties, biopsies were collected and serial sectioned with the deepest/widest point of each well calculated from the histological section using ImageJ. Fractional coverage for each laser system was quantified for three different settings: 70 mJ 1%, 70 mJ 5%, and 30 mJ 5%. Finally, re-epithelialization rate (as measured by transepidermal water loss), erythema and expression of genes encoding inflammatory cytokines were quantified in a porcine burn model prior to and at multiple time points following treatment with both laser systems (70 mJ, 5% fractional coverage).

Results
The two laser systems produced significantly different ablative wells. In the ex-vivo study, the fractional coverage measurements obtained differed from those provided by the manufacturer by 1.6 - 8.9%. In the porcine study, at 70 mJ, the ablative wells created from system 1 were deep and narrow, on average 1251 + 183 µm deep and 142 + 32 µm wide whereas wells from system 2 were shallow and wide, 374 + 44 µm deep and 267 + 35 µm wide. Following treatment, scars treated with system 2 re-established barrier function within 7 days whereas scars treated with system 1 re-established within 4 days. A significant increase in gene expression for IL-6 was observed in both systems at 1-hour post laser. Expression levels returned to baseline in system 2 by 24 hours whereas a return to baseline was not observed until the 96-hour time point for system 2.

Conclusions
While different FXCO2 laser systems utilize the same nomenclature for user selected properties, the same settings are not equivalent between systems resulting in significantly different ablative wells and downstream healing.

Applicability of Research to Practice
Laser systems should not be considered interchangeable despite being programmed for the same settings.
657 Preliminary Study on the Effect of Various Antimicrobial Formulations Containing Silver Oxynitrate on Reducing Pseudomonas Aeruginosa Using an in-vivo Porcine Burn Wound Model
Authors: Davis Stephen C , Gil Joel , Solis Michael , Higa Alex 
Published: March 2020

Abstract

Introduction
Silver has long been known for its antimicrobial effects and has been commonly applied topically to burn wounds for years. More recently, wound dressings compounded with silver ions, have been developed to prevent and treat wound infection in both burn and chronic wounds.

Methods
This preliminary study evaluates the effect of a proprietary silver oxynitrate creams on Pseudomonas aeruginosa (PA) biofilms using a well-established burn wound porcine model model. Swine were used due to their skins similarities to humans and response to wound treatments. Briefly, second degree burn wounds were created and inoculated with PA. Wounds were then covered for 24 hours with a polyurethane dressing to allow for biofilm formation. The polyurethane dressing was removed and wounds were randomly assigned to one of the following treatment groups: 1) silver oxynitrate cream 0%, 2) silver oxynitrate cream 4%, 3) silver oxynitrate cream 7%, 4) silver oxynitrate cream * 10%, 5) silver oxynitrate powder, 6) silver sulfadiazine cream (SSD)~, or 7) untreated control. All treatments groups were covered with a polyurethane dressing to prevent any cross contamination. On days 3 and 7 after wounding wounds were cultured using an established scrub technique.

Results
Silver oxynitrate powder was the most effective treatment group at reducing PA counts. Silver oxynitrate 10% formulation had a high percentage of bacterial reduction. On day 7, compared to untreated control the silver oxynitrate 4, 7 and 10% treatments showed a 3.45, 4.05, and 4.30 log CFU/ml reduction, respectively.

Conclusions
These studies suggest that the silver oxynitrate formulations can reduce the bacterial bioburden in vivo against wounds that have PA biofilms. Additional animals are needed to substantiate these findings.

Applicability of Research to Practice
Gram-negative bacteria such as PA pose a challenge for wound care practitioners and new effective therapies are needed.
727 Use of a Biodegradable Dermal Matrix in Conjunction with Meshed and Sprayed Autologous Cell Suspension with a Vacuum Assisted Dressing Achieved Limb Salvage in a 73 Year Old with Deep Full Thickness Burns Despite Exposed Tendon and Bone
Authors: Olivi Joe , Rodgers Megan 
Published: March 2020

Abstract

Introduction
Deep Full thickness burns require tangential excision of the burned tissues down to viable tissue. This often leaves exposed muscle, tendon and bone. Coverage of these areas is vital to limb salvage. Multiple modalities are necessary with these type of patients, such as, dermal matrix graft, split thickness skin graft, sprayed autologous cell suspension (ACS) and wound vacuum therapy(VAC). A dermal matrix provides a scaffold for tissue and vascular en growth that is suitable for accepting a skin graft and also provides a layer between the muscle, tendon, bone and the skin graft which improves movement and produces a more pliable graft.
Biodegradable temporizing matrix(BTM), produced by PolyNovo Ltd, was used to cover the muscle, bone and tendon. This product has a silicone backing which can be delaminated once it has matured with tissue and vascular en growth for auto grafting.
A combination of a wide meshed skin graft at 3:1 ratio and a sprayed ACS allows for faster healing and less donor site usage which decreases the overall wound burden.

Methods
A 73 y/o male with total body surface area burn of 24 % suffered deep full thickness burns to the bilateral lower legs. He underwent multiple debridements with management of the right leg with irrigating wound vacuum therapy. The deeper right leg had a wound base with that consisted of muscle from the thigh down onto the foot with exposed tendons and anterior tibial bone. The open wounds to the right leg were grafted with BTM for dermal substitute coverage. Once the BTM was mature it was delaminated, and the wound surface was covered with a 3:1 ratio split thickness skin graft (STSG) and sprayed on autologous cell suspension. This resulted in using less donor skin than a 1.5 or 2:1 meshed graft STSG which decreased his wound burden. Donor sites were also sprayed with ACS.

Results
We had nearly 100% take of the STSG and sprayed autologous suspension epidermal graft. There was a small area over the patella tendon where the BTM did not incorporate. This is though to be because of lack of immobilization of his knee and a pseudomonal infection.
Donor sites healed faster and there were minimal open areas to the graft POD 11 excluding the patella area.

Conclusions
BTM can be used to provide a suitable dermal substitute in complex wounds when muscle, tendon and/or bone are exposed.
Immobilization of the joints is necessary to allow the tissue en growth into the dermal matrix. Wide meshed graft with sprayed ACS can be used with good results with wound vacuum therapy.
Decreased wound burden and time to heal open wounds of the graft and donor sites.

Applicability of Research to Practice
Use of a dermal matrix, wide mesh split thickness graft and sprayed epidermal ACS with wound vacuum therapy is a good option for limb salvage when vital structures are exposed.
745 Pediatric Burn Transfers: A 10 Year Analysis of Adherence to ABA Transfer Criteria
Authors: Roller Janine , Courtemanche Rebecca , Bucevska Marija , Hynes Sally 
Published: March 2020

Abstract

Introduction
Severe burn injuries require complex care at certified burn centres to minimize morbidity and mortality. The ABA Burn Centre Referral Criteria was developed to aid clinicians in determining which patients warrant transfer as physician comfort with the management of pediatric burns, accurate estimation of TBSA, and burn depth varies. We hypothesize that pediatric patients are often transferred despite not meeting referral criteria. The aim of this study was to review pediatric patients with burn injuries that were transferred to the provincial burn centre over the past 10 years to better understand the reasons for the transfer.

Methods
A 10-year retrospective review from January 2008 to December 2018 was performed using the provincial Burn Registry. Pediatric burn patients under 18 years old who were transferred for burn care were identified and their demographics, burn characteristics, and the basis for transfer was analyzed against the ABA Burn Referral Criteria.

Results
A total of 130 pediatric burn patients were transferred from 42 different hospitals of varying trauma levels. Patients on average were 5 years old, predominantly male (59%), and scalds were the most common etiology (53%). Most patients were transferred by a fixed-wing ambulance (54%) and the average transport time was 1.5 days after the initial injury. All children met 1 or more ABA Referral Criteria for transfer. The most common reasons for transfer were for a TBSA greater than 10% (42.2%), burn to the hand (27.7%) or perineum (11.5%), 3° burn depth (12.3%), or significant pre-existing medical disorders (9.2%).

Conclusions
Over the past 10 years, all pediatric burn patients met ABA Burn Centre Referral Criteria based on TBSA, burn depth and burn location alone. This study is limited in that we were not able to capture all pediatric burn patients to identify those that warranted a referral but were not transferred.

Applicability of Research to Practice
The results indicate that burn-related transfers to the provincial burn centre were appropriate. The dissemination of this information to the referring centres may serve to reinforce these positive referral patterns. Furthermore, this audit provides insight into the geographic origins of pediatric burn referrals in the province to help direct burn prevention and physician education efforts, as well as resources for initial burn care and post-discharge rehabilitation services.
771 Psychiatric Illness Among Burn Patients: Experience at a Single ABA Verified Burn Center
Authors: Komak Spogmai , Cross James 
Published: March 2020

Abstract

Introduction
Burn injury is uniquely characterized by the initial traumatic event in addition to the psychiatric component associated with physical change and recovery. Recent work has highlighted the importance of pre-existing psychiatric illness on both recovery and final outcomes in burn patients (Tarrier et al 2005, Hudson et al 2017, Wisely et al 2009). We examined the prevalence and association of psychiatric illness in our ABA verified burn unit. Knowledge of this information is critical in allocation of limited resources aimed toward addressing both the physical and mental aspect of burn injury.

Methods
The burn registry at a single verified burn center was examined from July 2017-July 2018. All consecutive burn patients with psychiatric illness who were admitted were included. Psychiatric illness was broken down into: depression, anxiety, bipolar disorder, schizophrenia and delirium. Need for psychiatric consultation, %TBSA, length of hospital stay, and operative intervention was also examined.

Results
416 patients were admitted during the study period—44 pts (10.5%) had a psychiatric diagnosis on admission. Seventy-five percent of pts were male. The average TBSA burned was 15.3%. Seventy-five percent of patients required psychiatric consultation, and 57% required operative intervention (Table 1). The most common psychiatric condition was anxiety (50%), followed by depression (36%), bipolar disorder (27%), schizophrenia (23%), and delirium (18%). Forty-eight percent of patients had multiple (&gt;1) psychiatric conditions. Female patients had a significant less TBSA burn (5.8%) vs. male (18.2%), P=.001, as well as a shorter LOS (12.1 dys vs. 31.5 dys) p=.004.

Conclusions
The association between burn injury and pre-existing psychiatric illness is well known (Hudson et al 2017, Wisely et al 2009). We found that over 10% of pts admitted to our burn unit had a psychiatric diagnosis, and a large number of these required further inpatient psychiatry consultation. More than half of patients required operative intervention indicating that severity of burn injury was high, with optimization of pre-existing conditions especially important. Additionally, psychiatric illness did not occur in isolation--48% of pts had &gt;1 psychiatric diagnosis —a finding which has implications for resource allocation for mental health/ dedicated psychiatrist for burn patients.

Applicability of Research to Practice
Implications for resource allocations for dedicated burn psychiatrist/ resources for mental health.
781 Evaluation of the online-presence of ABA-verified burn centers
Authors: Branski Ludwik , Tapking Christian , Hundeshagen Gabriel , Popp Daniel , Houschyar Khosrow , Haug Valentin , Kneser Ulrich , Hirche Christoph R 
Published: March 2020

Abstract

Introduction
Currently, patients seek health-care information online. An up-to-date online presence is vital for success among the competition amid hospitals. Hospital websites have become an important medium to communicate with patients, provide information about certain diseases/conditions and advertise healthcare services. This study aims to evaluate burn centers websites verified by the American Burn Association (ABA).

Methods
The online presence of the 73 ABA-verified burn centers was evaluated according to criteria previously published by Benedikt et al. This included general information on burns, first aid, treatment at the burn unit, research, and education. ABA verified burn centers were then compared to 48 German-speaking burn centers evaluated by Benedikt et al.

Results
Online information about patient care including treatment options and techniques was more often present in ABA-verified burn centers. However, this information was still provided in only half of the websites. Furthermore, ABA-verified burn centers more often used multimedia-based elements and social media platforms. On the other hand, German-speaking burn centers more often provided translations, general information (e.g. staff, ward) about the burn center as well as research and education.

Conclusions
This study demonstrates that although many burn centers have well-designed websites, relevant burn-related information on patient care, research and education is often missing or sparse. Today, most patients look for health-care information online. Also, applicants for residency or fellowship programs tend to get a first picture of their potential employer on websites or social media.

Applicability of Research to Practice
Keeping websites and social media up-to-date and informative can improve recruitment of patients and employees.
799 Free Transportation for Socioeconomically Disadvantaged Burn Patients: Quality Improvement Project
Authors: Perez Laura , Castro Rebecca , Wolf Steven E , Lee Jong 
Published: March 2020

Abstract

Introduction
Our Burn Center provides care to persons living in southeast area of our State. Patients residing in this area sometimes have low socioeconomic status (SES), and are often unable to return to burn clinic for continued care due to transportation barriers. Typically driving distance is over 80 miles involving ferry access, taking two or more hours each way. The aim of this quality improvement project was to examine the feasibility of a free transportation program for low SES patients who have barriers to transportation.

Methods
Our first step was to assess transportation needs. We started with a patient survey in clinic to determine if patients would be interested in free transportation and if the service would increase access to care. Survey with six questions was used to assess needs.

Results
We surveyed ten patients during burn clinic to determine if transportation would increase access to care. Nine patients responded positively and found transportation would be beneficial. One responded that he would not use it as he would use clinic appointment as opportunity to vacation in the area.
Funding was secured from our School of Medicine. Community transportation providers were contacted and pricing was obtained. Transportation van was contracted with existing vender. Transportation is now available to patients with burn clinic appointments. We hope to expand to other clinics in the hospital in the future. The Transportation program will assist patients with access to care, compliance, decrease non-emergent Emergency Department visits and 30-day readmissions.

Conclusions
Transportation assistance for socioeconomically disadvantaged burn patients to follow up in clinic is needed. Nine out of ten patients surveyed were willing to use free transportation. We obtained funding to start a free transportation program once a month. This project began in October 2019.
We have begun a once-a-month transportation assistance service to determine ridership and continued need. Twice monthly assistance may be needed and will be assessed over time. Our goal is ultimately to expand the program to include other clinics.

Applicability of Research to Practice
Free transportation program can assist patients with access to care, compliance, and decrease non-emergent Emergency Department visits and 30-day readmissions.
803 Utilizing the Revised Baux Score as a Trigger for Advanced Care Planning with the Palliative Care Team
Authors: Littlepage Carrie , Strait Eli , Cabrera Jeremy , Lee Jeanne 
Published: March 2020

Abstract

Introduction
The objectives of this performance improvement project is to facilitate earlier goals of care discussions led by the Palliative Care team for burn patients with a high risk of mortality, and to improve overall communication with families of patients. The Advanced Care Planning Trigger Tool utilizes the Revised Baux Score, a burn mortality scoring system, which is calculated by adding the patient’s age, total body surface area (TBSA) of the patient’s burn as a whole number, and adding an additional 17 points if the patient has an inhalation injury. From January 1st, 2017 to June 1st, 2018 16 patients were admitted to the Burn Center with a Revised Baux Score of over 100. Of those 16 patients, 11 passed away due to their injuries during admission, equaling a 69% mortality. Palliative Care consults were triggered for 4 out of the 16 patients (25%), and all 4 of these patients passed away during their hospital stay.

Methods
Revised Baux Score is calculated on each new burn admission. A consult to the Palliative Care Team for Advanced Care Planning is triggered within 48 hours of admission, if a patient’s Revised Baux Score is above 110 and they are greater than 60 years old; or any adult patient (over 18 years old) with a score of 130 or greater.

Results
The project was implemented in June of 2018. This tool led to an increase in Palliative Care team involvement early on for patients with a high risk of mortality from their burn injury, more effective care planning discussions with families and improved collaboration between the Burn team and Palliative Care team.

Conclusions
All patients with a Revised Baux Score that triggered the Advanced Care Planning Tool for a consult were ordered palliative care consults within 48 hours of admission.

Applicability of Research to Practice
Advanced Care Planning with the Palliative Care team leads to increased communication and more effective care planning for patients with a high risk of mortality.
810 Routine Psychosocial Screening and Follow-up of Adult Burn Patients in an Outpatient Clinic
Authors: Tiani Alaina , Williford Desiree N , Jackson Carrie B , Durkin Kristine , Langholz Ariana , Hajduk Gina , Aballay Ariel , Duncan Christina 
Published: March 2020

Abstract

Introduction
Sustaining a burn injury is associated with increased risk of mental health issues, and common among these are depression, anxiety, post-traumatic stress disorder (PTSD), and substance use. Unfortunately, less than half of these adult burn survivors receive services related to their mental health concerns. Moreover, few studies have examined the routine implementation of a psychosocial screener in an outpatient burn clinic setting, and there is a paucity of research which examines how to proceed when patients endorse symptomology. The aim of the current study is to report on outcomes of a routine psychosocial screener in a sample of adult burn survivors and patient response to brief psychological consultation at initial screen and 1-month follow-up.

Methods
A psychosocial screener was developed and implemented (October 2016-August 2019) in an outpatient burn clinic to identify patients who endorse clinically significant psychosocial distress. Comprised of very brief, validated scales (and their clinical cut-off scores), the screener assessed for safety at home, suicidal risk, depression, anxiety, and substance use. Adult burn survivors completed the questionnaire at their first outpatient appointment. Patients who endorsed safety concerns at home and/or suicidal ideation/risk were immediately evaluated by a physician or psychology staff. Those who endorsed significant distress, but no suicidal or safety risk, were contacted by psychology staff within one week of the screener date. Those who did not indicate significant clinically significant distress did not require further action.

Results
Of the 393 patients who completed the screener, 102 individuals (26%) indicated clinically significant mental/behavioral distress. Psychology staff were able to reach 80 patients (78%) for initial brief consultation (i.e., within one week). Of those contacted, 14 (18%) indicated that they were already receiving psychological services, 25 (31%) reported they were not interested in a psychological referral, 20 (25%) accepted a new referral for psychological services, and 19 (24%) endorsed minimal or decreased symptoms. In February 2019, we began to conduct 1-month follow-up. A total of 19 individuals were eligible (had positive screens) and 8 (42%) were reached. Of those reached, 2 (25%) accepted a new psychological referral, 2 (25%) indicated no interest in a referral, and 3 (37%) reported minimal/no psychological symptoms.

Conclusions
Implementing a psychosocial screener is a feasible way to screen for distress in outpatients.

Applicability of Research to Practice
A 1-month follow-up contact helps staff to understand whether referrals are utilized or how symptoms may change over time and yields another opportunity to provide referrals to those previously uninterested.