bluuebunny/crossref_metadata_2025_split huggingface dataset:
764 What Do You Think? The Ethics of Treating the Medically and Socially Complicated Patient
Authors: Gerrek Monica L , Lambrix Marcie A , Schirokauer Oliver , Coffee Tammy , Yowler Charles 
Published: March 2020

Abstract

Introduction
Medically complicated burn patients also often present with complex social situations which raise difficult ethical questions for the providers caring for them. While the four principles of biomedical ethics, respect for autonomy, nonmaleficence, beneficence, and justice help guide medical decision making, providers are often faced with making recommendations that are ethically uncomfortable for them.

Methods
At the ABA Annual Meeting in 2019, we presented a poster of a case of a medically, socially, and ethically complicated patient who was treated at our verified burn unit about a decade ago. Embedded in the poster was a QR code and weblink that people could scan to get to a 10-item online survey containing questions regarding decision making in the case. For our regional burn conference in September 2019, we asked the organizers to send an email containing a summary of the case and a link to the survey via email to all of those who had registered two weeks before the conference. A summary of the case follows:
47-year-old male with an 81% TBSA burn from a car accident, currently intubated and sedated and unable to participate in medical decision making. He needs four limb amputations, though his chance of long-term survival is ultimately thought to be less than 10–20%; best case scenario is a vent-dependent life with tetraplegia, likely without prosthetics due to skin graft issues. He has a very complicated family situation.
Survey questions included those about whether it was medically appropriate to do or not do the amputations, how that appropriateness should be assessed, the extent to which the patient’s previous expressed wishes matter, who the appropriate surrogate is, and whether and to what extent the medical team’s feelings about the situation matter.

Results
Twelve people at the ABA annual meeting and 17 people from the regional meeting responded to the survey. Every respondent answered every question. While there were some similar responses, there were also those with significant variation. Of note, at the ABA, 50% of respondents felt the evidence needed to withdraw treatment was the same as that needed to continue treatment; 70% of participants at the regional meeting thought this. 25% of respondents at the ABA thought it was extremely important that a decision be made that allows team members to sleep at night; 17.65% of participants at the regional meeting thought this.

Conclusions
Burn care providers do not agree on important aspects of decision making for patients who are medically, socially, and ethically complicated.

Applicability of Research to Practice
Further discussion of decision making in burn care is needed to help increase provider comfort in making recommendations for patients who are medically, socially, and ethically complicated.
766 Clinical Outcome Assessment of a Psychosocial Intensive Retreat for Girls with Severe Burns
Authors: Stoycos Sarah A , Sammons Ashley J , Cartelli Lesia S , Price Leigh Ann 
Published: March 2020

Abstract

Introduction
Burn camps and peer support groups are widely utilized for the psychosocial care of pediatric burn survivors, providing community and recreation. However, camps and support groups often do not involve psychological therapy to assist with potential distress. This abstract presents program development outcome assessments for an alternative approach to psychosocial care: a psychosocial intensive retreat for adolescent survivors of pediatric burns, led by trained mental health professionals, with group therapy interspersed with recreation.

Methods
A 6-day, residential psychosocial intensive was open to adolescent girls with disfiguring burns. Psychological assessments were administered for clinical utility at the start (T0) and end (T1) of the program and were used to guide programming. Assessments included: Posttraumatic Stress Checklist for DSM-5 (PCL), Satisfaction with Appearance Scale (SWAP), Rosenberg Self-Esteem Scale (RSES) and the Acceptance and Action Questionnaire (AAQ) measuring psychological inflexibility. Bivariate correlations and univariate t-tests were used to assess program outcomes.

Results
Fifteen girls (Mage = 16, SD = 2.04; Mageofburn = 6.64, SD = 5.40) attended. At T0, girls reported subclinical scores (PCL (M = 23.53, SD = 20.20, range 1–65); SWAP (M = 44.93, SD = 11.88); RSES (M = 27.28, SD = 5.76); AAQ (M = 20.71, SD = 9.64) with a subset of 5 reporting clinical distress on PCL. Therapeutic programming was adjusted to primarily focus on typically developing adolescent issues such as communication, boundaries, identity formation, and healthy relationships, with some burns-specific groups (grief and loss, social exposures). Those with clinically significant distress participated in trauma and affect regulation training.
AAQ at T0 was negatively associated with RSES (r = -.78, p = .003) and positively associated with PCL scores (r = .82, p &lt; .001). RSES was negatively associated with PCL (r = -.87, p &lt; .001). SWAP was not associated with any measures. From T0 (M = 26.70, SD = 6.07) to T1 (M = 30.18, SD = 5.74) girls reported a significant increase in RSES, t(10) = -3.15, p = .01. As expected given low symptoms reported at T0, no other pre to post changes occurred. TBSA, time since burn and age were not associated with outcome variables.

Conclusions
Overall, girls suffered burn injury before the age of 7 and current symptom profiles replicated prior literature supporting subthreshold, long-term psychological morbidity for pediatric burns. A brief, 6 day psychosocial intensive may facilitate growth in self-esteem. Use of clinical assessments to inform programming is emphasized.

Applicability of Research to Practice
Psychosocial intensives that intersperse empirically-supported, assessment-driven therapeutic programming with social connection may be useful in increasing adolescent self-esteem for girls with a history of disfiguring burns.
792 A Retrospective Review of the Utilization of Burn Admission Criteria
Authors: Foster Kevin N , Krueger Larisa M , Richey Karen J 
Published: March 2020

Abstract

Introduction
Evidence-based criteria for burn patient admission are poorly defined. Attempts have been made by commercial entities to align payors and providers with evidence-based admission criteria to optimize resource use. However, these admission criteria have not be examined critically to see if they are appropriate and effective. We developed an admission criteria algorithm based on these existing standards and have utilized it for nearly 18 months. The purpose of this study is to retrospectively review this algorithm with respect to inpatient needs and outcome to assess its effectiveness.

Methods
A retrospective chart review of patients admitted the burn center over a 1 year period was performed. Incomplete datasets were excluded. Patients were grouped by TBSA, &lt; 10%, 10–20% and &gt; 20%. Appropriateness of admission was measured used length of stay (LOS) as surrogate marker, hospitalizations of &lt; 3 days, unless deceased, were deemed inappropriate (IAP) and 3 days or more as appropriate (AP)

Results
There were complete datasets for 530 patients, &lt; 10% (n=423), 10–20% (n= 72), &gt;20% (n=35). There were no significant differences in age, gender, or payor sources between the groups. Patients with larger TBSA burns were more likely to have suffered a flame/flash injury. All patients in the two larger TBSA groups met admission criteria per algorithm. All IAP were in the &lt; 10% group. When compared to AP, IAP were younger, 31.6 vs. 44.0 years (p&lt; .0001), had smaller TBSA injuries 2.8% vs. 3.5% (p=.0045), had fewer clinical findings 1.4 vs 1.8 (p&lt; .0001), fewer interventions 1.8 vs 2.6 (p&lt; .0001) but were more likely to have suffered burns to the head 30% vs 13% (&lt; .00001) and neck 9% vs 3% (=.0164). AP patients were more likely to have suffered contact burns 27% vs. 17% (p=.0323), full-thickness injuries 39% vs 14% (p&lt; .0001), involvement of a major joint 42% vs 29% (p=.0085), combined burn and trauma 3% vs. 0% (p=.0444) and burns to the buttocks 7% vs 2% (p=.0357). AP patients were also more likely to require IV analgesia 82% vs 71% (p=.0107) and evaluated as likely needing surgery 82% vs 15% (p&lt; .00001).

Conclusions
The admission criteria algorithm performed perfectly in patients with a ≥ 10% TBSA injury. For patients with burn &lt; 10% TBSA the algorithm was not followed as closely leading to some inappropriate admissions. Patients with smaller burns admitted appropriately were more likely to have full thickness burns, contact burns, burns over joints and to require surgery. The algorithm was highly accurate in patients with large burns, however additional refinement is needed for those patients with smaller burn injuries.

Applicability of Research to Practice
This study helps to define appropriateness of inpatient care following burn injury.
814 Do Patients Receive Reliable Outpatient Occupational Therapy After Hand Burns
Authors: Choi Katherine J , Pham Christopher H , Collier Zachary J , Carney John , Kurakazu Dawn , Yenikomshian Haig A , Gillenwater Justin 
Published: March 2020

Abstract

Introduction
Hands are the most commonly burned body part, and are prone to developing limited range of motion and scar contractures, which benefit from aggressive occupational therapy (OT). Many burn survivors are vulnerable with limited resources and poor follow up. The purpose of this study is to determine outpatient OT referral and compliance rates in our patient population.

Methods
All patients with hand burns admitted to a single ABA verified burn center from January 2015 to May 2016 were reviewed. Demographics (living situation, substance use, psychiatric illness), TBSA, interventions (type/number of surgeries), outcomes (length of stay [LOS]), and OT outcomes (inpatient and outpatient treatment, reason for discontinuation) were evaluated.

Results
Sixty-one patients met inclusion criteria. Mean age was 33±18 years. In terms of living situation, 17% (n=10) were homeless, and 3% (n=2) were incarcerated. A documented history of alcohol abuse was present in 13% (n=8), 23% (n=14) had positive urine toxicology screens, and 15% (n=9) had diagnosed psychiatric illness. Mean TBSA was 10%±6. Half (N=30, 51%) were managed non-operatively.
At discharge, 30% (n=18) had normal hand function and did not meet criteria for outpatient hand therapy. Over 70% (n=43) received outpatient referrals, but only 44% (n=19) of those referred reliably returned for outpatient OT.
Despite having outpatient OT referrals, 33% (n=14) did not present to outpatient therapy after repeats attempts of contact, and 67% (n=29) of those with referrals only came to one visit. Of those that did not complete therapy, most (n=14, 58%) were lost to follow up and unable to be contacted. Other reasons for not completing therapy within our system were out-of-network insurances requiring follow-up outside our hospital (36%) and incarceration (6%).

Conclusions
At our center, nearly 1 in 3 patients with hand burns had excellent function upon discharge and did not require outpatient therapy. However, when patients are referred for outpatient therapy, many do not show up or maintain reliable compliance. Many patients are simply lost to follow up.

Applicability of Research to Practice
While occupational therapy remains an effective and viable option for hand rehabilitation, further efforts must be aimed at providing patients mechanisms and education for achieving reliable outpatient follow up.
822 Smoking on Home Oxygen and Burn Related Injuries. a Single Center Experience
Authors: Mubang Ronnie , Horrell Erin Wolf , Folliard Sarah A , Beyene Robel , Gondek Stephen , Thompson Callie M 
Published: March 2020

Abstract

Introduction
Oxygen therapy is a mainstream treatment for many cardiopulmonary disease processes in the United States with COPD being most common. Despite various warnings against smoking on oxygen therapy, some patients continue to smoke on oxygen and sustain burn-related injuries. These patients are frequently intubated due to concern for inhalation injury. We aim to characterize the injury patterns, morbidities, and mortalities associated with burns sustained while on oxygen therapy at home. We hypothesize that the prevalence of these injuries is underrecognized.

Methods
We performed a retrospective review of all patients ≥45 years of age admitted to our regional burn center from 10/2018-4/2019. Injuries related to smoking on home oxygen were isolated and patient and injury characteristics are described.

Results
A total of 143 patients were included in this review, 20 patients (15%) had injuries related to smoking on home oxygen. Patient and injury characteristics are described in Table 1. Notably, 25% of patients were intubated and none of those patients had an inhalation injury documented on bronchoscopy. Four patients were extubated within a day of admission & one patient was extubated on hospital day 2. No patient died in-hospital. Nine patients (45%) required an escalation of care in the post-acute care period.

Conclusions
Smoking on home oxygen is an underrated problem and better education is needed for both patients receiving the therapy and providers prescribing the therapy. Due to the mechanism, inhalation injury is rare though a significant percentage of patients continue to receive prophylactic intubation.

Applicability of Research to Practice
This study describes the prevalence of thermal injuries associated with smoking while on oxygen therapy. This study provides additional data for patients and prescribers to underscore this risk.

External Funding
None.
832 Trends for Treatment of Complex Hand Burns in the Acute Setting
Authors: Sher Malvina , Freudenberger Stephanie , Auriemmo Stephanie , Tufaro Patricia , Hunter Hope , Marren Maureen , Chang Philip 
Published: March 2020

Abstract

Introduction
Complex hand burns require special consideration of therapy practices within the acute setting. Deep hand burns, their associated injuries, and the sequelae of healing can cause significant dysfunction. The purpose of this study was to examine current practices in the inpatient treatment of complex hand burns in order to identify potential trends that may guide clinical practice for edema management, anti-deformity positioning, and range of motion (ROM).

Methods
A confidential internet survey was sent to burn therapists in this country from the American Burn Association (ABA) Occupational and Physical Therapy (OT/PT) Special Interest Group list. One therapist from each burn center was asked to complete the survey.

Results
There were 41 respondents representing 33% of burn centers. The majority of respondents were occupational therapists (78%) from burn centers with 500 or less annual admissions (76%) and more than 16 years of experience treating burn patients (68%). Burn therapists most commonly measure composite (57%) and isolated (51%) joint passive/active ROM, followed by measuring distance from fingertip to distal palmar crease (43%). With questionable or confirmed tendon involvement, the majority (68%) of OT/PTs performed isolated joint techniques, with active ROM the most common at 38%. Therapists initiate edema management, other than elevation, within 24 hours (44%) from the patient’s admission. The most prevalent edema management practice is active exercise (94%) compared to other more aggressive practices such as self-adherent wrap (50%). Anti-deformity orthotics are initiated within 24 hours (44%) and are the most common means of post-graft immobilization (41%). For hand stiffness, 53% of therapists utilize casting. For stiff proximal interphalangeal (PIP) joints, joint mobilization (45%) and thermal modality with ROM exercises (32%) were viewed as the most effective interventions, surpassing orthotics and casting. While 88% of centers utilize an interdisciplinary approach to care for the hand, 59% view the hand as a surgical priority. Percutaneous pins are utilized for joint stability, most frequently in PIP joints (62%) and remained 2–3 weeks on average (45%).

Conclusions
The survey highlights trends directed towards a more conservative management of complex hand burns related to edema management, anti-deformity positioning, and ROM. There is less of a clear consensus among burn therapists on how to approach complicated hand injuries that involve exposed/injured tendons or stiff joints. Interdisciplinary rounds can be utilized to promote communication regarding more aggressive means of therapy intervention in order to improve patient outcomes related to the hand.

Applicability of Research to Practice
Present current trends in the inpatient treatment of complex hand burns.
857 Reconstruction of the Pediatric Upper Extremity Following High Voltage Electrical Burn Injury
Authors: Depamphilis Matthew A , Cauley Ryan , Sadeq Farzin , Sheridan Robert , Driscoll Daniel N 
Published: March 2020

Abstract

Introduction
High voltage electrical burns are often associated with significant morbidity, posing great acute and delayed reconstructive challenges for plastic surgeons. As survival from these injuries increases, attention has been focused on improving quality of life post burn injury through restoration of sensory and motor function. However, due to the complexity of the upper extremity and its small surface area in pediatric patients, its reconstruction can be a very complex endeavor. Especially in pediatric patients that are still growing, ensuing great risk for upper extremity contracture and deformity.

Methods
A retrospective chart review was conducted on patients aged 0–18 years admitted to our institution with a high voltage electrical burn involving the upper extremity. The timeframe under study was 13 years from January 1st 2005 to December 1st 2018. This project was undertaken at our institution as an exempt project under 45 CFR 46.101 and, as such, it was not formally supervised by an Institutional Review Board.

Results
Out of the 68 electrical burns treated at our pediatric burn center, 58 involved the upper extremity. This further divides into 37 patients with high voltage and 31 patients with low voltage upper extremity electric burns. Of the 37 high voltage upper extremity patients, 35 underwent acute surgical management and 18 had delayed surgical reconstruction for the upper extremity.

Conclusions
The reconstructive techniques employed at our institution following severe electrical injuries typically follow a reconstructive ladder. The majority of chronic contractures in our series were successfully treated with either minimally invasive techniques such as laser and steroid infiltration, local tissue flaps, or release and skin grafting. Applicability of Research to Practice Multidisciplinary treatment of severe electrical injuries to the upper extremity is vital to optimizing a patient’s long-term function. Given the significant depth of injury in cases of electrical burns to the upper extremity the risk of developing contractures is relatively high. The expeditious treatment of secondary contractures is important to maximize a patient’s long-term function. The general treatment of contractures of the upper extremity should be based on the location and severity of the contracture, with considerations made for the patient’s reconstructive goals.
868 Guideline for Discharge Opioid Prescription Management in Adult and Pediatric Burn Patients
Authors: Bui An , Williams Felicia N , Chrisco Lori , Sljivic Sanja , Nizamani Rabia , Cairns Bruce , Jones Samuel W 
Published: March 2020

Abstract

Introduction
Pediatric and adult burn survivors are at risk for chronic opioid dependency. Conversely, undertreatment of pain can negatively affect mental health and patient compliance. Overtreatment has arguably led to the current opioid legislation. Despite an opioid-limiting mandate, there has been little direction for streamlining prescribing practices and there has been no guideline established to facilitate prescribing practices for burn patients. We evaluated the efficacy of a standard opioid prescribing schedule (SOPS) for surgical patients admitted greater than four days, based on pain scores, in our adult and pediatric burn patients.

Methods
This was a retrospective review conducted between June 2018 to June 2019 of our prescribing practices compared to a newly established standardized prescribing schedule. All patients admitted to the burn center were included if they had a length of stay longer than 4 days, and were prescribed oxycodone doses between 0-60mg within the last 24 hours of their stay. The primary outcome was amount of oxycodone prescribed upon discharge compared to the doses they received within their last 24hrs before and after the SOPS was established.

Results
The year before the SOPS was developed, we prescribed an average of 140mg of oxycodone to our pediatric patients upon discharge, even when they used 0mg within 24 hours of discharge. We prescribed an average of 165mg of oxycodone to adult patients who required 0mg 24hrs prior to discharge. We prescribed an average of 200mg to adult patients who required 15mg. We prescribed an average of 235mg to adult patients who required 35mg. We prescribed 310mg to adult patients that required the maximum of 60mg within their last 24 hours. This represented 0% compliance. After adopting the surgical standard opioid prescribing schedule to determine doses, we became 87.5% complaint with all patients and saw no increased in readmissions for pain.

Conclusions
An institutional guideline for discharge opioid prescribing practices has reduced the number of opioid pills patients take home, and the risk for overtreatment. A Standardized Opioid Prescribing schedule for burn patients is feasible and merits further investigation.

Applicability of Research to Practice
This study demonstrates the benefits of a standardized prescribing schedule and its applicability to burn patients.
Concussion Symptom Characteristics and Resolution in 20 United States High School Sports, 2013/14-2017/18 Academic Years
Authors: Chandran Avinash , Kerr Zachary Y , Roby Patricia R , Nedimyer Aliza K , Arakkal Alan , Pierpoint Lauren A , Zuckerman Scott L 
Published: March 2020

AbstractBACKGROUNDHigh school (HS) sport-related concussions (SRCs) remain a public health concern in the United States.OBJECTIVETo describe patterns in symptom prevalence, symptom resolution time (SRT), and return-to-play time (RTP) for SRCs sustained in 20 HS sports during the 2013/14-2017/18 academic years.METHODSA convenience sample of athletic trainers reported concussion information to the HS RIOTMsurveillance system. Symptom prevalence, average number of symptoms, and SRT and RTP distributions were examined and compared by event type (practice, competition), injury mechanism (person contact, nonperson contact), sex, and contact level (collision, high contact, and low contact) with chi-square tests and Wilcoxon rank-sum tests.RESULTSAmong all SRCs (n = 9542), headache (94.5%), dizziness (73.8%), and difficulty concentrating (56.0%) were commonly reported symptoms. On average, 4.7 ± 2.4 symptoms were reported per SRC. Overall, 51.3% had symptoms resolve in <7 d, yet only 7.9% had RTP < 7 d. Differential prevalence of amnesia was seen between practice and competition-related SRCs (8.8% vs 13.0%;P < .001); nonperson-contact and person-contact SRCs (9.3% vs 12.7%;P < .001); and female and male SRCs in low-contact sports (5.8% vs 17.5%;P < .001). Differential prevalence of loss of consciousness was seen between practice and game-related SRCs (1.3% vs 3.2%;P < .001); and female and male SRCs in high contact sports (1.2% vs 4.0%;P < .001). Differential longer SRT (>21 d) was seen between new and recurrent SRCs (9.4% vs 15.9%;P < .001).CONCLUSIONHeadache was the most commonly reported symptom. Notable group differences in the prevalence of amnesia, loss of consciousness, and SRT may be associated with more severe SRCs, warranting further attention.