bluuebunny/crossref_metadata_2025_split huggingface dataset:
564 Managing California’s Creek Fire Mass Casualty’s Incident
Authors: Henry Shana M , Kopari Nicole M , Wolfe Mary 
Published: April 2021

Abstract

Introduction
California’s Creek Fire is not only the largest single wildfire in a state known for huge and destructive blazes, it spawned two rare fire tornados with winds over 100mph, a day after the fire started in early September. Huntington Lake and Mammoth Pool were the sites of these rare events leading to hundreds of trapped campers. An air rescue operation airlifted hundreds of trapped people to safety. Twenty days after the start of the fire, it had burned &gt;300,000 acres with only 36% containment by fire crews. This review is an evaluation of our hospitals response team and the events surrounding that night.

Methods
Our on-call surgeon had called in the back-up surgeon to run a second trauma operating room. It was at this time, the news had reported trapped campers near Mammoth Pool. The burn surgeon was notified and reported to the emergency department (ED) as word of 65 possible victims spread. Local disaster response planning was initiated with an ED physician triaging patients at the regional airport. Initial calls were made to the division chief and burn medical director. The nursing director was notified along with any available nursing staff with 8 ICU nurses volunteering to report. Immediately, lateral transfer orders were placed for all burn patients housed in the burn center which has 10 ICU bed capabilities.

Results
The first helicopter landed with 5 of the burn victims presenting to our hospital. 4 of the victims were male and 1 female with ages ranging from 17 to 27. Total body surface area burn was estimated on each with 2 minor burns &lt; 10% and 3 moderate sized burns of roughly 25%. These patients were quickly triaged in the ED and traumatic injuries evaluated. 3 of the patients were placed in ICU level care with the 2 remaining patients housed in the ED as word trickled in about another rescue effort with an additional 95 people. By morning, an additional 2 patients were transferred to our burn center from the surrounding hospitals and another 2 patients evaluated for burns sustained in separate events. All patients were taken to the operating room over the next 24–48 hours for excision and autologous spray on skin cells (ASCS) in combination with widely meshed skin grafts or ASCS alone.

Conclusions
Communication, teamwork, and personnel that are dedicated to the care of burn patients made this tragic incident manageable. The Creek Fire hit home for many of the burn staff not only because of the patients that were cared for, but because this area of California was a beloved respite for many. A debriefing with a chaplain, grief counselor, and psychotherapist, was held within 2 weeks of the incident to provide support to the staff during this devastating time.
611 Measuring Health Outcomes in Pediatric Burn Survivors: A Systematic Review
Authors: Patel Khushbu F , Rodríguez-Mercedes Silvanys L , Rencken Camerin A , Grant Gabrielle G , Kinney Erin M , Austen Amelia , Hou Carina N , Brady Keri J , Schneider Jeffrey C , Kazis Lewis E , Ryan Colleen M 
Published: April 2021

Abstract

Introduction
Acute burn injuries often result in chronic sequelae that affect functional and psychosocial outcomes. Few prior reviews on pediatric populations report on outcomes across multiple domains. The aim of this systematic review was to identify study characteristics and design of published burn literature that focus on the impact of burns on physical and psychosocial outcomes.

Methods
We included literature published after 1980, focusing on multifunctional burn outcomes in children aged 5–18 years. PubMed and Web of Science were searched with keywords covering broad and domain specific terms (e.g., “pediatric burns”, “outcomes”, “psychosocial recovery”) along with a manual reference check. After screening 751 potential abstracts, each eligible study was systematically reviewed using the McMaster Critical Review Form and assigned a score by two coordinators. Dyad discussions resolved inconsistencies. Extracted data elements included study designs, participant types, measurements, outcomes, clinical and demographic information, and main findings of each study.

Results
Sixty-two studies met inclusion criteria, and outcomes were classified into physical (n=31), psychological (n=53), and social (n=38) domains. The majority of studies were cross-sectional designs (n=33) and received a complete critical review score on all applicable categories (n=42). Study population ranged from six to 678 patients. Half of the studies did not have a comparison group. Patient- and parent-report measures were used in 43 and 41 studies respectively, with 25 studies using both types of measures. Across 62 studies, 85 different measures used, with only nine used in more than three studies. Parents and children generally reported better functioning in social and physical domains compared to age-matched groups, and worse psychological outcomes compared to non-burned population. Physical disabilities were associated with psychosocial functioning in 16 studies. Physical and social functioning improved where follow-up data was reported in six studies. Examples of selected factors that significantly impacted physical and psychosocial outcomes across domains included burn size, pain and itch, visible scars, body image satisfaction, athletic competence, peer relations, and adjustment skills.

Conclusions
This review demonstrated important associations with physical health and psychosocial status as outcomes. Additionally, there is a need for a standardized burn-specific measurement tool. These findings are relevant to burn clinicians and researchers to understand pathways and outcomes that affect quality of life in pediatrics post-burns.
615 The Effects of the COVID-19 Pandemic on Implementation of a Psychological Distress Screening Program after Burn Injury
Authors: Brown Nathan H , Carter Jeffrey E , Nakonezny Paul A , Phelan Herb A 
Published: April 2021

Abstract

Introduction
The relationship between psychiatric conditions and burn injury is complex, as disorders in thought or mood can both predispose to as well as result from thermal injury. We sought to describe our center’s experience with implementation of a psychological distress screening program in the run-up to and during the COVID-19 pandemic.

Methods
We undertook an analysis of de-identified data as part of a quality improvement review focusing on the results of psychological screening of our outpatient burn population. In the spring of 2019, our verified burn center implemented an outpatient screening program consisting of a registered nurse administering three validated test to screen for Post-Traumatic Stress Disorder screen, depression and anxiety, and problematic alcohol consumption to all patients at the time of physically checking in for their first burn clinic appointment. All outpatients triggering a positive screen are subsequently referred to the burn unit PsyD while a negative screen results in monthly repeat screenings until discharge from the burn clinic or a positive screen, whichever comes first. We analyzed data from the last twelve months of normal outpatient workflow. Loess regression was used to analyze the monthly proportions of patients screening positive.

Results
During the peak of COVID-19 in our region, clinic staff were reduced, and screening procedures suspended for the months of March and April 2020. Therefore, the study period consisted of 01 July 2019 to 31 August 2020. A median of 36.5 screens were conducted per month [interquartile range 27.75, 44.75]. Of these screens, 26.5% were positive, with 94.2% successfully referred to the burn unit’s postdoctoral fellow. The Loess regression showed the proportion of patients screening positive for psychological stressors from July 2019 until a peak in November 2019. A downtrend was then noted in the proportion screening positive from December 2019 to date (Figure).

Conclusions
Psychological stressors are prevalent in burn outpatients. We attribute the decrease in positive responses beginning in December 2019 to a combination of a decrease in the frequency of repeat administrations of the screening test in patients after screening positive, and a reluctance of anxious patients to present to the burn clinic for fear of COVID exposure while at the facility.
632 How A Recurring Problem Prompted the Combination of Technologies. Our Institutional Experience with The Simultaneous Application of Poly Lactic Acid Polymer Dressings After Application of Suspension Epidermal Autografts.
Authors: Short Tracee 
Published: April 2021

Abstract

Introduction
Our institution has utilized the suspension epidermal autograft solution since a first application with FDA compassionate use protocol. We have since used this commercially available technology for the management of deep partial thickness and full thickness burn wounds. There is a non-adherent dressing in the commercially available kits to cover the suspension in a semi-porous fashion. We often would have beautifully dressed extremities and trunks only to find that in positions of function the non-adherent layer would pop through the intact staples. We then investigated the source of this discrepancy and found the non-elastic property of the dressing the likely culprit. We then began the process to determine an alternative dressing that could work more efficiently.

Methods
In an effort to determine if the institutional standard of care could be benefitted by this patient-based observation, the charts of patients that underwent simultaneous application of the epidermal autograft suspension and the poly lactic acid polymer dressing were interrogated. The data was identified by the institutional tissue tracker. Once the patient was identified, the chart was then reviewed to determine the desired data points. We evaluated the charts of patients that were recorded as utilizing the suspension epidermal autograft charge as wells charges for the poly lactic acid polymer skin substitute. The charts were then evaluated to determine if there were any deviations from our expected outcomes using the suspension alone.

Results
Our preliminary results indicate that the patients were able to discharge sooner as the wound care associated with the polymer skin substitute is more streamlined. It did not reflect any areas of graft loss but did in 2 instances remained in place longer than our standard. The wound was healed beneath but the skin substitute remained adhered.

Conclusions
The simultaneous use of suspension epidermal autografts and poly lactic acid skin substitutes has become common place for our institution. A quick review as a QI project has resulted in the desire to delve further into comparative data points. A formal retrospective review of the charts will be undertaken for a case series of about 20 patients.
633 Use of an ICU Rounding Tool Enhances Critical Care Learning for Trainees on a Burn Surgery Rotation
Authors: Nosanov Lauren B , Libraro Kaitlyn , Heffernan Jamie , Chang Philip H , Houng Abraham , Gallagher James 
Published: April 2021

Abstract

Introduction
An institutional Burn Intensive Care Unit (ICU) Rounding Tool was implemented for both quality improvement data collection and trainee education. Forms are completed by trainee team members daily for all critically ill patients prior to teaching rounds. Gathered data are structured to facilitate evaluation of patient volume status, sepsis risk and ventilator management. The forms are then used to guide discussion among students, residents, mid-level providers, fellows, attending surgeons and other members of the multi-disciplinary rounding team. We conducted a series of interviews with trainees regarding their user experience to assess the tool’s educational utility.

Methods
A convenience sample of residents who had recently completed their Burn Surgery rotation were interviewed in a structured format. Questions focused on the form’s ease of use and comprehensibility. Emphasis was placed on the extent to which it stimulates learning while rounding. Additional feedback was sought for the purpose of improving the tool for continued use.

Results
Participants were post-graduate year one or two resident physicians training in General Surgery, Urology, Emergency Medicine or Anesthesia. Prior experience and comfort with ICU level care ranged from very little to moderate. All interviewees found the tool helpful in their patient assessments, though the current layout of the form was a frustration for many. Overall, they unanimously found the forms beneficial for preparation of patient presentations and felt that utilization during rounds facilitated learning.

Conclusions
Interviews with trainees on their burn surgery rotation demonstrate that implementation of an ICU Rounding Tool has provided educational benefit, particularly for those less experienced in intensive care. Feedback from this cohort will be used to improve the tool’s usability. Our next steps will include a more formal survey of all trainees involved since the inception of this project.
648 The Negative Impression Makes a Positive Impact
Authors: O’Rourke Cassandra 
Published: April 2021

Abstract

Introduction
Providing timely and appropriate pressure to prevent/address hypertrophic scarring for burn survivors is an ongoing challenge. From time of measurement to obtaining a custom compression garment can be several weeks requiring creative solutions to providing interim pressure, particularly in the pediatric population and even more challenging for a facial burn scar. Historically, fabric custom garments were ordered, then with the advancement of silicone lined materials, clear facial masks could be fabricated. This process started with taking a plaster cast of the survivors’ face, frequently using sedation to allow for optimal fitting, but sedation can change the tone of the facial muscles adding to the challenge. With the advancements in technology, less invasive, more accurate, and more timely fabrication of face masks is possible.

Methods
A 3D picture was taken of a 14-month-old pediatric burn survivor with hypertrophic scarring on the face. This image was uploaded to a 3D printer and a positive print (facial surface down) was completed. The positive print was used to make an alginate mask and plaster was poured to create a casting of the positive printed face. A check mask was pulled from this positive plaster cast (+ mask). This check mask was too large for the patient’s face. To have a better fitting mask, another approach to the mask fabrication was completed. From the same 3D picture, a negative print (facial surface up) was completed. Plaster was poured directly into this negative print to create a casting of the negative printed face. A check mask was pulled from this negative plaster cast (- mask). Both check masks were fit to the patient to assess for accuracy of fit and estimation of required adjustments for optimal fit.

Results
There was a significant difference in the fit of the two masks created from the same 3D picture. The mask pulled on the positive casting was too large. The required adjustments to have the mask fit properly to provide appropriate compression to the hypertrophic scarring on the face would have been extremely difficult and time consuming to complete. The mask pulled on the negative casting fit well and only required small adjustments to ensure adequate pressure would be provided to the focused areas of hypertrophic scars on the face.

Conclusions
With advances in technology, 3D photography partnered with 3D printing allow for significant improvement in the accuracy of fitting facial masks, improve timeliness of compression, and improve the patient experience in the process of obtaining a facial mask.
650 Factors Influencing the Rising Trends in US Physician and Surgeon Suicide Rates 2003–2017: Analysis of the CDC-National Violent Death Reporting System
Authors: Kinslow Kyle , Elkbuli Adel 
Published: April 2021

Abstract

Introduction
With the rate of physician suicide increasing, more research is needed in order to implement adequate prevention interventions. This study aims to identify trends and patterns in physician/surgeon suicide and the key factors influencing physician suicide from 2003–2017.

Methods
Retrospective review of physician and dentists listed as dying by suicide as reported to the CDCs National Violent Death Reporting System (NVDRS) for 2003–2017. Twenty-eight different medical, surgical, and dental specialties were included in our search.

Results
905 reported suicides were reviewed. Physician suicides increased from 2003–2017. Majority of reported surgeons dying by suicide were middle-aged, Caucasian males. Majority of physicians were from North Carolina and 53.5% died by firearms. Orthopedic surgeons had the highest incidence of suicide among surgical fields (28.2%). Compared to the general population, surgeons were 6% more likely to die by suicide at an older age (OR=1.06, 95% CI: 1.04–1.08). Black/African American surgeons were 56% less likely (OR=0.44, 95% CI: 0.06–3.16) and Asian/Pacific Islander were 438% more likely (OR=5.38, 95% CI: 2.13–13.56) to die by suicide. Surgeons were 362% more likely to have a history of a mental disorder (OR=4.62, 95% CI: 2.71–7.85), were 139% more likely to use alcohol prior to dying (OR=2.39, 95% CI: 1.36–4.21), and were 289% more likely to have experienced civil/legal issues (OR=3.89, 95% CI: 1.36–11.11).

Conclusions
The incidence of physician suicide increased over the 2003–2017 time frame with over a third of deaths occurring from 2015–2017. Among surgeons, orthopedics has the highest incidence of reported suicide. Surgeon suicide risk factors include Asian/Pacific Islander race/ethnicity, older age, history of mental disorder, alcohol use, and civil/legal issues.
657 Bilayer Dermal Substitute in Management of Deep Hand Burns
Authors: Hillebrecht Karalyn E , Ziembicki Jenny A 
Published: April 2021

Abstract

Introduction
Bilayer dermal substitutes, composed of bovine collagen cross-linked with glycosaminoglycan and silicone, have become increasingly integrated into the algorithm for management of complex burns. In complex hand burns, dermal substitutes improve functional and aesthetic outcomes while also allowing early excision in high percentage TBSA burns. We detail the outcomes of 17 patients with 25 cases of complex hand burns managed at our center using a staged procedure of cadaveric allografting followed by dermal substitute placement and early definitive STSG.

Methods
Between Jan 2018 and Aug 2019, all patients who sustained deep partial/full thickness burns to their hands managed with dermal substitution were identified. Patients less than 18 yo, with additional non-burn trauma to the hands, and with initial operative management at another center prior to transfer were excluded. A retrospective chart review was used to collect data regarding time to operative excision, placement of allografts and substitutes, definitive STSG, and functional outcome.

Results
17 patients from 18 and 89 yo presented with 25 deep partial/full thickness hand burns. TBSA varied from 0.75 to 78% (mean 17.7%). On average, patients underwent first excision 5.3 (2–16) days after initial burn or 4.2 days after presentation. Our protocol often uses allografting prior to placement of the dermal substitute, therefore, 22 of 25 burned hands received cadaver allografts at initial excision. Dermal substitute was placed an average of 9.2 days later. 3 of 25 burns had immediate application of dermal substitute at first excision. Following substitute, non-meshed, split-thickness autografts were placed on 18 hands. 5 of the burns did not require STSG and two hands were not further evaluated due to loss of patient follow-up. Of the 25 cases, all had near complete incorporation of the substitute without need for revision. In follow-up, patients who did not require STSG have shown no major limitations in ROM/scarring. Of those who underwent STSG, 6 hands underwent contracture release, with 2 of these progressing to amputation. One hand required repeat autografting due to graft loss. All remaining 18 hands healed well with near complete graft take and minimal scarring or functional limitation.

Conclusions
Dermal substitutes assist in the closure of complex deep hand burns. Cadaveric allografting prior to placement of the substitute ensures an appropriately excised wound base, allowing for near complete integration without need for reapplication. Autografting following dermal substitution placement may be initiated earlier than previously pursued and occasionally allows for healing without STSG.
671 Burn Wound Healing Effect of Bromelain-loaded Chitosan Nanofibers
Authors: Kalalinia Fatemeh , Aamiri Nafise , Bayat Samaneh , Movaffagh Jebrail , Hahsemi Maryam 
Published: April 2021

Abstract

Introduction
Bromelain is a mixture of proteolytic enzymes present in all tissues of pineapple (Ananas comosus). It is known as an efficient debriding agent in burn treatment and has been shown to effectively and selectively debride burn eschar. In this study, the efficiency of bromelain-loaded chitosan nanofibers for burn wounds repair was investigated in animal model.

Methods
Chitosan nanofibers containing bromelain were prepared by electrospinning method. The physicochemical characteristics of the synthetized nanofibers, release profile and activity of bromelain loaded in nanofibers were evaluated. The burn healing effect of bromelain-loaded nanofibers were studied in the induced burn wounds in rats for 21 days. The efficacy of treatment was assessed by evaluating changes in wound closer and histological analysis at different time point.

Results
Successful electrospinning of bromelain-loaded chitosan nanofibers resulted in uniform and bead-less nanofibers which released bromelain up to 48h. The formulation kept bromelain enzyme activity after 6-month storage at 4 °C and did not show any cytotoxicity on human dermal fibroblasts. Moreover, in vivo study in a rat burn model confirmed the safety and efficacy of applying bromelain loaded nanofibers in burn wound healing when a significant improve in wound closer was observed in bromelain loaded group and histopathological studies showed more effects on re-epithelialization, debridement and more reduction of necrosis compared to chitosan alone.

Conclusions
Together, these results suggest that bromelain chitosan nanofiber possesses great wound healing activity and could be considered as an effective natural topical burn wound healing treatment.