bluuebunny/crossref_metadata_2025_split huggingface dataset:
621 Discharge Survey of Burn Patients Reveals Concerns About Attending Follow up Appointments
Authors: Solomon Eve A , Phelan Elizabeth , Tumbaga Lilia G , Karashchuk Irina P , Greenhalgh David G , Sen Soman , Palmieri Tina L , Romanowski Kathleen S 
Published: April 2021

Abstract

Introduction
Follow-up appointments are important after a burn injury to minimize adverse sequelae. A retrospective study at our institution revealed that over 25% of patients never attend a follow-up appointment. Failure to follow-up was associated with homelessness, drug use, and distance to the clinic. The purpose of this study was to design and administer a survey prior to discharge that seeks to identify patient-perceived barriers to follow-up.

Methods
A multidisciplinary team consisting of a burn surgeon, medical student, discharge planner, and social worker developed an 18-question survey that examined areas that might influence following up in burn clinic. There were questions regarding transportation, living situation, motivation to return for follow-up, homelessness, drug use, and social determinants of health. As a quality improvement project the surveys were administered to patients discharged following a burn injury by either the discharge planner or social worker from September 2019 to July 2020. Statistical analysis included descriptive statistics of survey responses.

Results
There were 473 patients discharged during the study period. A total of 342 patients completed surveys (72.3% response rate). Most patients (208, 60.8%) were very confident that they would come to a follow-up appointment and stated they had no obstacles to keeping their appointment. The most common obstacles stated were: transportation (143, 41.8%), cost (100, 29.2%), and time off work/school (70, 20.5%). The planned mode of transportation to appointments was being driven by someone else in a personal car (234, 68.4%), the second most common response was that they were unsure of their transportation (29, 8.5%). Patients traveled a great distance to come to the clinic with 188 patients (55%) traveling more than one hour. The most frequent discharge location was the patient’s home (169, 49.4%), with the second most frequent being the home of a friend or family member (95, 27.8%). Sixty-two patients (18.1%) were homeless at the time of admission. When asked about their motivation for following up in clinic the most common response was concern about their injuries/healing (269, 78.7%). The most common levels of educational attainment were high school (149, 43.6%) and College (114, 33.3%). The most common employment status was unemployed (131, 38.3%) and 141 patients (41.2%) made less than $25,000 per year. With respect to substance use, 171 (50%) patients used alcohol, 151 (44.2%) patients smoked, and 82 (24%) patients used illicit drugs.

Conclusions
Many patients are motivated to come to their follow-up appointments but face significant difficulties in coming to appointments due to distance to the clinic, transportation, and cost issues.
625 The Impact of COVID-19 on Burn Care at a Regional Burn Center
Authors: Rogers Alan D , Surg Plast 
Published: April 2021

Abstract

Introduction
The COVID-19 pandemic has had a profound global impact, not least on hospital functioning. Institutions have all had to prepare and adapt to a large number of admissions, and the influence on elective and emergency surgical services, including burn care, has been significant; it may be some time before we know the full extent of this. While many centers were able to commence more normal activities for a while, we are now seeing an exponential rise in cases again, with potentially catastrophic consequences for the provision of burn care.

Methods
A review of all admissions, operative cases and clinic visits between 1 April and 31 August 2020 was undertaken at an American Burn Association verified burn center. These data were compared with the same five-month period in the preceding two years.

Results
Selected data highlights are tabulated (Table 1). During the five months in question, fewer patients were admitted than the previous two years (N=81 versus 121). The mean total body surface area was slightly higher this year (13.7%), and the mean length of hospital stay longer (18 days). The male-to-female ratio of admitted patients was greater during the five months of 2020, at 2.9:1, compared to 1.7:1. No significant differences in terms of etiology were detected, however. As expected, clinic visits reduced dramatically from a mean of 160 patient visits per month to just 81 per month, with the majority conducted virtually. During 2020 the operative cases were similar in number to previous years (N=176), but the mean duration was significantly longer (190 minutes). The total time utilised for burn surgery was similar to previous years (572 hours).

Table 1. Selected burn center data comparing 2020 with 2019 and 2018.

Conclusions
This study demonstrates that although total admissions were slightly reduced, the demands on Burn ICU bed resources and burn operating time were similar. The data supports the notion that removing scheduled operating time for our service resulted in less efficient execution of acute burn surgeries and longer hospital stays. Although formal clinic visits were significantly reduced and were mainly conducted virtually, several patients were satisfied by a novel and user-friendly email service conducted by our clinic nurse specialist.
627 Strategies for Reducing Emergency Department Lengths of Stay for Admitted Pediatric Burn Patients
Authors: Shostrand Lisa M , Hartman Brett C , Frazee Belinda , Daniels Dawn , Zieger Madeline 
Published: April 2021

Abstract

Introduction
Various strategies to reduce emergency department (ED) lengths of stay (LOS) for admitted pediatric burn patients may be employed as a quality improvement project. Decreasing ED LOS may promote patient outcomes and reduce morbidity. Initial discussions were brought forth during trauma and burn multidisciplinary peer review rounds in March 2019 and have persisted to present day.

Methods
Several strategies, such as preparation of the burn unit staff within one hour of patient arrival in ED, notification to the burn unit by the burn attending of an incoming pediatric burn patient, allowing the PICU charge nurses or advisors to assist with room set up and admissions, and creating a checklist to assist PICU nurses and advisors in helping prepare for anticipating inpatient admissions. These strategies were designed and enforced in March/April 2019. In addition to these action plans, trauma activation alerts were added in December 2019 to the burn charge nurse phone for pediatric burn trauma one and trauma alerts for more expedient notifications. Finally, communication efforts between ED and burn leadership teams were conducted in June 2020 to help with additional mitigating of ED LOS, such as discussing the appropriateness of specialty consults while in the ED.

Results
Initial ED LOS was reduced from 209 minutes in March 1019 to 150 minutes in June 2019. Increased trends were noted in early 2020, with a peak at 244 minutes in July 2020. Additional interventions, such as trauma activation alerts and ED/Burn team communications, did not provide sustainable long-term reductions.

Conclusions
Recent strategies to reduce overall ED LOS trends have been beneficial, but not consistent, in sustaining downward trends. Action to perform a gap analysis to discover persistent barriers and to introduce additional structure, such as a burn trauma one algorithm, may provide stability to this metric.
628 Venous Thromboembolism Prophylaxis in Burn Patients: Analyzing the Effectiveness of a Standardized Protocol
Authors: Folliard Sarah A , Gabbert Jared L , Rumbaugh Kelli , Thompson Callie M , Oleis Cathy 
Published: April 2021

Abstract

Introduction
Burn patients have a high risk of developing venous thromboembolism (VTE) due to extensive immobilization, surgical interventions, endothelial injury, and the presence of polytrauma. Studies have shown VTE rates ranging from 0.25% to 23.3% in this patient population. Although burn patients have a greater risk for VTE compared to other hospitalized patients, there are no standardized guidelines on how to approach VTE prophylaxis in the burn population. In March 2018, the Burn Intensive Care Unit (BICU) implemented a new VTE prophylaxis protocol that stratified patients based on risk factors for VTE. Patients were started on enoxaparin 30mg every 12 hours or 40mg every 12 hours depending on body mass index (BMI). The purpose of this study was to examine compliance with the new protocol and overall rates of VTE in the burn population.

Methods
A single-center, retrospective analysis was conducted from March 1, 2018 to July 31, 2018. Patients included were admitted to the BICU with a documented burn injury for at least 48 hours and were ≥ 18 years of age. The primary outcome was compliance with the VTE prophylaxis protocol. Secondary outcomes included reasons for non-compliance and incidence of VTE events.

Results
Out of 105 patients that met inclusion criteria (median age, 53 years [36 to 63]; BMI 27.1 kg/m2 [25.7 to 33.2]; total body surface area 6% [3% to 18%]), the protocol was correctly utilized in 81 patients (77%). The most common reason for non-compliance to the protocol was incorrect dosing (60.9% [14/105]). Of 105 patients, 1 (0.9%) developed a VTE.

Conclusions
Overall, the compliance to the Burn Intensive Care Unit VTE pharmacologic prophylaxis protocol has room for improvement. Despite following the protocol, one VTE event occurred during the five-month study period. To improve compliance, additional education and training regarding the dosing of and monitoring anti-coagulants was provided to nursing and medical staff.
634 Utilizing Simulation Based Training to Teach Wound Management Strategies When Caring for Burns Treated with Autologous Skin Cell Suspension
Authors: Bell Cameron C , Johnson James E 
Published: April 2021

Abstract

Introduction
Simulation based training (SBT) is an experience meant to replace real-life events with guided simulated clinical scenarios. The goal is fully interactive training that closely replicates the real world. SBT is well known in military and aviation and has been well integrated into the education of new nurses and physicians however, it has not been fully integrated into the ongoing development of skills for clinicians practicing in hospitals that are learning new technologies. Following FDA approval of a regenerative medicine platform that prepares autologous skin cell suspension (ASCS), an opportunity was identified to augment conventional training with a SBT educational program giving clinicians the opportunity to practice wound care in a simulated learning environment.

Methods
A prototype was developed alongside experts from a university-based experiential learning center. It included an anatomical silicone mold of a thigh (model) with silicone cartridges of ASCS treatment areas (excised deep partial-thickness burn with dermis and excised full-thickness burn with wide meshed split thickness skin graft). The cartridges fit in a depressed area of the thigh and can be exchanged between case scenarios. The cartridge allows for moulage to be applied, enhancing the life-like appearance of the model. The initial prototype was tested during a pilot with burn center staff. A total of 4 case scenarios related to ASCS aftercare were evaluated. Following the pilot, the program was demonstrated to our internal clinical team to gain additional insight. The feedback was incorporated into a final design.

Results
There were 17 participants in the pilot training (6 hands-on/11 observers). All hands-on participants either agreed or strongly agreed that SBT was useful to their clinical practice. Comments included: “Very realistic”, “really liked the hands-on”, “confidence booster”, “these are the most common scenarios we see”. One participant commented that even though she had never participated in an ASCS dressing change, she has the confidence to do so now. Soliciting feedback from our internal team on the design and portability of the model was an important step to ensure barriers to use were removed. To date, 11 training systems including models, cartridges, case scenarios, debrief tools and dressing kits have been distributed with a total of 30 systems expected by the end of 2020.

Conclusions
During development of the SBT program, input from clinicians and educators helped gain insight to the program and ensured the scenarios were relative to real-world experiences. Early findings suggest SBT is a value add for clinicians caring for patients post ASCS application.
635 Free Versus Pedicled Flaps for Primary Reconstruction of Electrical Injuries: A Systematic Review and Observational Meta-Analysis
Authors: Khoo Kimberly , Bashour Laura , Peterson Joshua M , Padilla Pablo L , Mulay Sagar R , Dziewulski Peter 
Published: April 2021

Abstract

Introduction
Both high-voltage (&gt;1000 V) and low-voltage (&lt; 1000 V) electrical burns can cause serious injuries due to dissipation of heat as electric current passes through deep tissues. Because of tissue loss and vital structure exposure, flap-based reconstruction is frequently performed in patients with these injuries. Depending on clinical presentation, both free and pedicled flaps may be indicated. We wondered if reported reconstructive outcomes after electrical injury differ between free and pedicled flaps when implemented in the immediate post-injury period.

Methods
A systematic literature review following PRISMA guidelines was conducted using PubMed and Ovid MEDLINE databases. Articles that were included described patients with electrical burn injuries who underwent reconstruction with either free or pedicled flaps within 90 days of injury. Technique articles or articles lacking outcomes analysis were excluded. Data was extracted from articles that met inclusion and exclusion criteria, including flap type, timing of reconstruction, complications, and patient demographics. Statistical analysis was performed with chi-square tests.

Results
Of 536 articles obtained from the literature search, 37 met criteria. To date, no randomized control trials comparing these modalities have been performed. In total, these studies reported on 364 total patients who experienced high- and low-voltage electrical burn injuries. Pooled reported outcomes of 374 flap reconstructions were analyzed, including 145 free flaps and 229 pedicled flaps. Reported complication rates did not differ significantly between free flaps (30/145, 20.7%) and pedicled flaps (46/229, 20.1%; p = .89). However, free flaps experienced significantly higher failure rates than pedicled flaps (13/145, 9.0% vs. 0/229, 0%; p = &lt; .05).

Conclusions
Electrical burn injuries present a unique indication for flap-based reconstruction in the immediate post-burn phase of care. However, substantial variation exists amongst physicians regarding whether to proceed with a free flap or pedicled flap surgery when indicated. Our data identified an overall significant difference between free versus pedicled flap failure rate but did not identify a significant difference between overall complication rates.
638 Biodegradable Temporizing Matrix in Combination with Wide Meshed Graft and Autologous Spray Cell Suspension (ASCS) Graft Can be Used for Reconstruction of Extensive Necrotizing Infections: A Case Report
Authors: Olivi Joe A , Rodgers Megan D 
Published: April 2021

Abstract

Introduction
Background: A necrotizing infection of the left upper extremity underwent extensive debridement with remaining exposed muscle, tendon, and bone. BTM was used to provide an acceptable temporizing matrix in conjunction with wide meshed split thickness skin graft (STSG) 3:1 ratio and ASCS graft for successful reconstruction. This left a functional limb and avoided arm forequarter amputation.

Methods
Case Presentation: We present a 67 y/o male with necrotizing infection who underwent extensive surgical debridement of skin and subcutaneous tissues of the left hand, forearm, and upper arm. BTM was applied for coverage over muscle, tendon, and bone to salvage his arm and avoid forequarter amputation. Following maturation of the BTM a 3:1 ratio STSG was placed along with application of an ASCS graft. A vacuum assisted closure (VAC) dressing was successfully used to stabilize the grafts. One month post grafting the wound was approximately 94% healed, with good range of motion, and limited but improving function of his arm.

Results
Conclusion: Necrotizing infection extremity reconstruction can be achieved with BTM, wide meshed STSG, and autologous ASCS grafting. A wound VAC provided a safe and effective dressing over these grafted mediums.

Conclusions
Conclusion: Necrotizing infection extremity reconstruction can be achieved with BTM, wide meshed STSG, and ASCS epidermal autograft. A wound VAC provided a safe and effective dressing over these grafted mediums.
641 North American Practices for Facial Massage and Stretching Post Facial Burns
Authors: Barwick Alexa , Nakamura Dana Y , Holmes James H , Molnar Joseph 
Published: April 2021

Abstract

Introduction
Facial burns can be complicated by the development of scar tissue and contractures, resulting in decreased flexibility of the tissue involved in swallowing, facial expression, and verbal communication. Maximizing functional range of motion is an important preventative measure for improving functional outcomes for swallowing, communication, and for the prevention of microstomia. A range of therapy interventions including stretching, massage, compression, and use of appliances has been reported in the literature; however, there is limited to no information on current practice patterns amongst North American providers (MD, DO, PA, NP, etc.) or therapists (PT, OT, and SLP).

Methods
A RedCap survey was developed by a Speech-Language Pathologist and Occupational Therapist involved in burn care. The survey consisted of 18 total questions, with participants responding to between 12–13 questions due to branching logic. Questions were related to demographic and service provision related to facial massage and stretching. Survey questions were multiple choice, multiple answer multiple choice, or contained text boxes. The survey was distributed to Providers and Therapists from the United Stated of America and Canada who were members of the American Burn Association (ABA).

Results
A total of 69 surveys were collected, with 57 surveys meeting criteria for inclusion. Respondents consisted of therapists 68%, providers 23%, and other health professionals 9%. Forty-six ABA burn centers from across the United States and Canada were represented. The majority of respondents had over 10 years of experience working with burn patients. 91% of respondents reported that facial massage and stretching was used as a tool at their facility. Respondents, who report facial massage is utilized at their facility, report OT as being the primary discipline responsible for assessing (67%) and completing (65%) facial massage, with 85% reporting additional discipline(s) also participating in facial massage. 9% of respondents report that facial massage and stretching is not utilized at their facility following facial burns. Of those who responded that facial massage and stretching is not utilized following facial burns, 40% felt this would be beneficial to patients, while 60% were unsure.

Conclusions
Facial scar management is an important part of burn care, with the majority of respondents reporting completion of facial massage and stretching as part of the services provided to patients who have suffered facial burns. OTs are the primary service providers for facial massage and stretching post facial burn. Practices for facial massage varies greatly, with the majority of respondents reporting no specific protocol for facial massage and stretching is followed.
646 Telehealth in Burn Rehabilitation: Virtual Objective Measures
Authors: Siwy Katherine G 
Published: April 2021

Abstract

Introduction
The COVID-19 pandemic thrusted many burn therapists into the world of telehealth overnight. While telehealth has been widely utilized since and has played a vital role in burn care overall, adaptation of platform has been minimal amongst burn therapists. As more hospital systems integrate telehealth as a service delivery mode, there is a need for guidelines on how to capture data collection and recommended documentation language which indicates progress and justifies therapy.

Methods
The following virtual visit documentation and objective data collection guidance form was created in an effort to capture ability, disabilities, limitations and barriers of the burn survivor participating in the burn rehabilitative virtual visits. The guidance form is intended to demonstrate examples of data collection can be captured in the virtual environment along with pointers to enhance the experience and recommended documentation language. It is not all inclusive, nor are all the tests listed necessarily required for a successful virtual interaction. (Attachment A)

Results
Despite the inability to perform formal standardized objective measurements, a burn therapist is still able to measure and document gains and losses. Posture, gait, range of motion, skin integrity, strength, motor control, body mechanics, coordination, adl’s, functional mobility, transfers are a few of the many categories which a burn therapist can focus their documentation.

Conclusions
When appropriately administered and thoroughly documented telehealth can not only provide quality care to burn survivors but also demonstrate gains to optimal outcome goals and return to baseline levels of independence with ADLs, IADL’s, mobility, transfers, range of motion, strength and sensation.