bluuebunny/crossref_metadata_2025_split huggingface dataset:
578 Failure to Follow-Up: Implementation of a Program to Reduce Risk and Engage Patients
Authors: G’Sell David , Phelan Herbert , Smith Sydney , Virgadamo Lacy , Rivera-Barbosa Mario , Mai Kathryn , Carter Jeffrey E 
Published: April 2021

Abstract

Introduction
Establishing a patient-physician relationship creates a duty to meet the standard of care for inpatients and outpatients. Growth in burn ambulatory care, workforce changes, and the digital age of healthcare communications have broadened the definition of the patient-physician relationship and increased ambulatory medical liability especially when patients fail to follow-up (FTF). To mitigate this risk, many professional liability insurers have advised physician practices to implement processes to ensure appropriate follow-up and communication. Our study reviewed a multidisciplinary quality and performance improvement initiative to reduce risk from FTF with a goal to improve patient engagement.

Methods
In response to notification by our medical professional liability insurer, a multidisciplinary team of burn specialists reviewed, designed, and implemented a FTF risk reduction program at an ABA-verified burn center. Burn surgeons, physician assistants (PA), nurses, schedulers, and administrative assistants contributed to the development of the FTF protocol. Patients were discharged with follow-up date and time from inpatients stays or at the conclusion of outpatient encounters. If a patient had a FTF event, three attempts were made to contact the patient starting with the scheduler, followed by the nurse, and finally the PA or MD. Each attempt was documented in the EMR. Compliance with the FTF protocol was monitored twice monthly as a component of the burn quality and performance improvement program. Outpatient encounters were abstracted from the EMR into three categories: completions, cancellations, and FTF over a 4-month period prior to implementation and 4-month period post implementation.

Results
Our analysis included over 2,678 outpatient physician/PA encounters. Prior to implementation patients were intermittently contacted with no consistent processes or documentation in the EMR. Staff compliance with the FTF protocol improved from 83% the first month after implementation to 100% by the fourth month. Interestingly, the failure to cancellation rate remained stable while the failure to follow-up rate declined from 15% prior to implementation to 13% post implementation. Patients failing to follow-up commonly stated that they forgot or had transportation challenges.

Conclusions
FTF protocols are essential to engage patients and reduce ambulatory professional liability. Patients will continue to face FTF challenges with language barriers, transportation issues, natural disasters, and even the pandemic. This study was not designed to reduce cancellations or FTF as it is reactionary. Additional work is needed to reduce all causes of FTF and to improve outpatient engagement.
585 Burn Wound Care for Patients and Families through Video Education
Authors: Beaucock Beverly 
Published: April 2021

Abstract

Introduction
The treatment and care of a burn injury is specialized and can be very intimidating to the patient and family. It is the obligation of the burn team to educate the patient and caregiver at a level where they clearly understand and are comfortable. It is important to be mindful of how others comprehend whether it is visual, auditory, reading/writing, or kinesthetic. When attempting to learn something new, especially when compounded by a burn injury, can be quite challenging.

Methods
Videos of burn injury cleansing techniques and various applications of dressings were produced to enhance patient and family education.

Results
Our analysis of feedback from the patient and family indicates an appreciation for other learning platforms and is a complement to written instructions.

Conclusions
We concluded that by offering video education along with other educational tools, it has enhanced the patient and family experience in the burn center.
589 Methadone in Procedural Care for Burn Injuries of 20–30% Total Burn Surface Area: A Retrospective Chart Review
Authors: Taylor Loryn , Maynell Kimberly , Tran Thanh , Smith David J 
Published: April 2021

Abstract

Introduction
Prolonged opioid usage remains a concern in pain management in procedural care. Recent evidence also suggests that a considerable number of patients who were prescribed opioids struggle with transitioning to non-opioid pain medications. As a continuous effort to reduce opioid consumption following burn surgical procedures, our institution recently evaluated methadone administration for burn procedural care in patients with 20–30% total burn surface area (TBSA) requiring excision and grafting.

Methods
After IRB approval, we performed a retrospective chart review of patients who underwent excision and grafting procedure for 20–30% TBSA burn injuries between January 1, 2019 and June 30, 2020. The following data was evaluated: postoperative opioid consumption, postoperative pain intensity (rated as “No Pain” [NRS=0], “Minor Pain” [NRS 1 to 3], “Moderate Pain” [NRS 4 to 6], “Severe Pain” [NRS 7 to 10]), time to physical therapy and time to hospital discharge. Data was analyzed using chi square/Fisher exact test for categorical variables and t-test/Wilcoxon rank sum test for continuous variables.

Results
Our preliminary data included 12 patients who met inclusion criteria, of which two patients received methadone administration. Our patient sample consisted of average age of 43 years, 75% male, and 24% TBSA (92% were flame burns). Patients in both methadone and non-methadone groups had no significant differences in medical histories and TBSA (23% TBSA in methadone, 25% TBSA in non-methadone). There was no significant difference in reported preoperative pain intensity between the two groups, rating moderate to severe. Postoperative pain intensity remained the same, rating moderate to severe and controlled with fentanyl, oxycodone, morphine and non-opioid analgesics. While there was no difference in postoperative fentanyl, opioid and non-opioid analgesic consumptions between the two groups, morphine consumption was significantly lower in the methadone group compared to non-methadone group (2±2 mg vs 51±54 mg, respectively, p=0.02). There was no significant difference between average time from surgery to first physical therapy session and time to hospital discharge (about 21 days after surgery) between the two groups.

Conclusions
This evaluation shows a potential trend in reduction of inpatient postoperative opioid consumption with the conjunctive administration of methadone, although a bigger sample size is needed for further assessment.
603 Evaluating real-world national and regional trends in definitive closure in US burn care: A survey of US Burn Centers
Authors: Carter Jeffrey E , Amani H , Carter Damien W , Foster Kevin N , Griswold John A , Hickerson William L , Holmes James H , Jones Samuel W , Surgery General , Khandelwal Anjay , Kopari Nicole M , Litt Jeffrey S , Savetamal Alisa , Shupp Jeffrey W , Sood Rajiv , Ferrufino Cheryl P , Vadagam Pratyusha , Kowal Stacey , Walsh Tom , Sparks Jeremiah 
Published: April 2021

Abstract

Introduction
Real-world data is observational data gathered outside of the experimental setting from diverse sources which is analyzed to produce real-world evidence. To better understand the impact of burn center treatment patterns, a national sample survey for real-world data sought to benchmark key burn center practice patterns, resource utilization, and clinical outcomes with national data contained within NBR version 8.0 (NBR).

Methods
A survey was developed by healthcare economists and burn specialists and administered to a representative sample of US burn centers. The survey collected information across several domains, including: burn center characteristics; patient characteristics including number of patients, and burn size and depth; aggregate number of types of procedures; and resource use such as autograft procedure time, length of stay (LOS), and dressing changes; and costs. Nuanced information was collected on care practices and patient outcomes for TBSA burns under 20%. Survey findings were aggregated by key outcomes (LOS, number of procedures, costs) nationally and regionally. Aggregated burn center data were also compared to the NBR to identify trends relative to current treatment patterns.

Results
Benchmarking survey results demonstrated shifts in burn center patient mix, with more severe cases being seen in the inpatient setting and less severe burns moving to the outpatient setting. Additionally, an overall reduction in the number of autograft procedures was observed compared to NBR, and time efficiencies improved as the intervention time per TBSA decreases with TBSA increases. Both nationally and regionally, an increase in costs were observed.

Conclusions
The results suggest resource use estimates from NBR version 8.0 may be higher than current practices, thus highlighting the importance of improved NBR reporting and further research on burn center standard of care practices. This study demonstrates significant variations in burn center characteristics, practice patterns, and resource utilization thus increasing our understanding of burn center operations and behavior.
613Pediatric Burn Bibliotherapy - An Initial Assessment of Novels About Young Burn Survivors and Their Collective Experiences
Authors: Chang Philip H , Barrios Antonella , Heffernan Jamie , Rabbitts Angela , Jedlicka Caroline 
Published: April 2021

Abstract

Introduction
Bibliotherapy is the use of books as a therapeutic intervention for structuring interaction between facilitator and participant based on the mutual sharing of literature. Bibliotherapy has been utilized to address childhood teasing, healthy lifestyles in children, and eating disorders. With the dramatic improvements in survival of burn patients over the past decades, biographies and novels featuring pediatric burn survivors have emerged. These patients often face significant barriers in accessing psychosocial support. Our team hypothesized that bibliotherapy could benefit pediatric burn patients. In order to test this hypothesis, as a first step, our team conducted an assessment of the available burn survivor literature.

Methods
WorldCat book database was queried using the terms “Burn Patient Fiction” (45 results) and “Burn Patient Biography” (53 results). The authors identified 12 books out of these 98 results likely to be appropriate for adolescent and teenage burn patients based on the brief summaries. The 12 books were then read by the research team and analyzed for burn patient demographics and relevant clinical data when available. Simple descriptive statistics were utilized for numerical data

Results
Out of 12 books read, 5 were biographies & 7 fictional novels. Protagonists mean age at time of injury was 8.7±5.1 years (range 2–16), with 5 males and 7 females. Average injury size was 57±21% TBSA (range: 14–85). 10 of 12 protagonists suffered facial burns; 7 of 12 suffered hand burns. Oral health/dental issues were described in 4 of 12 books. Geographically, these English language novels spanned Australia (1), Canada 92), and the U.S. (9). Average page length was 237±88 pages (range: 64–372).
In 11 of 12 books, mechanism of injury involved flame from car accidents (2), house fires (4), and campfires (2).
With regards to sources of positive support during the recovery phase, family was the most commonly cited source (11 novels) followed by friends (10), spiritual/religious support (5), sports (3), burn survivor groups (3), hospital psychiatrists (3), and performing arts (2).
Appropriate audience group for most books were teenagers (11) with 5 books deemed also appropriate for adults (only 1 book judged appropriate only for adults), and 2 books appropriate for adolescents.

Conclusions
Several novels and biographies with pediatric burn survivor protagonists have been written over the past 20 years. Commonalities across these books include flame burn etiology, relatively large TBSA, and burn injuries to visible body areas (face and hand). Family and friends were the most common emotional support for these protagonists. Most books were appropriate for teenagers.
636 Subcutaneous Contracture Band Release in Burn Scars
Authors: Blome-Eberwein Sigrid A , Lepage Lisa , Starner Sophia 
Published: April 2021

Abstract

Introduction
Contracture scars post-burn injury often develop in areas near joints and can restrict movement as well as cause cosmetic deformities.1,2 The goal of subcutaneous scar release is to maximize mobility and minimize the need for invasive procedures which can require more recovery time and cause less aesthetically pleasing outcomes, although this new minimally invasive technique may also be used in conjunction with invasive procedures or after more invasive reconstructions to yield the best functional and cosmetic outcome.

Methods
Retrospective data from May 2016 to July 2019 were collected and analyzed for 28 patients ranging from ages 6 to 68 years old that were diagnosed with a subcutaneous contracture in one or more areas of their body. The data recorded included demographics, procedure specifics and outcomes, patients’ assessments, and areas of which the procedure was most frequently done on.

Results
Of the data available, range of motion per site improved by 19.1 degrees. Average pain scores reported directly after the procedure were relatively low at 1.5 on a 10-point scale. Vancouver Scar Scale scores decreased by 0.6 from pre-operatively (10.7) to post-operatively (10.1). The most frequently occurring areas that subcutaneous scar release was done on was the neck (15), axilla (7), and shoulder (7). Overall, 83% of patients reported being very satisfied or satisfied with the outcome of their procedure.

Conclusions
Subcutaneous scar release improves burn patients’ range of mobility with less residual scarring and less recovery time than standard of care treatments for scar contractures.
639 Maximizing Safe Positioning of Upper Extremities after Axillary Burn Injuries to Prevent Contractures and Maintain Function
Authors: Greiser Connie , Lorello David , Lyons Dan , Richey Karen J , Murray Derek , Foster Kevin N 
Published: April 2021

Abstract

Introduction
Burns crossing over a joint can result in a contracture of that joint. Axillary burns and subsequent contractures are common and may impact negatively on burn survivor rehabilitation. Positioning of burned extremities at the most lengthened position is ideal for maintenance of function and contracture prevention, 90 degrees of abduction is the most accepted position for axillary burn injuries. However, many activities of daily living require shoulder range of motion (ROM) greater than 90 degrees. The primary objective of this study was to describe and examine the incidence of paresthesia, pain, and intolerance in healthy subjects when the shoulder was placed in a position of 90 degrees or greater of shoulder abduction.

Methods
The subject’s nondominant upper extremity (NDE) was randomly placed in a series three of positions, including: (1) 90 degrees shoulder abduction, 30 degrees horizontal adduction with elbow extension, forearm neutral; (2) 130 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral; (3) 150 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral. Each position was maintained for a maximum of 2 hours. Subjects experiencing subjective symptoms including paresthesia lasting longer than 1 minute, pain rated greater than 3/10, and/or intolerance 2/5 was removed from the position. All subjects received at least 30 minutes of rest between positions.

Results
A total of 25 subjects were enrolled, mean age was 25.8 years, the majority were female (60%) and 20% had a history of NDE shoulder injury. The right arm was the dominant extremity (DE) in 88% of subjects. There were no significant differences in ROM between the DE and NDE extremity with the exception of external shoulder rotation, 94.96⁰ vs 84.8⁰ (p=.0142). Average total splint time was 136 minutes with a range of 40 – 360 minutes. Only 1 subject successfully completed all 3 splinting periods. There were 75 individual splinting events over the 3 splinting periods, and 90% of the time the splinting was stopped early. The most common reason for stopping early was paresthesia (88%) followed by pain (7%).

Conclusions
The positions selected represent the routine and usual care at our burn center. Patients are routinely positioned from hours to days depending on patient need. This study demonstrated that healthy subjects were unable to tolerate positioning for even two hours.
644 Use of Plantar Foot Plate Splints and High-Profile Leg Net Devices for Prevention of Plantarflexion Contracture following Placement of Cultured Epidermal Autograft to Lower Extremities
Authors: Dean Brooke , Andre Gregory , Vocke Scott F 
Published: April 2021

Abstract

Introduction
Burn Therapists strive to prevent burn scar contracture through positioning strategies beginning in the acute phase of burn injury. This task is even more challenging when paired with posterior offloading and joint immobilization required for the viability of cultured epidermal autograft (CEA). High profile leg net devices are the standard for posterior offloading after application of CEA circumferentially to lower extremities but can result in poor positioning of the ankle. Custom foot plate splints were designed and fabricated to preserve ankle dorsiflexion during the initial stages of CEA healing.

Methods
The high-profile leg net devices were assembled using 3/4 inch PVC piping and PVC fittings (45 degrees, 90 degrees, and tees) with double layered elastic tubular netting to allow proper wound ventilation while supporting the lower extremity with the patient in supine. The plantar foot plates were custom molded to the patient’s foot using thermoplastic material and lined with medium density temper foam for pressure relief. The foot plate was attached to the frame using Velcro and straps. Instructions with photographs were posted in the patient’s room for nursing staff to reference. Netting was exchanged daily and frames were disinfected using standard techniques.

Results
Goniometric measures were taken for ankle dorsiflexion were taken on day of CEA application with lower extremities positioned on high profile nets (in alignment with cutaneous functional unit modified position): -6 degrees right ankle, -2 degrees left ankle. Repeat measures were taken after one week period of bilateral lower extremity immobilization per CEA protocol: -1 degree right ankle, 2 degrees left ankle. One month follow-up at the discontinuance of leg net devices showed bilateral ankle dorsiflexion preserved with 3-degree right ankle dorsiflexion and 5 degrees on the left.

Conclusions
The use of custom foot plates on high profile leg net devices appears to improve ankle dorsiflexion range of motion while maintaining adequate posterior offloading required for CEA precautions for a burn survivor with extensive lower extremity burn wounds.
530 Case Report of Curling’s Ulcer in Convalescing Burn Patient
Authors: Hunter Lucas , Williams Jeffrey W , Craig Christopher K , McEathron Rachel , Saraswat Anju , Holmes James H , Bailey John K 
Published: April 2021

Abstract

Introduction
Although stress ulcer disease related to burn injury was noted previously, it was the report of a series of 10 cases by Curling which lent the name to the finding. Occurrence of the disease has been attributed to the stress factors of hemodynamic instability with resultant decrease in defense factors of the gastroduodenal epithelium noted as patients began to survive massive burns. At one time, the incidence was reported as high as 23% of hospitalized burn patients. However, with advances in supportive care and antacid therapy, some have wondered if Curlings ulcers may have become extinct.

Methods
We report the case of a 21-year-old male admitted after MVC with 53% TBSA burn (32% full-thickness) and multiple blunt trauma injuries. Early in his course he underwent splenectomy, small bowel resection, right hemicolectomy, and ORIF of an unstable lumbar fracture, and below-knee amputation. He underwent staged excision and grafting of burn wounds and had been autografted with exception of about 11%TBSA of the left lower extremity (wound controlled with allograft). On hospital day 38, the patient was noted to have melanotic colostomy output with a concomitant drop in hemoglobin level from 7.6 g/dl to 3.5 g/dl.

Results
The gastroenterology service was consulted, and they performed upper endoscopy on hospital day 39. A large amount of clotted blood was seen in the stomach, but the source of bleeding was not visualized. Subsequent endoscopy the following day showed an erosion of gastric mucosa in the gastric fundus consistent with ulcer, on which two clips were placed. The patient’s stool was tested for H. pylori antigen and the test was negative. The patient continued on a proton pump inhibitor, non-steroidal anti-inflammatory drugs were held, and his hemoglobin stabilized and melanotic ostomy output resolved.

Conclusions
Antacid therapy, H2-blockers, and proton pump inhibitors have historically been used in cases of large burns. However, in the care of other critically ill patients the association of this therapy with ventilator associated pneumonias has lead to new scrutiny. In addition, a renewed emphasis on multimodal pain management may be introducing a bias towards an increase in so-called aggressive factors, namely NSAIDS administered over longer periods. Advances in critical care of burn patients have made Curling’s ulcers rare, but not extinct.
Providing Effective Mental Health Support for Oncology Health-Care Workers in the COVID-19 Era: Responding Quickly but Carefully
Authors: Major Ajay , Recklitis Christopher J , Bober Sharon 
Published: April 2021

AbstractOncology health-care workers (HCWs) are facing substantial stressors during the current coronavirus disease 2019 pandemic, resulting in a wide range of acute stress responses. To appropriately meet the growing mental health needs of HCWs, it is imperative to differentiate expectable stress responses from posttraumatic stress disorder and mental illness, because traditional mental health interventions may pathologize healthy stress reactions and risk retraumatizing HCWs under acute duress. Further, HCWs are experiencing protracted forms of acute stress as the pandemic continues, including moral injury, and require mental health interventions that are flexible and can adapt as the acuity of stressors changes. Previously developed frameworks to support people experiencing acute stress, such as Psychological First Aid, are particularly relevant for HCWs in the ongoing pandemic. Acute stress interventions like Psychological First Aid are guided by the Stress Continuum Model, which conceptualizes stress reactions on a continuum, from a zone of normal readiness and expectable consequences to a zone of more persistent and extreme reactions such as posttraumatic stress disorder and major depression. Key principles of the Stress Continuum Model include the expectation that emotional reactivity does not lead to psychiatric problems, that interventions need to be appropriately targeted to symptoms along the stress continuum, and that people will return to normal recovery. Various core actions to reduce acute stress include delivering practical assistance, reducing arousal, mobilizing support, and providing targeted collaborative services. This nonpathologizing approach offers a valuable framework for delivering both individual and organizational-level interventions during the coronavirus disease 2019 pandemic.