bluuebunny/crossref_metadata_2025_split huggingface dataset:
514 Duration of Nebulized Heparin for Inhalation Injury
Authors: Zavala Sarah , Chowdhury Ibrahim , Moomey Kyle , Liu Yuk Ming 
Published: April 2021

Abstract

Introduction
Inhalation injuries (IHI) are a major source of morbidity and mortality in burn patients. The purpose of this study is to evaluate short versus long duration of nebulized heparin in IHI and its effect on ventilator-free days.

Methods
This was a single-center retrospective analysis of adult patients with bronchoscopy-confirmed IHI admitted to a large academic medical center with an American Burn Association-verified Burn Unit between March 2013 and March 2018, who received nebulized heparin 10,000 units every four hours for three days or until the patient no longer had carbonaceous sputum, whichever is longer. Patients were excluded if they expired within 24 hours, had less than 48 hours of mechanical ventilation, or were made comfort care. The primary outcome was ventilator-free days of the first 28 days. Secondary outcomes include in-hospital mortality, length of hospitalization, baseline and day 3 lung inhalation score, reintubation, discharge disposition, and major and minor bleeding events. Baseline demographics were compared using descriptive statistics. Nominal data was compared using Chi-square test. Continuous data was analyzed using student’s t-test or Mann-Whitney U test, as appropriate. A sample size of 24 patients to be appropriately powered (β = 0.2; α = 0.05) was required to show a mean difference of 8 days on the ventilator.

Results
A total of 40 patients were included in the study. Eleven patients received nebulized heparin for three days or less, and 29 patients received nebulized heparin for more than three days. Patients were primarily white, middle-aged males. More patients in the short duration group had a history of never smoking (4 vs 1, p = 0.04), and patients in the long duration group had a higher grade of inhalation injury (grade 3 vs grade 2, p = 0.01). Median ventilator free days of the first 28 was 4 days for the short duration group and 6 days for the long duration group (p = 0.88). There was no significant difference in length of hospital stay (12 days vs 20 days, p = 0.12), lung injury score, incidence of ventilator associated pneumonia, or bleeding events. No major bleeding events occurred.

Conclusions
This study introduces the potential use of carbonaceous sputum as a clinical marker for directing therapy and using a shorter duration of therapy as compared to previous studies. There was no difference found in ventilator free days between groups, and this study affirmed the safety of using nebulized heparin for IHI.
528 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: April 2021

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 the 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.
538 Antishear Therapy for Toxic Epidermal Necrolysis: A Follow-up Study
Authors: Haravu Pranav N , Gottlieb Lawrence J , Vrouwe Sebastian Q 
Published: April 2021

Abstract

Introduction
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN) are life-threatening dermatologic conditions, which are best approached by a multidisciplinary team practicing burn-equivalent care. There is a lack of consensus on wound management in these patients, in particular whether to debride detached epidermis. Our center instituted “antishear” wound therapy thirty-five years ago, where detached skin is left in situ as a biologic dressing. A standardized protocol aims to avoid shear forces to prevent further desquamation of involved areas. In this study, we follow-up on our outcomes with antishear therapy during the latter half of our center’s experience.

Methods
A retrospective chart review was conducted for all patients admitted between July 2004 – May 2020 with a Dermatologist-confirmed diagnosis of SJS/TEN. Patients admitted with non-SJS/TEN dermatologic diagnoses and those treated outside of the burn center were excluded. All patients were treated with burn-equivalent critical care and antishear wound therapy. Data was characterized by demographics, inciting agent, total body surface area (%TBSA) affected, hospital course, and any administered systemic therapy. Univariate regression was performed to identify factors that increased mortality. Standardized mortality ratios were calculated at each SCORTEN level and in aggregate.

Results
Of the 51 patients that met inclusion criteria, 10 (20%), 22 (43%), and 19 (37%) developed SJS (&lt; 10% TBSA), SJS/TEN overlap (10%-30% TBSA), and TEN (&gt;30% TBSA) respectively. Mean SCORTEN (day 3) and %TBSA were 2.6 and 28%, respectively. Overall mortality was 22%; SCORTEN (p&lt; 0.001), %TBSA involvement (p&lt; 0.02), and development of multi-system organ failure (p&lt; 0.001) correlated with increased mortality. No mortality was observed for patients with a SCORTEN ≤2. Patients with SCORTEN scores of ≤3 and &gt;3 had standardized mortality ratios of 0.63 (p=0.21) and 0.78 (p=0.17), respectively, representing 37% and 22% reductions in mortality. The standardized mortality ratio across the entire cohort was 0.73 (p=0.14), representing a 23% reduction in mortality.

Conclusions
Incorporating the antishear approach as part of burn-equivalent care in SJS/TENS patients is an effective alternative with equivalent mortality outcomes compared to SCORTEN predictions. Standardized mortality ratios were lower for patients with SCORTEN ≤3 and SCORTEN &gt;3, but limited sample size reduced ability to show statistical significance.
545 Pharmacologic and Comorbid Factors Associated with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome
Authors: Africa Robert , Mobli Keyan , Hallman Taylor , Schober Marc , Torres Mark Jason , Wermine Kendall , Gotewal Sunny , Cuartas-Olarte Andres , Ozhathil Deepak K , Song Juquan , El Ayadi Amina , Golovko George , Wolf Steven E 
Published: April 2021

Abstract

Introduction
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis syndrome (TENS) share immune-mediated etiology for epidermal detachment and pharmacologic triggers. Both conditions are on a spectrum of diseases of varying severity, with TENS representing the graver end of the continuum. The demographics and comorbidities of this population remain relatively unknown due to their rare incidence. Comorbidities determine the causative drugs used, but also afford triggers for the autoimmune cascade resulting in SJS or TENS. We analyzed the trends of comorbid and pharmacologic risk factors associated with these diseases in over 3,000 patients.

Methods
We used the TriNetX Global Health Research Network from 2009–2020 to identify 3,515 patients diagnosed with SJS or TENS (ICD-10 codes L51.1–51.3). We then obtained annual demographic and comorbidity data. We indexed patients into cohorts that were prescribed a high-risk drug as previously reported in the literature to be associated with SJS and TENS development. Our control cohort consisted of patients that did not take these high-risk drugs. These cohorts were analyzed to identify the relative risk of developing SJS or TENS 4 to 56 days after taking a high-risk drug. Similarly, we excluded co-medication of the other high-risk drugs and compared these patients to our control group.

Results
The mean age was 46 with a female predominance (59.8%). The most common comorbidities were hypertension (20.2–21.3%), mood affective disorders (12.4–15.8%), or kidney disease (11.6–12.8%), and the prevalence of these have remained constant. Phenobarbital had the highest risk for these diseases (RR: 20.2, CI: 13.58–29.93), with carbamazepine second (RR: 14.1, CI: 8.68–22.85). After excluding other high-risk medication, phenobarbital continued to be associated with the highest risk (RR: 30.3, CI: 16.12–56.73), followed by phenytoin (RR: 25.3, CI: 13.51–47.53) and carbamazepine (RR: 24.7, CI: 13.74–46.34). Well reported triggers like sulfamethoxazole, allopurinol, and sertraline only represented moderate risk (RR: 7.7, CI: 6.11–9.83; RR: 5.2, CI: 2.77–9.73; RR: 1.7, CI: 0.90–3.16) even after excluding co-founding factors.

Conclusions
This study suggests that seizure disorder medications such as phenobarbital, carbamazepine, and phenytoin demonstrate the highest risk for developing SJS and TENS.
550 A retrospective Study of a Zinc-oxide/dimethicone for Pediatric Perineal Burn Treatment
Authors: Diab Waseem , Ridelman Elika , Cloutier Dawn , Vitale Lisa C , Klein Justin D , Shanti Christina M 
Published: April 2021

Abstract

Introduction
Silver-based treatments have seen widespread use for the management of burns. Recent literature, however, has demonstrated silver nanoparticles may negatively impact healing time due to its toxic effect on keratinocytes and fibroblasts at higher concentrations. At our institution, an ABA-verified pediatric burn center, the use of a silver sulfadiazine cream for management of post-discharge perineal and genital burn wounds has been replaced by a zinc-oxide/dimethicone spray-on solution initiated for its comparative ease of use. The dimethicone allows the spray to be occlusive without interfering with clothing, yet easily removed. We believed this would improve compliance with at-home treatments. Zinc-oxide’s antimicrobial activity has been demonstrated in vitro and the results from animal studies are promising for burn management. This is the first study of zinc-oxide’s efficacy as a burn management agent in humans. Our burn center’s experience with both silver sulfadiazine and zinc-oxide/dimethicone creates an opportunity to compare these products for the treatment of burn wounds. We sought to analyze the time to healing of burns treated by silver sulfadiazine against zinc-oxide/dimethicone in order to determine if zinc-oxide/dimethicone, in its easy-to-use form, is a viable alternative to silver sulfadiazine.

Methods
A retrospective review of medical records was conducted at a large pediatric verified burn center. Data on 98 patients was collected from the burn registry and electronic medical records. 58 patients received silver sulfadiazine while 40 received zinc-oxide/dimethicone. Four patients were removed from the silver sulfadiazine group due to incomplete data. All patients were initially treated by the burn team with follow up in burn clinic on a weekly basis until healing was achieved.

Results
Time to healing was significantly lower in the zinc-oxide/dimethicone intervention group (10.61 +/- .918 days) than the silver sulfadiazine control group (16.88 +/- 2.134 days). The silver sulfadiazine group contained patients with total body surface area burns significantly greater than the zinc-oxide/dimethicone group (mean: 11.57% versus 6.64%); likely due to selective treatment when zinc-oxide/dimethicone was first introduced at our facility. Differences in depth and size of burn wounds may have confound our results and negatively impacted healing time in the control group. No infection, allergic reaction, or other adverse events were noted in any patient.

Conclusions
Zinc-oxide/dimethicone had a significantly lower healing time than silver sulfadiazine in the treatment of at-home, post-discharge 2nd degree pediatric burns to the perineum, genitalia, suprapubis, and buttocks. Further study is needed to quantify its efficacy.
572 Integrating Shared Governance Principles with Real-time Technology to Improve Infection Rates in a Large Burn Center with Patients of Varying Acuity Levels
Authors: Echols Jane , Gamble Ashley , Berry Lisa , Dowling Lynn , Wheeler Michael 
Published: April 2021

Abstract

Introduction
Increased job satisfaction, and nursing retention are outcomes that have been related to nursing empowerment.1 Probably one of the most beneficial results of nursing empowerment is improved patient outcomes.1 Empowering nurses is not always an easy task, but the nursing best practice of shared governance through unit-based councils gives nurses the ability to mobilize resources within their own groups to get things done. Couple this mobilization of resources with real-time technology that provides a true clinical picture of outcomes, and this creates a template for success.

Methods
This is a nursing Quality Improvement project. Shared governance in the form of unit-based councils created within all of our patient care units has proven to be part of the equation for improved infection rates in all units. Our number of CAUTI AND CLABIS from 2018–2019 were reduced, we significantly reduced the number of device days (hospital-wide) for both foleys and central lines, which was also a goal. Through extensive nursing education, utilizing nurse driven protocol for foley removal, increased use of bladder scanning (each unit now has their own bladder scanner) and teaching about de-escalation of central lines/PICC lines as soon as possible, we have been able to reduce our device days overall.
Alongside this nursing best practice, a new nursing data portal that allows for real time data collection to identify breaks in protocol with regards to central line and foley maintenance leading to CAUTIs and CLABSIs was also implemented, which allowed nursing to have direct impact on achieving success.

Results
Percent Change
2018 – 2019
CAUTI
BU = 83% decrease, 3E burn = 100% decrease, 4W burn = 100% decrease
Overall decrease = 90%
CLABSI
BU = 85%, 3E burn = 67% increase, 4W burn = no change
Overall decrease = 78%

Conclusions
Implementation of nursing best practice efforts such as shared governance and unit-based councils, coupled with cutting edge technological resources directly contribute to improved infection rate outcomes. Another result of these efforts is the overall positivity fostered among nursing staff, boosting their sense of empowerment and creating better retention rates in all our units.
573 A Novel Nursing Approach in Reducing Catheter-Associated Urinary Tract Infections in a Regional Burn Center
Authors: Smith Lisa C , Phillips Alexis T , Cox Carrie A , Orosco Rowena , Flores Carolina , Caffrey Julie 
Published: April 2021

Abstract

Introduction
Catheter-associated urinary tract infections (CAUTI) adversely affect more than 30% of patients in critical care hospital settings. Considered one of the most prevalent of nosocomial infections, CAUTI are linked to extended hospital stays, rising health care costs, and increased morbidity and mortality. CAUTI are attributed to prolonged catheter use, contaminated catheter insertion, and improper care and maintenance. Adhering to infection control guidelines is essential in preventing CAUTI in healthcare institutions. To illustrate, nearly 380,000 CAUTIs could be prevented and 9,000 lives saved, annually, with the prevention of CAUTI (Centers for Disease Control and Prevention, 2019).

Methods
Over the last nine months, our burn team has been working to reduce the CAUTI Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR) in the Burn Center. Efforts to facilitate this reduction include the education of nurses and providers on the indications for placement, replacement, and removal of indwelling urinary catheters. We also developed and assigned a PowerPoint presentation and post-assessment to staff members to educate and measure their understanding of the proper care for patients with urinary catheters in place. The hospital facility’s protocol was revised to reflect the specific needs and alternatives for urinary catheters in our burn patient population. The new burn specific protocol now serves as a guideline for the multidisciplinary team during daily rounds to reduce the risk of CAUTI in the Burn Center. Charge Nurses continue regular audits.

Results
The SIR benchmark for 2019 was 0.774. The SIR for the Burn Center in the third quarter of 2019 was incalculable because the predicted number was less than one. The SIR for the fourth quarter of 2019 was 0.913. The SUR benchmark for 2019 was 1. The SUR for the Burn Center in the third and fourth quarters of 2019 were 1.035 and 1.150, respectively. This data indicated the need for a comprehensive plan for improvement.
Following the implementation of our team’s comprehensive improvement plan, the SIR and number of infections for the first quarter of 2020 was zero, which is below the SIR benchmark 0.727 for 2020. The improvement plan we instituted also reduced the SUR to 0.897 for the first quarter of 2020, compared to the benchmark of one for 2020. The SUR rate for the second quarter was 1.118.

Conclusions
Instituting this simple nurse-driven protocol has resulted in a noteworthy improvement in patient outcomes. Achieving benchmark goals remains a significant priority to our burn center team as we continue to see the progress and health benefits of fostering the safest care environment for our patients, while remaining financially responsible to our institution.
579 Benefits of Licensed Clinical Social Worker Utilization in an Adult Burn Clinic: More Than Just Checking the Box
Authors: Broers Michelle , Wojcik Jodi , Journey Lindsey k 
Published: April 2021

Abstract

Introduction
Our burn institution cares for critically ill burn patients and provides post-acute care for a large referral base. The clinic is staffed by a wound certified physical therapist, an advanced practice registered nurse and a licensed clinical social worker (LCSW), with consult access to Trauma/Burn Surgeons. The incidence of acute stress symptoms after burn injury is noted in up to 35% to 40% of patients. Therefore, it is important to identify symptoms of anxiety and depression early and begin symptom management. Burn patients have access to a multi-disciplinary team, and a licensed therapist, that can identify symptoms of acute stress and make recommendations for appropriate treatment in concert with the medical staff. This project seeks to determine the prevalence of acute stress in post-acute burn patients seen in an adult burn clinic and the benefits of utilizing a Licensed Clinical Social Worker to perform screening.

Methods
For a one-year period all burn patients in the burn clinic were screened by the LCSW. The subjects underwent initial screenings for depression, anxiety, and suicide risk at their first clinic visit. The PHQ-2 and PHQ-9 were utilized to assess depression, the GAD-7 for anxiety and the Columbia Suicide scale to assess suicide risk. Patients were initiated into multi-modal therapies based on specific scoring. These intervention strategies were based on the Depression Screening Protocol which included education on depression, and/or anxiety, with or without participation in a Trauma/Burn Peer Support Group. Patients were prescribed medication per provider discretion, and/or connected to community resources such as, counseling, and psychiatric mental health services.

Results
During the one-year assessment period screening compliance was &gt;90%. During this period, &gt;50% of patient’s scores were clinically significant for acute stress. Over half of those that screened positive were connected to community resources of counseling services or psychiatric care. 100% of those that screened positive were given education and connection to peer support services. An incidental correlation was noted between increased total body surface area involvement and work-related accidents with increased symptomology.

Conclusions
The inclusion of an LCSW in the burn clinic has improved the overall care of the burn injured patient. The assessment of depression and anxiety related to the burn injury has led to an increase in peer support participation and an increase in referrals to counseling and/or psychiatric services.
582 A Survey of Burn Care Providers Regarding the Utility of Telehealth to Provide Outpatient Burn Care
Authors: Foster Kevin N , Jacobsen Sarah J , Jain Arpana , Peck Michael , Richey Karen J 
Published: April 2021

Abstract

Introduction
Telehealth is purported to be the wave of the future, offering improved access to care by overcoming geographical and other logistical challenges while simultaneously improving efficiencies within the healthcare system. As the global COVID-19 pandemic swept through our state, we were abruptly forced to take our burn clinic to a telehealth platform for most patients. The purpose of this study was to evaluate our experience with telehealth in managing burn wounds and other complex skin defects.

Methods
A 16-item survey was developed using the framework outlined by the National Quality Forum for the development of telehealth measures. The survey was distributed to direct care providers and focused on the domains of experience and effectiveness and the subdomains of efficiency and satisfaction.

Results
There were a total of 14 respondents, including physicians, allied healthcare professionals, therapists and nurses. Seventy-seven percent of participants felt that overall, the system was efficient in the 4 categories of time required for scheduling, check-in, visit conduct and care coordination. Telehealth was deemed moderately to very effective by 80% in providing the patient access to care and the provider’s ability to educate the patient. However, providers, therapists and nurses uniformly found telehealth to be either not at all effective or slightly effective in assessing wounds, musculoskeletal function and developing a plan of care. When rating satisfaction with connectivity and overall quality of the clinic visit 70% of respondents were either dissatisfied/neither satisfied nor dissatisfied with the platform.

Conclusions
The operational aspects of our burn clinic telehealth program implemented during the COVID-19 pandemic were found to be largely satisfactory, with the exception of connectivity issues. However, the clinical aspects of the program were found to be largely unsatisfactory and, notably, were judged to be inferior to in-person visits.