bluuebunny/crossref_metadata_2025_split huggingface dataset:
596 Homeless Tent Fires: A Descriptive Analysis of Tent Fires in the Homeless Population
Authors: Huang Samantha , Choi Katherine J , Pham Christopher H , Collier Zachary J , Dang Justin , Kiwanuka Harriet , Sheckter Clifford C , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2021

Abstract

Introduction
Homelessness is a rising concern as insufficient housing and significant barriers to shelter has led to more individuals seeking shelter in tents. Within this demographic there has been an increased trend of burn injuries from tent fires in regions with large homeless populations. This represents a public health crisis given the long-term psychosocial and functional sequela of burn injuries and existing data that suggest worse outcomes in the homeless population. To our knowledge, homeless related tent fire burns have not previously been studied in the literature. The aim of this study is to describe the characteristics and outcomes of tent fire burn injuries in the homeless population.

Methods
A retrospective cohort study was conducted involving two verified regional burn centers with patients admitted for tent fire burns between January 1, 2019 to July 31, 2020. Patients were identified as either domiciled or homeless based on medical records at the time of injury. Variables recorded include demographics, injury characteristics, hospital course, and patient outcomes.

Results
A total of 45 patients were identified. The most common mechanisms of injury were by portable stove accident (29%), assault (27%), bonfire (22%), and tobacco or methamphetamine paraphernalia-related (16%). Median percent total body surface area (%TBSA) burned was 5.5 (IQR 5.5). Maximum depth of injury was second degree in 62% (n=28) of patients and third degree in 38% (n=17) of patients. Burns to the upper extremities were present in 84% of patients and burns to the lower extremities were present in 53% of patients. Median hospital LOS was 9.5 days (IQR=10) and median ICU LOS was 2 days (IQR=4.8), with inhalation injury present in 16% (n=7) of patients. Surgical intervention was required in 40% (n=18) of patients, which included debridement, skin grafting, and escharotomy. In-hospital mortality occurred in 5% (n=2) of patients.

Conclusions
Burn injuries from tent fires incur significant injury burden to an already vulnerable population, with risk factors that predispose them to poor burn outcomes. Injuries in our cohort were severe enough to require inpatient and ICU level of care. We saw a high proportion of injuries to the extremities, which pose functional and psychosocial challenges to the wellbeing of these patients. Further resources are needed to better prevent tent fires and care for this population.
605 Representation Matters: An Assessment of Diversity in Current Major Textbooks on Burn Care
Authors: McLawhorn Melissa M , Travis Taryn E , Tejiram Shawn , Shupp Jeffrey W , Johnson Laura S 
Published: April 2021

Abstract

Introduction
Racial and gender disparities in health care have been well described. The Association of American Medical Colleges states they are committed to diversity, equity, and inclusion in preparing medical trainees. Increasing attention is paid to representative diversity in the images and educational resources utilized during medical training. One recent example of this is the Instagram account, “Brown Skin Matters,” that focuses on the representation of dermatologic diseases in the skin of people of color. Nearly 40% of the population of the United States identifies as a person of color, and patients of color reflect 41% of the total burn population seen in the United States. In comparison, national data on providers suggests about 5% of the Burn Team would be people of color. As representation matters, a better understanding of the diversity represented by burn related medical literature could affect management of patients with diverse backgrounds and recruitment into this field. The goal of this study is to investigate the representation of diverse skin tones in the leading medical textbook of burn care.

Methods
The 5th edition of “Total Burn Care (TBC)”, 5th ed, DN Herndon editor, was reviewed from cover to cover. All photographs that contained people were evaluated for the number of people present and the depicted role of person present (i.e.: provider, patient or other). Each picture was considered as an isolated image, regardless of whether it was part of a series. Diversity count was assessed in a binary fashion - was the individual represented a person of color or not? Additional information was collected on the gender of providers present.

Results
690 total individuals were identified in images in TBC. There were 3 providers of color identified in TBC images out of a total of 63(5%); 24 providers were women (38%), of whom none were women providers of color. People of color were represented in 107 of 627 non-providers shown in TBC (17%). There were 29 patients whose skin color was unable to be evaluated due to the nature of the injury, the quality of the image or the surface area of dressings visualized in the image (5%).

Conclusions
Both patients and providers of color are underrepresented in the leading textbook of burn care. Proper representation must be included in modern educational materials to better prepare providers for a diverse population of burn injured patients and appropriately address injury identification, wound healing properties, and scar outcomes. Diverse and proportional representation of potential outcomes needs to be a component of educational materials. to ensure effective and thoughtful care.
616 Young Adults Burn Survivors - Key Challenges They Faced While Growing Up
Authors: Brubaker Ruth B , Bay Curt , Rutter Cindy , Chacon Daniel W , Wise Dustin K , Duke Desiree , Milem Mik , Foster Kevin N 
Published: April 2021

Abstract

Introduction
There is a paucity of research regarding the challenges faced by young adults (YA) who matured with burns. It is well documented that acute burn care is laden with painful surgeries/dressing changes, gruesome physical/occupational therapies, anxiety and time away from family & friends. However, the specific issues young adults burned as children find most challenging remain largely unknown. This study sought to provide YA survivors with an opportunity to describe the difficult issues they endured.

Methods
Burn surviving youth responded to the open-ended statement “The hardest thing about being burned is…” Seven themes were derived from their responses: People Staring at Me, Being Bullied, Remembering When I was Burned, Having Additional Surgeries, My Scars, Getting Questions About My Burns,& the Pain & Itching, Young adult survivors were asked to rate each item on a 4-point scale from (1) Not at all to (4) Really a lot.

Results
Participants were YA survivors (n=64) mean age 19.1 years, female (62%) male (38%), average age at burn of 6.4 yrs. Sixty-eight percent reported both visible & hidden scars; 25% had a TBSA &gt; 50%., Sixty-six percent were minority race/ethnicity. More than half of respondents reported issues with My Scars (65%), Remembering the Burn (52%) and Pain & Itching (50%). People Staring and Bullying has been bothersome for over 70%, 72% reported Being Bullied and 71% noted People Staring. The highest 5 means among YA subgroups included: Participants with hand scars- Being Bullied (2.6), those with visible scars - My Scars (2.6). Those reporting both facial & hand scars endorsed People Staring (2.4), youth with a TBSA ≥ 50% - Being Bullied (2.4) and with visible scars - Remembering the Burn – (2.4). Girls were bothered significantly more by My Scars (p=.02). Youth with both facial & hand scars had greater issues with Pain/Itch (p=.03).

Conclusions
This study provides insight into problems encountered by maturing burn survivors and discloses the more challenging issues they endured. These data can assist burn centers, camps, and psychotherapists in discussing potential survivor issues and suggest interventions to help burn-injured youth respond to challenges. Special consideration should be given to girls, those with facial/hand scars, large TBSAs and visible scarring.
623 Procedural Pain Management in Burn Patients – A Quality Improvement Project
Authors: Fleishhacker Zachary , Galet Colette , Wibbenmeyer Lucy 
Published: April 2021

Abstract

Introduction
Achieving adequate burn pain control in patients is paramount as inadequate control can lead to PTSD, suicidal ideation, and depression. The pain accompanying hydrotherapy can be extreme and challenging to manage. The purpose of this quality improvement project was to assess our burn center’s current nurse-driven procedural pain control protocol during hydrotherapy.

Methods
Burn patients admitted from June to August 2020 who underwent hydrotherapy were observed during the procedure. Demographics, comorbidities, injury related data, and pain and sedation medication data were collected. Pain scores (1–10), patient and nurse satisfaction scores (1–10) were collected before, during, and after hydrotherapy. A single patient could be surveyed for up to three times. Paired t-tests and one-way ANOVA were performed to assess significant differences between pre- and post-procedure patient pain scores and satisfaction ratings across encounters, respectively. P &lt; 0.05 was considered significant.

Results
Twenty-eight patients and 48 hydrotherapy events were surveyed. Patients were predominately male (23, 82.1%), middle aged (44.8 ± 19.6), and had a TBSA of 11.9 ± 10.5%. Analyzing only the first hydrotherapy sessions, time from initial opioid dose to hydrotherapy varied greatly as did the opioid morphine equivalent dose (OME) provided prior to hydrotherapy (Table 1). Only 13 (46.4%) subjects received versed during hydrotherapy. Pain scores post-procedure significantly increased compared to pre-procedure scores (5.39 vs. 6.32; p = 0.035). There was no significant difference in patients’ or nurse’s satisfaction scores regarding pain control nor with nurse’s rating of ease of procedure when comparing scores across the three encounters (Table 1). No adverse events (SaO2 &lt; 92% or deep sedation RAS &lt; 2) were observed across all encounters.

Conclusions
Our results suggest that procedural pain control during hydrotherapy, while safe, has opportunities for improvement. Pre-procedural medication timing remains imprecise and widely divergent. Satisfaction scores, while high, also have room for improvement. Finally, pre-procedural pain control is unacceptable (mean 5.39) and requires attention.
629 Acute Kidney Injury, Burn Resuscitation, and a Novel, Visualization Approach to Resuscitation Review
Authors: Luttrell Charles J 
Published: April 2021

Abstract

Introduction
A review of patients who sustained 20% or greater TBSA burns (n = 33) found 58% of the sample to have a stage 1 (n = 5), 2 (n = 4), or 3 (n = 10) acute kidney injury (AKI). Of those who sustained an AKI, 63% did not survive their injuries. An inquiry into the current, resuscitation protocols used at this facility was subsequently conducted. Protocol dictated the Parkland Formula/method as the standard of care for resuscitation needs of the sample. While information for net-totals of inputs and outputs (I&O) and hourly I&O values was easily obtainable, presenting these numbers in table-form was both cumbersome to create and difficult to quickly convey to both clinical and non-clinical staff. Thus, a visual approach was chosen to better understand how each patient was resuscitated in the first 24-hours of burn injury.

Methods
The software package R (R Core Team, 2020) was used to clean/analyze data, as well as create a graphical illustration of the data via an interactive dashboard using these variables: urine output (UOP); nurse charting of I&Os; fluid orders by provider; pre-hospital fluids; lab values; and vital signs. Using this software an interactive dashboard was created to allow users to interact with the graphs and visualize not only the numerical values associated with resuscitation, but to also see how each of these numbers relate to one another in an hourly timeline (e.g., reducing fluids by half is followed by a decrease in UOP).

Results
A trend of over-resuscitation in the first 24-hours of burn injury, as compared to the calculated requirements based on the Parkland Formula was observed. Also, irregularities of hourly administration of fluids (e.g., frequent/over blousing) and inadequate hourly charting were observed.

Conclusions
While this method for assessing resuscitation is a new approach at this facility, the ability to visually recount the resuscitation efforts of each patient has opened the conversation about best practices. Also, more disciplines can participate in the resuscitation efforts due to the ease with which the presented information can be disseminated and explained to both seasoned and novice staff. This has allowed for more stakeholders to participate in the burn program. Finally, further uses and applications of interactive dashboards are being explored for other aspects of burn care management.
630 A Multidisciplinary Approach to Decrease Infection using Visual Management
Authors: Grubbs Alicia 
Published: April 2021

Abstract

Introduction
Burn patients are at high risk for infection secondary to skin loss from their wounds. These infections come at great risk for patient safety and are known to increase length of stay, morbidity, and mortality. Due to these factors, we used a multidisciplinary approach to maintain the environment in our Regional Burn Center using visual management. The purpose of this project is to improve communication and follow-through between the Environmental Services Team (EVS), Facilities Management department and the Burn Center Team to initiate and complete repair work and improve cleanliness in patient rooms. The goal is to decrease risk for infection from environmental factors through collaboration with multiple departments and improve patient experience and care.

Methods
Each room in the Burn Center is mapped out on the Visual Management Board (VMB). Anytime a staff member notices that EVS and/or Facilities Management repair work is needed, they can take the appropriate magnet from the board (see legend) and place it on that room square. Unit leadership will round each morning to see what needs are indicated on the board and initiate work orders or communication with designated unit EVS to meet that need. The issues indicated by the magnets will be logged into a printed spreadsheet (placed on VMB). Each day unit leadership will round to facilitate completion of needed work and will place a date of completion on the spreadsheet when that work is finished as well as remove the magnet from the rooms space. Every Monday, Unit leadership will round at the VMB with EVS and Facilities Management Leadership to address any further needs that were unable to be completed at the unit level that need escalated. EVS/Facilities Management will round back with unit leadership when these items are completed.
Key Stakeholders
4. Environmental Services Staff (housekeeping) and Leadership
5. Facilities Management (carpentry) Staff and Leadership
6. Burn Unit Staff and Leadership
Additional Resources
• Legend for needed work
• Communication Tracking Tool
• Picture of VMB workspace for this project

Results
Maintenance and daily cleaning improved. Increased staff engagement in facilities issues in each patient room and the autonomy to notify someone and get escalation of issues when needed. Improved communication and collaboration with multidisciplinary teams for increased awareness of unit-based needs and improved patient safety.

Conclusions
Upon completion of this presentation, learners will be prepared to discuss multidisciplinary ways to collaborate with the partners that support your Burn Center to enforce patient care and safety.
642 Orthotic Fabrication of the Upper Extremity Survey
Authors: Warthman Renee , Martinez Andria , Murray Derek , Richey Karen J , Yelvington Miranda L , Foster Kevin N 
Published: April 2021

Abstract

Introduction
Designing and fitting orthoses is an essential component of burn care. Burn therapists fabricate and fit orthoses at a high rate due to continuous changes in patient presentation. The purpose of this survey was to assess the current level of comfort with orthosis fabrication of burn therapists, identify trends about management and quality assurance regarding orthoses, and determine areas that may be improved through a directed educational initiative.

Methods
An anonymous, internet-based, 31-item survey was developed to evaluate training and comfort level of practicing therapists. The survey was distributed to burn therapists at North American burn centers. Descriptive statistics were performed.

Results
There were 44 respondents to the survey. Most were occupational therapists (75%), followed by physical therapists (25%). The majority of respondents had more than 15 years of burn experience (61%). Most respondents reported education at a master’s degree level or higher (59%), 18% reported being a certified hand therapist, and 13% a burn certified therapist. A large majority of respondents indicated they received orthotic instruction as part of their academic curriculum (91%), and 80% indicate instruction lasted a semester or less. Since graduation, 89% respond that they have had further orthotic instruction, with most training occurring on the job (92%). One hundred percent of respondents indicated therapists were involved in fitting orthoses. Most indicated they were very comfortable with fabricating both static (90%) and static progressive (69%) upper extremity orthoses. Elbow extension orthotics received the highest very comfortable rating at 92%, while shoulder abduction splints received the lowest relative rating at 56% reporting very comfortable. Despite these confident scores, 51% of respondents reported complications due to orthoses at least sometimes or more often, and these are seldom or never (55%) reviewed through a formal process.

Conclusions
Unanimously, therapists are involved with fitting orthoses. The majority of respondents do not have advanced certifications and receive limited post-graduate orthotic training. Complications occur at least sometimes according to most respondents and appear only modestly integrated into peer review. Given the potential consequences of orthotic induced complications and the high reported comfort levels fabricating orthotics by primarily veteran burn therapists, there is concern that these issues are under-examined through formal processes.
649 The Quality of Survey Research in Burn Care: A Systematic Review
Authors: Anderson Dana , Fordyce Erin , Vrouwe Sebastian Q 
Published: April 2021

Abstract

Introduction
Burn care is a relatively small field with contributions from many healthcare disciplines. Further, the practice of burn care varies considerably from center to center and between regions. Given these factors, survey studies are frequently used to better understand practice variations, establish guidelines, and direct future research questions. If survey research is poorly designed or reported, it limits the ability to form meaningful conclusions. Given the prevalence of clinician surveys published in burn care, this study aims to evaluate its quality and to determine which approaches lead to a more successful survey.

Methods
A systematic review was performed by two independent reviewers using PubMed, Scopus, and Web of Science databases for the dates January 1, 2000 to March 19, 2020. Articles were included if they were published in English and surveyed providers on a topic related to burn care. Surveys of patients, those that evaluated an intervention or included other research designs were excluded. Data related to survey content, methodology, and quality was extracted independently by two reviewers.

Results
The search identified 7351 non-duplicate citations, of which 247 underwent full text review, and 144 met inclusion criteria. The number of published surveys increased by an average of 21% annually over the study period (P&lt; 0.001). The majority of surveys originated in the United States (40%), United Kingdom (19%) and Canada (7%) and were either national (47%) or international (37%) in scope. The most common themes were education/training/workforce (21%), resuscitation/critical care (17%) and wound care (14%). Burn surgeons/physicians (45%) were the most frequently surveyed population, but all disciplines were represented. The majority of surveys were electronic (51%) and sampled all members of a defined group (72%). Few studies reported the use of reminders (29%) or incentives (2%) to improve survey completion. In terms of quality, the majority did not report any survey development steps (71%) or survey validity/reliability (92%), and half did not include the questionnaire in the manuscript or appendix. A response rate was calculated in 82% of studies. The median (IQR) response rate of all studies was 54% (32–83). A subgroup analysis of national and international studies sent electronically to burn surgeons/physicians (N=28) had a response rate of 40% (26–50).

Conclusions
Survey research is increasingly published in the burn care literature and covers a range of themes and populations. Despite the limited use of reminders and incentives, survey participation is relatively high. The quality of survey reporting is generally poor, limiting the ability to apply this research into practice.