bluuebunny/crossref_metadata_2025_split huggingface dataset:
521 Assessing the Utility of Visceral Proteins as Markers of Nutrition
Authors: Taylor Billy Jay , Calder Sara , Shawe Isabella G , Islas Claudia , Richey Karen J , Foster Kevin N 
Published: April 2024

Abstract

Introduction
Burn injury leads to a profound catabolic state requiring aggressive nutritional support to facilitate healing, homeostasis, rehabilitation and to decrease infections. However, monitoring efficacy of nutritional support is difficult. Following the serum levels of visceral proteins is common practice, but recent studies have questioned the value of these tests in evaluating nutritional status. The purpose of this study was to examine the utility of visceral proteins as a measure of nutritional assessment and intervention.

Methods
This was a retrospective chart review of adult patients admitted over one year who required enteral feeding and had indirect calorimetry testing. Caloric data and associated visceral protein labs (pre-albumin, albumin, transferrin, and CRP) were collected during their enteral feeding duration. Patients were stratified by respiratory quotient (RQ), “Normal RQ” (RQ = 0.85-1.00) and “Low RQ” (RQ &gt; 0.85), and Caloric % weekly intake, adequate intake (&gt;90%) and inadequate intake (&lt; 90%). Differences between groups were analyzed using a T-test or Wilcoxon rank sum test depending on data normality.

Results
A total of 44 patients met inclusion/exclusion criteria. Mean age was 50 years, mean TBSA was 27 %, mean BMI was 30.3. The majority were male 70% (n=31), mean length of stay was 58.5 days, mean ventilator days were 41 days. Mortality was 27% (n=12). There were no significant differences in visceral protein levels between RQ groups. There was no significant difference between % Caloric intake (adequate vs. inadequate) for the first 4 weeks. In the fifth week there were differences in pre-albumin, transferrin, and C-reactive protein levels between groups, with p-values of 0.02, 0.03, and 0.006, respectively. There was no significant difference in albumin levels at week 5. Analysis beyond 5 weeks was not conducted due to insufficient data.

Conclusions
Historically, visceral proteins such as albumin and pre-albumin have been used as nutrition markers. We now better understand that the albumin pool of the human body is comprised of little newly synthesized albumin, and protein intake has little effect on the value itself. Albumin and pre-albumin are negative acute-phase reactants and are greatly affected by the inflammation seen with burn injuries. We found no significant differences between pre-albumin and RQ. Conversely, there was also no significant difference between pre-albumin and those who were able to meet greater than 90% of their nutrition needs, and those who met less than 90% needs during weeks 1-4 of testing. There was a significant relation between all visceral proteins and caloric intake during week 5. This is likely explained by improved levels of CRP and overall decrease in inflammation.

Applicability of Research to Practice
Our results support that visceral proteins are not good indicators of nutrition status in burn patients, while in a state of inflammation.
525 Evaluating Adherence to a New Pre-Operative Enteral Feeding Guideline in a Single Burn Center
Authors: Marsh Molly , Cruz Aryn , Chrisco Lori , Hollowell Jamie L , Levine Ashley , Nizamani Rabia , King booker , Williams Felicia 
Published: April 2024

Abstract

Introduction
Malnutrition increases hospital length of stay, mortality, readmissions, overall costs, and also delays healing. Enteral nutrition via tube feeding (TF) is often used as primary or supplemental nutrition for burn patients. Our institution recently adopted a new policy to reduce TF hold times pre-operatively. An algorithm determining when TF are held pre-operatively to mitigate full body catabolism considers type of TF access (gastric or post-pyloric), the presence of a secure airway, and if the surgery involves the aerodigestive tract in order. We aimed to evaluate our compliance with the initiation of these new guidelines.

Methods
This was a single center, retrospective study using our institution’s electronic medical record (EHR) admission list for patients on the burn service. Inclusion criteria consisted of patients admitted from June 1 through September 26, 2023, &gt;18 years of age, had &gt;20% TBSA burns requiring operative intervention, and received TF pre-operatively for at least one of their surgeries. Data collection included burn diagnosis, operating room (OR) date and time, feeding access, if the patient would be prone, receiving aerodigestive surgery or extubated post operative, NPO time ordered versus NPO time desired per guidelines, if the feeding protocol was followed, the hours of missed nutrition based on the expected feeding times outlined in the new policy, the calculated loss of protein and energy, and the percent of estimated nutrition needs lost.

Results
There were 9 patients (n=9) who met the inclusion criteria and underwent a combined total of 14 surgeries. Out of the 14 operative days, the policy for the new NPO policy was only followed on one day (7.1%). These policy deviations led to an average of 6.7 missed hours of tube feed, 931 missed kilocalories, 60 grams of protein, 32.7% estimated energy needs, and 31.9% estimated protein needs per operative trip. All patients survived.

Conclusions
Missed opportunities for enteral nutrition led to significant morbidity for our patients. Despite global acceptance to this guideline, compliance was suboptimal and resulted in substantial loss in nutrient delivery for our patients. Further education, time to allow culture change to take effect, and a standardized EHR order set can contribute to the success of this guideline in the future.

Applicability of Research to Practice
This was one step of many to improve nutrient delivery to burn patients in our center and attenuate the risk and adverse effects of malnutrition for our patients. Reducing pauses in TF is a critical step in optimizing nutrient delivery for patients with high metabolic demands in order to improve outcomes.
533 Preliminary in Vivo and Atomic Force Microscopy Assessment of Uninjured Skin, Donor and Graft Sites
Authors: Pistek Apolline S , Burnett Lindsay , Gabriel Vincent , Bharadia Shyla K , Mukherjee Priyanka G , Amrein Mathias 
Published: April 2024

Abstract

Introduction
With limited dermal function at the recipient site, fibrosis is expected following split-thickness skin grafting. Additional hypertrophic scar may develop within the graft, along seams and margins or at the donor site. This study focuses on the mechanical changes in the skin following split-thickness skin grafting as assessed by a non-invasive negative pressure device and atomic force microscopy to describe gross and sub-cellular mechanical properties in the differing skin states post-grafting.

Methods
Participants with full-thickness burn injuries acutely managed with a split-thickness skin graft, closed donor and graft sites without any previous steroid injection or laser therapeutic interventions and a suitable control site were recruited. A negative pressure device was applied to grafted, donor, and uninjured contralateral control sites and response recorded to vacuum pressure and release to calculate Young’s elasticity modulus. A 4mm punch biopsy was harvested from each labelled site and immediately processed using atomic force microscopy using silicon cantilevers conjugated with a spherical glass tip (radius 2.5 μm;) in a custom 3D printed frame to determine Young’s elasticity based on the Hertz fit model (fig 1a-b).

Results
A total of 5 participants (3 male, mean age 32.4 range 21-54, 152-427 days post-injury) have been recruited for the study thus far. Measurements were taken on the thigh of 4 participants and on the abdomen of 1. Atomic force microscopy data demonstrates lowest Young’s elasticity modulus (mean 1.49 ± 0.12 kPa) at the control sites (fig 1b graft 3: x-axis frequency, y-axis YM) with highest Young’s elasticity modulus (mean 2.70 ± 0.10 kPa) at the grafted sites. The donor sites are in the middle of the graft and control, (mean 1.98 ± 0.88 kPa). This trend is in concordance with clinical observation and elasticity probe measurement, where the graft is the toughest and the donor and control are similar (fig 1c).

Conclusions
Initial elasticity measurement by a non-invasive vacuum device has been in agreement with atomic force microscopy assessment. Further sampling is required to verify preliminary results, simulate resting tension in the skin and assess change following intervention.

Applicability of Research to Practice
Valid and reliable non-invasive measures will be informative of treatment effectiveness. Sub-cellular assessment of mechanical changes in skin graft and scar may direct therapeutic interventions.
534 Retrospective Study Comparing Acute Healing Outcomes of Two Epidermal Skin Substitutes in Paediatric Partial-Thickness Burns
Authors: Khamise Ameer , Lapid Hadas , Mishra Ankit , Murray Alexandra M 
Published: April 2024

Abstract

Introduction
Paediatric burns are a significant global health issue; partial thickness (PT) wounds from scalds are a common injury pattern. Skin substitutes, such as collagen based (CB) dressings, are frequently used in managing these cases. We conducted a novel comparative study analysing the acute healing outcomes of a CB dressing and a novel biosynthetic cellulose (BC) dressing in paediatric PT burns.

Methods
All paediatric patients (age &lt; 18) with PT burns that were managed with either the CB or the BC dressings over a four-year period at our paediatric burns centre were included. Data on adherence, infection, length of stay, complete healing time, acute follow-up time, and return to theatre were extracted and a statistical analysis performed.

Results
Of the 89 patients included, 28 received BC dressing and 61 received CB dressing. Mean Total Body Surface Area (TBSA) was 5.9% (range 1-15) and median age was 23 months (range 8-169). BC dressing had a higher adherence rate (85.7% vs 78.7%, P=0.767) and a lower infection rate (3.6% vs 16.4%, P=0.164) than CB dressing. These trends were preserved when superficial PT only and superficial and deep PT sub-groups were analysed. Healing and infection rates were unaffected by post-operative antibiotics in both groups (P=1 and P=0.803, respectively). Return to theatre for further surgery was required in 10.7% of the patients for BC and in 6.6% for CB dressing (P=0.507). Median time to complete healing was longer in BC (19.5 vs 16 days, P=0.279). BC dressing median hospitalisation length was 1 day compared to 2 days for CB dressing (P=0.706).

Conclusions
The findings demonstrate that acute healing outcomes with the BC dressing in paediatric PT burns are comparable to those with the CB dressing, establishing the BC dressing as a viable alternative given its advantages in cost and avoiding porcine components. However, further prospective studies are warranted to compare acute and long-term outcomes with these products.

Applicability of Research to Practice
The study will directly inform clinical decision making on the use of frequently applied epidermal skin substitutes when managing paediatric partial thickness burns.
559 Rates of Follow up in Massively Burn Injured Patients
Authors: Heard Jason , Valdez Jessica , Palmieri Tina L , Romanowski Kathleen S , Sen Soman , Greenhalgh David G 
Published: April 2024

Abstract

Introduction
As burn care continues to improve, large total body surface area (TBSA) burn survival will increase. These survivors require more extensive care than smaller burns and are at higher risk for wound/scar related complications. In previous studies follow up after burn injuries tended to be low, especially with burns that cover a smaller TBSA%. The low follow up compliance has been linked to socioeconomic factors such as housing insecurity and substance use. There are limited studies that evaluate socioeconomic factors that contribute to follow up attrition in massive burn patient populations We hypothesize that patients with massive burn injuries and housing insecurity and substance use will have lower rates of follow up.

Methods
After approval by our Institutional Review Board, a retrospective chart review study was performed in adult patients admitted from 2009-2019 with &gt;50% TBSA burns. Patients were excluded if they died during hospitalization or were discharged with plan to follow up at another burn center. Data collected included demographics, injury characteristics, zip codes, insurance type/status, follow up visits and number/type of reconstructive surgeries. County level data was abstracted from data.census.gov which. Univariate and regression analyses were performed using R software.

Results
There were 155 patients that met the inclusion criteria, 72 patients survived to discharge, and 7 patients were discharged to another burn center leaving 65 patients in the final analysis. Mean TBSA of all patients was 63.5% and mean age was 35.6 years. Fifty-four patients (83.1%) attended at least one follow up after burn injury. The median number of follows up scheduled and attended were 4 and 3.5 (range: 1-135) respectively. On Univariate analysis female patients followed up longer than male patients (771 vs 131 days; p=0.007) and patients with housing insecurity were less likely to follow up at all (4 vs 0 visits; p=0.0009). On multivariate regression analysis for attending any clinic visit, larger TBSA burn was independently associated with follow up (OR 1.22, p=0.046) and housing insecurity was independently associated with not following up (OR 0.003, p=0.02).

Conclusions
Patients with large TBSA% burn injuries are a unique patient population and in theory should require more frequent follow up than patients with smaller TBSA burns. Data from our single center study showed patients that survived massive burn injuries did have reasonable one time follow up. However, certain patient populations should be targeted for closer follow up adherence, including patients facing housing insecurity, uninsured patients, and male patients.

Applicability of Research to Practice
This research can help other burn programs identify patients who may be vulnerable to have higher follow up attrition rates so that these specific patient populations can be followed closely after discharge.
560 Is the Need for Follow up Lost in Translation?
Authors: Epstein Larissa , Franco Carina , Coward Alexandra , Heard Jason , Sen Soman , Palmieri Tina L , Romanowski Kathleen S 
Published: April 2024

Abstract

Introduction
There is limited research evaluating patients of limited English proficiency (LEP) on outcomes after burn injury. Studies have shown that patients with LEP have reduced access to care, longer admissions, are more likely to be discharged to a nursing facility and are more likely to return to the emergency department (ED). Burns require significant inpatient and outpatient coordinated care for successful discharge planning and patient education regardless of language preference. This study examines the effect of LEP on outcomes following burn injury. We hypothesize that burn patients with LEP will have longer hospital stays, fewer follow up (F/U) visits, and more ED visits after discharge.

Methods
Following IRB approval, a retrospective chart review was conducted using electronic medical records for burn patients admitted from January 2018 to December 2019. Data collected includes patient demographics, burn injury, burn outcomes, preferred language, and F/U care. Analysis was conducted with SAS statistical software, version 9.4 (SAS Institute, Cary, NC, USA) using Chi-square, Fisher Exact, Spearman Correlation, Wilcoxon 2-sample and Kruskal-Wallis tests.

Results
A total of 760 patients with a median age of 46 years (Interquartile range (IQR) = 26) were analyzed. Median total body surface area (TBSA) burn was 6.5 (IQR = 12) and 15% had inhalation injury. The median length of stay (LOS) was 9 days (IQR = 18) and 38 patients (5%) died. Reviewing post-burn care, 613 patients (81%) scheduled F/U, 397 patients (52.7%) attended a F/U appointment within 30 days of discharge, 85 patients (11.2%) presented to the ED, and 46 patients (6.1%) were readmitted. Only 61 patients (8%) preferred a language other than English. Among patients with LEP, Spanish was the most spoken language (5.6%), followed by Hmong (0.92%). When patients with LEP were compared with English speakers there was no difference in age (42 (22) vs. 46 (26), p=0.67), TBSA (5.5 (10.5) vs. 6.6 (11.8), p=0.32), mortality (3.3% vs. 4.7%, p=1), LOS (8 (16) vs. 9 (18), p=0.43), ICU days (2 (16) vs. 3 (15), p=0.43), inhalation injury (13.1% vs. 14.9%, p=0.87), and discharge to home (86.9% vs. 75.9%, p=0.44). Patients with LEP were more likely to have follow up scheduled at discharge (93.4% vs. 80.2%, p=0.04), attend F/U (78.7% vs. 50.7%, p=0.0005), and present to the ED after discharge (19.7% vs. 10.5%, p=0.03). There was a trend towards them being readmitted more than native English speakers (11.5% vs. 5.6%, p=0.08).

Conclusions
Patients with LEP were no different from their English-speaking counterpart with respect to traditional outcome measures (LOS or mortality) but had increased healthcare utilization (F/U or return to the ED).

Applicability of Research to Practice
As the number of patients with LEP increases, health care providers must be aware of the influence this has on outcomes following burn.
567 Distance to Burn Center Is Not Associated with Long-term Psychologic Outcomes Following Burn Injury
Authors: Dye Crystal , Risinger William B , Thompson Spencer , Keeven David , Smith Jason , Bozeman Matthew 
Published: April 2024

Abstract

Introduction
Burn injury predisposes patients to significant psychologic morbidity including anxiety and depression. Adding to the burden of injury, patients often require transfer to specialized burn centers located far from home, family, and friends. We sought to assess the impact of distance to burn center on long-term psychologic outcomes.

Methods
Patients admitted to our American Burn Association verified center from January 2021- June 2023 were identified. Demographics, burn characteristics, and follow up anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnarie-2) screening scores were reviewed. Distance to burn center (miles) was determined based on patient’s home address. Wilcoxson rank-sum, chi-squared, and logistic regression tests were used to identify variables associated with post-burn anxiety. Linear regression was used to evaluate the relationship between distance to burn center and GAD-7 scores.

Results
Of the 267patients identified, 35.6% and 27.9% screened positive for anxiety (GAD-7 &gt; 10) and depression (PHQ-2 &gt; 3) respectively at follow-up. On univariate analysis, female sex (38% vs. 21%, p &lt; 0.01), morphine milligram equivalents (MME) on the last day of hospitalization (30 vs. 22.5, p=0.02), prior psychiatric history (37% vs. 13%, p&lt; 0.01), and inhalation injury (9% vs. 3%, p=0.05) were associated with positive anxiety screens. Distance to burn center was similar between patients with positive and negative anxiety screens (40 vs. 47 miles, p=0.49). Via logistic regression, MME on the last day of hospitalization (OR: 1.02, p=0.03) and a history of psychiatric illness (OR: 3.93, p &lt; 0.01) all predicted post-injury anxiety when accounting for age, %TBSA, burn mechanism, sex, injury at workplace, inhalation injury, and hand/face involvement. Distance to burn center showed no linear relationship to GAD-7 scores (β = -0.004, R2=0.00, p=0.64).

Conclusions
Distance to burn center is not associated with increased long-term psychologic outcomes following burn injury, further supporting the transfer of patients to specialized burn centers. However, prior history of psychiatric illness and increased utilization of inpatient narcotics are all associated with increased probability of long-term anxiety.

Applicability of Research to Practice
Provides further evidence for the transfer of burn patients to specialized centers.
568 Clinician Survey on Emotional Challenges in Treating Self-Immolation or Self-Inflicted Burn Patients
Authors: Honea Ashley E , Richey Karen J , Foster Kevin N 
Published: April 2024

Abstract

Introduction
Self-immolation (SIM) is an uncommon method of attempted suicide involving flammable substances, with suicidal intent. By contrast self-inflicted (SIF) burn injuries utilize a chemical or heated object to cause injury, without suicidal intent. Caring for either patient population can have emotional and ethical challenges. The purpose of this study was to better understand the perspectives and experiences of the healthcare clinician when caring for these patients and identify the need for enhanced support.

Methods
An 11-item survey was distributed to burn center professionals via SurveyMonkey. Questions were developed to seek healthcare professionals’ attitudes, emotional and ethical challenges in treating these patient populations. Respondents were stratified into two groups, those that responded yes to having found it emotionally challenging to care for this patient population (Y) and those that responded no (N).

Results
A total of 65 individuals responded to the survey, and 58 surveys were fully completed. The majority, 65%, of respondents were between ages 22-39, (n=41). Most were burn nurses, 46.7% (n = 29), followed by rehabilitation professionals (rehab), 12.9% (n = 8), advanced practice practitioners (APP), 9.6% (n=6) and physicians 8% (n=5). When stratified, 53% (n=31) responded yes (Y) when asked if they found it emotionally challenging to care for this patient population and 48% (n=28) responded no (N). There were no significant differences between groups for age, gender, years in profession or years in burn care. When examined by profession, 75% of rehab, 67% of psychosocial, 50% of nurses, 40% of physicians and 33% of APP respondents answered yes that care of this population was emotionally challenging. The majority of both groups responded that they received support from team members. When asked if care of these patients created an ethical or moral dilemma 42% of Y and 25% of N responded yes. Y were more likely to have experienced a change in their own mental health 52% vs 7% N. When asked if same day support would be helpful 74% (n=23) of Y and 42% (n=12) responded yes. The preferred format for help was 1:1 or group.

Conclusions
The majority of staff reported emotional and/or ethical challenges when caring for this population created. Of those who responded that care of these patients was not emotionally challenging, interestingly, 25% experienced ethical or moral dilemmas and 43% felt that having same day support would be beneficial. Identification of the need for enhanced support for staff in the hospital setting is critical to avoid burnout, secondary traumatic stress and compassion fatigue for healthcare professionals.

Applicability of Research to Practice
This study highlights the need for a specialized in-house enhanced support program for burn professionals to address their emotional and mental well-being.