bluuebunny/crossref_metadata_2025_split huggingface dataset:
34 The Costs of Caring: Quantifying Compassion Fatigue and Compassion Satisfaction in Burn Therapists
Authors: Yelvington Miranda L , Corson Tyler , Hu Jiale , Wood Rachel E , Reynolds Stacey 
Published: April 2024

Abstract

Introduction
Recovery from a severe burn injury requires early and aggressive therapy, which is often painful and distressing to the patient. Burn therapists who guide these interventions may be prone to experiencing secondary trauma and compassion fatigue through repeated exposure to difficult situations. At the same time, therapists may gain a sense of purpose and altruism from their work, fostering compassion satisfaction. Despite being well documented in other health professions, compassion fatigue and compassion satisfaction have not been sufficiently explored among burn therapists. The purpose of this study was to quantify and characterize burn therapist’s compassion fatigue and satisfaction using the Professional Quality of Life (ProQOL) scale and to answer the question of what job-related factors may impact these outcomes.

Methods
This cross-sectional study surveyed active burn therapists using Research Electronic Data Capture (REDCap). ProQOL scores were calculated for individual respondents and described for the sample using mean, standard deviation, and range. Multiple regression analyses were conducted to assess the impact of predictor variables of years in burn care, practice setting, and population on the subscales of the ProQOL for compassion satisfaction and compassion fatigue (burnout and secondary traumatic stress).

Results
A total of 143 burn therapists were included, which exceeded the n needed to achieve statistical power. The included participants presented with low to moderate burnout scores (mean=23.5, range=11-38), secondary traumatic stress (22.5, 11-40), and moderate to high compassion satisfaction (40.4, 25-50). Regression analyses found years of practice significantly predicted (p ≤ .01) each of the compassion constructs.

Conclusions
This study presents new knowledge for the field of burn care in its quantification of professional quality of life in burn therapists. While burn therapists experience moderate-to-high levels of compassion satisfaction in their work, burnout and stress also approached moderate levels. Years of practice was a significant predictor of compassion and may be related to increased competence or confidence in practice.

Applicability of Research to Practice
This study is the first to study compassion fatigue and satisfaction in burn therapists. Understanding and addressing these issues are essential to recruiting and retaining a healthy and productive burn care workforce. Regular assessment of professional quality of life and career stage-specific supportive measures could provide a protective measure against compassion fatigue.
60 Safety of Maintaining Nutrition Through Moderate Sedation for Burn Wound Care
Authors: Kohler Amber D , Donnelly Melanie , Balstad Blaire , Mueller Scott W , Patton Lacey , Gibson Cameron , Wiktor Arek J 
Published: April 2024

Abstract

Introduction
Physiologic changes in burn patients create a hypermetabolic state increasing nutrition requirements. The American Society of Anesthesiology recommends patients be made NPO with enough time to allow for gastric emptying prior to procedural sedation. Daily burn wound care needs requiring sedation make this approach untenable. We aimed to assess the risk of moderate sedation in those without interrupted nutrition.

Methods
A 12-month single centered retrospective analysis at our ABA verified center was performed. Burn patients with natural airways (non-intubated/non-trached) receiving moderate sedation for wound care with a Richmond Agitation-Sedation Score (RASS) goal of -3 were included. Timing of nutritional intake prior to the start of procedural sedation, total amount of drugs administered, lowest RASS score, and all adverse events throughout procedural sedations, including aspiration/pneumonia were recorded. Confidence intervals (CI) were calculated to estimate the risk of adverse events in this cohort.

Results
A total of 97 moderate sedations were completed on 24 patients (66.7% male) with a mean age 43 years (range 18-79), mean total TBSA 13.3% (range 4.5-38.5), and mean ASA score 1.9 (range 1-3). Patients averaged 2.9 oral premedication agents (opiate 100%, lorazepam 92%, ketamine 75%, dexmedetomidine 18%) and 2.75 IV agents administered, with mean doses of fentanyl 148mcg, midazolam 2mg, ketamine 50mg, and maximum dexmedetomidine infusion of 0.85 mcg/kg/hr. Patients achieved a mean RASS of -1.9 (range 0 to -4). On average, nutrition of any kind was consumed 109 minutes prior to sedations, with an average of 171 minutes from consumption of solids. In 24 sedations (24%), 6 patients had tube feeds continued throughout wound care. Location of feeding tubes during sedations: 21 gastric, 3 post-pyloric. One episode of nausea occurred after premedications were given (95% CI 0.03-5.6%). Ondansetron was given to the patient prior to the start of the moderate sedation without further nausea/complications. No complications related to aspiration were noted in any sedation event (97.5% upper CI 3.7%), including no episodes of vomiting, evidence of aspiration, pneumonia, hypoxia, complete airway obstruction, laryngospasm, or death. Hypertension was noted in 17 sedations, treated in 1 event. Hypotension was noted in 6 sedations, each requiring a decrease in the IV dexmedetomidine infusion.

Conclusions
No harmful adverse events were associated with maintained nutrition throughout the peri- and intra-sedative wound care periods, despite ongoing gastric tube feeds in this small sample of burn patients. A large prospective study is required to further validate this practice.

Applicability of Research to Practice
Institutions should consider ongoing nutrition requirements and apply risk-benefit conversations when adopting a burn specific sedation policy.
61 The Influence of Sarcopenia on Patient Outcomes Among Burn Patients: A National Burn Repository Study
Authors: Blears Elizabeth , Ballou Jessica , Murton Andrew , Caffrey Julie A 
Published: April 2024

Abstract

Introduction
Over recent decades, improvements in triage and hospital protocols have resulted in remarkable increases in survival following major burns. Despite this, patients continue to experience profound muscle cachexia, in large part, a consequence of the hypermetabolic response to burn injury. However, the rates of cachexia among burn and adult patients are not well established across multiple burn centers.

Methods
The National Burn Repository (NBR) was used to explore the rate of sarcopenia and associated characteristics of patients diagnosed with sarcopenia while undergoing burn treatment in both the acute and follow-up setting. Diagnoses of sarcopenia was made according to appropriate ICD-9 and ICD-10 codes. Appropriate descriptive statistics were used to characterize the burden of muscle wasting and sarcopenia among burn patients with alpha &lt; 0.05 as significant. Binomial and linear multivariate regression was performed to determine whether sarcopenia was an independent predictor of adverse burn outcomes after adjusting for common confounding variables, such as age, burn size and comorbidities.

Results
In total, the NBR provided 84,438 adult and pediatric burn patients injured between 2000-2018 from over 100 burn centers predominantly in the United States. Only 2.5% (N=2,118) of the patients in the NBR were diagnosed with having sarcopenia or other forms of muscle atrophy. Patients with sarcopenia were significantly older (: 51.9 years (SD±21) vs 35.5 years (SD±23.6), P&lt; 0.001), larger Total Body Surface Area burn (mean: 16.1% (SD±19.2) vs 7.1% (SD±11.5), P&lt; 0.001) and required more surgical procedures (mean: 21.9 total procedures (SD±30.4) vs 7.9 total procedures (SD±13.7), P&lt; 0.001). After adjusting for confounding variables, sarcopenia remained an independent predictor of ability to discharge to independent living (vs nursing facility or home with home nursing), longer inpatient days as well as increased number of surgical procedures (P &lt; 0.001).

Conclusions
Sarcopenia is an independent risk factor for adverse outcomes in burn patients, such as decreased likelihood of discharge to independent living, increased length of stay inpatient and increased number of surgical procedures. Confidence in these findings would be improved with more accurate data collection, as the diagnosis of sarcopenia is likely under-reported, under-diagnosed or both.

Applicability of Research to Practice
Understanding the role of sarcopenia in clinical outcomes can better optimize nutrition and exercise service that can lead to better long-term outcomes.
62 Cognitive Behavioral Therapy Improves Symptoms of Depression in Burn Survivors
Authors: Rothbauer Mikki J , Pasek Zuzanna , Wewerka Sandi S , Dalrymple Kirsten A , Adams Nell 
Published: April 2024

Abstract

Introduction
Burn injury patients can suffer severe trauma as they cope with the events that led to their injuries and their new physical abilities and appearance. Mental health is a component of care that is often overlooked for these patients. The purpose of this prospective study was to evaluate whether burn psychotherapy is effective in reducing depression in burn survivors.

Methods
Our Burn Center has a full time licensed clinical psychotherapist who uses Cognitive Behavioral Therapy (CBT) to treat patients. Burn clinic nurses administered the Patient Health Questionnaire-9 (PHQ-9) depression screener to n=1842 patients between 2016-2019. Patients were referred to psychotherapy if their total PHQ-9 score met the definition for moderate depression (total score ≥ 10) or they endorsed the question about suicidal thoughts. Patients could also participate through self-referral.
Our final sample included n=146 patients (47% female, mean age=41.8) who attended at least one psychotherapy appointment and contributed at least one post-appointment PHQ-9 score. We computed a difference score for each patient by subtracting their baseline PHQ-9 score from their mean post-psychotherapy score. We used a one sample t-test to compare the mean difference score for the group to zero (zero = no change). We also examined how many participants showed a change in PHQ-9 category from pre- to post-psychotherapy.

Results
The mean baseline score was 11.49 (SD = 6.92) vs. mean post-psychotherapy score 8.54 (SD = 6.45). The mean group difference score was significantly different from zero (mean = -2.95, SD=5.72), t(145)=-6.23, p&lt; 0.001, [95% CI = -3.88 to -2.01]. The negative mean difference indicates a decrease in depressive symptoms. When examining changes in depression category, 50.7% of patients moved to a less severe category of depression after psychotherapy, 13.7% of patients moved to a more severe category, and 35.6% did not change.

Conclusions
These results support psychotherapy as a measurable benefit to some, but not all individuals undergoing specialized burn care. Burn centers should consider having a full-time burn- and trauma-trained psychotherapist on staff to complete assessments on admission. Continuity of mental health care in burn centers has the potential to positively influence patient outcomes.

Applicability of Research to Practice
Cognitive behavioral therapy is used in many different populations. Our findings support the practice of specialized psychotherapy intervention in the burn population as effective in decreasing symptoms of depression in some patients.
118 Retrospective Analysis of Pathogens for Guided Creation of an EMPIRic Antibiotic PrEscribing Pathway (EMPIRE)
Authors: Todor Lorraine A , Hill David M 
Published: April 2024

Abstract

Introduction
Mortality from infection due to P. aeruginosa is remarkably high; therefore empiric regimens include its coverage. In a prior study, we showed manual inclusion of bedside prescribing considerations heavily reduced antibiogram-based, empiric recommendations (i.e, double Gram-negative [GN] coverage to a single agent + vancomycin [VAN]). The purpose of this study is to determine if empiric regimens in the burn unit may be optimized further per suspected infection source. We hypothesized an initial regimen of VAN and cefepime (C4) will still adequately cover 90% of definitive pathogens isolated within one week of admission in absence of healthcare-associated infection risk factors (HAIRF). For suspected pneumonia, a narrower beta-lactam can be used with adequate coverage. Lastly, difficult to treat pathogens (DTp) are rarely the cause of wound infection within one week of admission.

Methods
This single-center, retrospective study included patients admitted to the burn unit between January 1, 2020 and December 31, 2022. Patients were screened by reviewing microbiology reports during the study period and exclusion criteria applied to generate a final sample of patients and cultures. Only treated infections were considered (i.e., not surveillance data). A 3-year sample was utilized to ideally achieve 30 isolates of the most common pathogens. Demographic data was reported using descriptive statistics. Sensitivities were reported via antibiotic*pathogen and cumulatively according to source and hypothetical future regimen.

Results
The final sample included 268 pathogens. Tissue samples from wounds, respiratory samples, and blood accounted for 183 (68%) 35 (13%), and 30 (11%) culture sources, respectively. Urine and bone samples made up less than 8% of pathogens. VAN and C4 covered 98% and 90% of Gram-positive and GN pathogens, respectively, within the first week of admission and in absence of HAIRF. Fifteen respiratory cultures grew GN pathogens, of which 83% were susceptible to C4. When used in combination with VAN, 93% of all respiratory pathogens that grew were covered. Narrower beta-lactams, ampicillin-sulbactam or ceftriaxone, plus VAN covered 83% of respiratory pathogens. Of the 183 wound cultures collected, 10 (5.5%) DTp were isolated.

Conclusions
Despite recommendations for empiric double coverage of GNs per the local unit-specific antibiogram, initial use of VAN and C4 remains adequate for pathogens isolated within one week of admission in patients without HAIRF. For pneumonias, a narrower spectrum beta-lactam would not sufficiently cover respiratory pathogens isolated within the first week of admission. DTp are rarely isolated from wound cultures within one week of admission.

Applicability of Research to Practice
Antibiotics must be used judiciously to combat antibiotic resistance. We describe a method to consider for creating empiric prescribing pathways for adequate pathogen coverage while preserving broader agents.
120 Venous Thromboembolism Prophylaxis in Burn Patients
Authors: Stanton Eloise , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2024

Abstract

Introduction
Venous thromboembolism (VTE) is extensively studied in trauma patients, but burn patients require special consideration due to their unique pathophysiology and management strategies. Currently, there are no specific prophylaxis recommendations to help mitigate VTE in burn patients.

Methods
The US National Trauma Data Bank (NTDB) was analyzed to identify patients with burn encounters from 2017-2021 using ICD-10 event codes. Our primary outcome measure was incidence of VTE, which included deep venous thrombosis and pulmonary embolism. Secondary outcome measures included need for blood transfusion and need to return to the operating room due to hemorrhage from skin/soft tissues/extremities. Multivariable regressions were conducted to evaluate the relationship between various VTE prophylaxis types and timing of VTE prophylaxis and VTE incidence while controlling for age, sex, %TBSA and inhalation injury.

Results
A total of 326,614 patients with burn injuries were identified in the NTDB during the study period, of whom 5,604 (1.7%) had a VTE event during their hospital admission. The majority of patients did not receive VTE prophylaxis (54.1%). Of those that did, the most commonly used VTE prophylaxis was LMWH (37.9%), followed by unfractionated heparin (4.1%). When controlling for age, sex, inhalation injury, and %TBSA, unfractionated heparin and LMWH were significantly associated with an increased risk of VTE (heparin: OR=1.8 95% CI 1.3-2.5, p &lt; .001; LMWH: OR=1.5 95% CI 1.2-1.8, p &lt; .001). Longer time to VTE prophylaxis was significantly associated with increased odds of VTE when controlling for the same covariates (OR=1.04 95% CI 1.03=1.07, p &lt; .001). Neither VTE prophylaxis type nor timing of VTE prophylaxis administration was significantly associated with an increased need for blood transfusion. Heparin was the only VTE prophylaxis type significantly associated with increased odds of returning to the OR for a bleeding-related complication (p &lt; .001).

Conclusions
A majority of burn patients in the NTDB did not receive VTE chemoprophylaxis, and counterintuitively, patients who received VTE chemoprophylaxis had higher rates of VTE than patients who did not, despite controlling for known VTE risk factors. In patients who did get chemoprophylaxis, unfractionated heparin is associated with a higher rate of VTE and surgical bleeding complications when compared with LMWH. Delayed initiation of VTE prophylaxis correlates with a higher likelihood of VTE occurrence. These findings underscore the importance of better studying and developing specialized VTE prevention guidelines for burn patients to enhance their care and outcomes.

Applicability of Research to Practice
Prompt initiation of VTE prophylaxis is essential to reduce the risk of VTE among burn patients, highlighting the importance of timely interventions. Developing specialized VTE prevention guidelines for this population can enhance their care and outcomes.
122 Itchy Burns: Debilitating Effects of Pruritus on Daily Activity in Burn Follow-Up Care
Authors: Shrader Elizabeth A , Rathjen Esther A , Eischeid Alexander C 
Published: April 2024

Abstract

Introduction
Current practices in the long term treatment of burn wounds often ignore or only minimally respond to prolonged pruritus, or itching. In truth, the presence of pruritus in patients receiving follow-up care which negatively impacts patient lifestyles is likely under documented and not effectively treated. Quantifying and treating pruritus in a similar fashion to pain management is thus the next logical progression of burn care in an outpatient setting. In this study, we hypothesize that the presence of pruritus positively correlates to daily activity disability and warrants investigation into further intervention.

Methods
All patients presenting for an outpatient appointment for treatment of burn injuries at a regional burn center were provided a 5-D Pruritus Scale questionnaire at the time of their arrival with other clinic paperwork prior to being seen by a provider. Interpreter services for non-English speaking patients and writing assistance for patients with hand injuries were provided, when necessary. The survey collected patient ratings on pruritus duration, degree, direction, disability, and distribution. Responses were de-identified and recorded in numerical form. Of the 127 submitted surveys, blank responses (n=13) and responses which struck/altered the word “itch” and replaced it with “pain” (n=2) were omitted.

Results
Surveys were collected for a 6 week period with a total of 112 valid responses obtained. Of the valid surveys, 44 (39%) reported moderate (level 3/5) itching or higher with 47 patients (41%) indicating at least occasional sleep disruption/challenges resulting from pruritus. Under daily activity disability categories (leisure/social, housework/errands, and work/school), 44 (39%) reported at least occasional inability to complete at least one of the activities with 39 (35%) and 29 (26%) indicating at least occasional disability in two or three of the activities, respectively. It was determined patients reporting moderate pruritus were significantly more likely (p &lt; 0.001) than patients only reporting minimal or mild pruritus to report daily activity disabilities (61% versus 25%, respectively) and sleep disruptions (68% versus 25%, respectively).

Conclusions
This study revealed a higher than expected proportion of patients reporting pruritus leading to daily activity disability during follow-up care for burn injuries. Further, there exists a correlation of patients indicating moderate or worse pruritus with sleep and activity disruptions.

Applicability of Research to Practice
The relationship between increased rates of daily activity disability and degree of pruritus indicates providers should be vigilant in screening for pruritus-related disability and supports trialing additional itch management such as oral and topical medications.
124 Numerical Cut Points for Mild, Moderate and Severe Pain in Adult Burn Survivors
Authors: Carrougher Gretchen J , Bamer Alyssa M , Orton Caitlin M , Pacleb Maiya I , Slavin Mary D , Schneider Jeffrey C , Yenikomshian Haig A , Stewart Barclay T 
Published: April 2024

Abstract

Introduction
The optimal numerical cut points for mild, moderate, and severe burn pain have been established. Investigators at a single center determined that average burn pain can be categorized as mild (0-2), moderate (3-5), and severe (6-10). To address concerns about small sample size and limited diversity, we aimed to identify the most suitable average pain intensity rating scores for mild, moderate, and severe pain in a large, diverse cohort of adult burn survivors using a Patient Reported Outcome Measures Pain Interference (PROMIS-PI) short form.

Methods
Average 11-point pain intensity Visual Analog Scale (VAS) or Numerical Rating Scale (NRS) scores (0-10) and a customized PROMIS-PI 4-question short form were administered to adults with burn injury treated at 5 centers in the US at hospital discharge (baseline) and 6, 12, 24-months and 5-years post-injury. To identify pain intensity scores that best represent mild, moderate, and severe pain, F value statistics associated with multiple ANOVA comparisons for mean pain interference scores by various pain intensity cut points were computed. Based on previous research, 6 possible cut points (CP) were compared: CP 3,6; 3,7; 4,6; 4,7; 2,5; and 3,5. The optimal cut points were considered those with the highest ANOVA F statistic.

Results
Data from 1,190 participants (68% male, 80% white, 22% Hispanic, mean age 46 years) and 5 study centers with VAS/NRS pain intensity and PROMIS-PI scores at one or more study timepoints were analyzed. The optimal classification for mild, moderate, and severe pain was CP 2,5 at all timepoints (see table).

Conclusions
This study confirms that for a diverse cohort of burn-injured adults from multiple centers within the United States, burn intensity ratings of mild (0-2), moderate (3-5), and severe (6-10) is appropriate for up to 5 years post-injury. These findings support previous research findings and continue to advance our understanding of burn pain and pain intensity reporting while providing clinicians and researchers with an objective measure that can be used for screening, treatment, quality improvement, and research.

Applicability of Research to Practice
Use of this numerical classification for burn pain in the adult burn survivor can be used with greater confidence in diverse populations.