bluuebunny/crossref_metadata_2025_split huggingface dataset:
26 Formalizing Burn Nurse Education, a Literature Review on Nursing Fellowships and Discussion for Furthering Training
Authors: Hao-Smith Alison , Fletcher Elisabeth , Lodin Daud 
Published: April 2024

Abstract

Introduction
With the recent implementation of the exam for Certified Burn Registered Nurses (CBRN) by the Board of Certification for Emergency Nursing (BCEN), a curriculum for burn nursing has been developed to better strengthen and standardize burn nursing care. Given the depth of the curriculum and the overall demand of becoming a burn nurse, the need for creating an educational track for burn nursing becomes apparent. While most burn centers utilize a preceptorship model to help train registered nurses to become burn nurses, a nationally recognized fellowship has not been developed. This study discusses the outcome of formalized nursing fellowships and how it could impact burn nursing training.

Methods
This is a literature review of published data from 2000 to 2023. This review utilizes PubMed to search indexed articles, using the terms “nursing fellowship”, “nurses fellowship”, and “nurse fellowship”. The articles were examined for content and outcomes. Articles discussing fellowships for advanced practitioners and those that did not discuss the direct benefit of their programs were excluded. The results were collated based on specialty, type of fellowship, and both the positive and negative outcomes discussed in these articles.

Results
Eleven articles were identified related to nursing fellowships. These involved formalized training programs in primary care, addiction medicine, leadership, research, gastroenterology, perioperative care, and critical care. Many articles discussed the benefit of increased knowledge and student performance in fellowship graduates. From an expense perspective, the articles identified cost benefits from employee retention and prevention of error resulting in decreased cost of hospitalization and litigation. One publication discussed an improvement in measured professionalism inventory scores in graduates. Several articles commented on nursing retention, which noted that in some instances, units were able to improve retention by over 40 percent.

Conclusions
The development of burn nursing certification paves the way for the development of a burn nursing fellowship. This literature review identifies benefits that other specialties have had with the development of formalized nursing fellowships, which include increased knowledge, improved skills, fewer errors, and increased retention.

Applicability of Research to Practice
This study discusses the potential to improve burn nursing education in a formalized setting, intended to improve nursing knowledge and skills, and ultimately improve outcomes.
36 The Impact of Sensory Issues on Health-related Quality of Life for People with Burn Injuries
Authors: Oh Geun-woo , Orton Caitlin M , Stewart Barclay T , Schneider Jeffrey C , Yenikomshian Haig A , deGrauw Xinyao , Pacleb Maiya I 
Published: April 2024

Abstract

Introduction
The association between sensory issues with lowered health-related quality of life (HRQOL) has been repeatedly described, mainly in the elderly population with age-related hearing and vision issues. Although sensory issues after major burn injuries are common, the relationship between these new impairments and HRQOL after burn injury is unknown. We aimed to understand the impact of sensory issues on HRQOL to inform care and rehabilitation paradigms.

Methods
Data from a multicenter national longitudinal database of people living with burn injuries were analyzed. Participant data were stratified into self-report (yes/no) of currently experiencing hearing loss, vision problems, dual sensory impairment (DSI), or no issues at the time of data collection (discharge, 6-, 12-, and 24-months post-injury). The primary outcome, patient-reported VR-12/PROMIS Global-10 physical component scores (PCS) and mental component scores (MCS), were collected at discharge (pre-injury recall) and all follow-up time points. Mixed-effect linear regressions were used to assess the impact of sensory issues on MCS and PCS at each time point.

Results
The study included 1,113 participants. Participants with sensory issues had significantly lower MCS and PCS scores than those without sensory issues at pre-injury (p &lt; 0.05, Figures 1 and 2). All cohorts experienced a significant PCS loss at 6-, 12-, and 24-months post-injury compared to pre-injury scores (p &lt; 0.001). All cohorts experienced a significant MCS loss at 6 months post-injury compared to pre-injury (p &lt; 0.05). The hearing-only and no sensory impairments cohorts continued to experience a significant MCS loss at 12- and 24-month post-injury (p &lt; 0.05). DSI cohort continued to experience a significant MCS loss at 12- months (p &lt; 0.05). The vision-only cohort had more PCS loss than the no sensory impairment cohort at 24-months (-3.3, p&lt; 0.05).

Conclusions
Although there were no statistically significant losses of participants with sensory impairments compared to those with no sensory issues, these cohorts reported consistently lower scores overall during the 24 months post-injury. Given these lower HRQOL scores, systematic screening and focused management of sensory impairments during and after rehabilitation from a burn injury should be considered.

Applicability of Research to Practice
Integration of specialized mental and physical health burn rehabilitation programs that address person-specific needs may improve short- and long-term outcomes for people with hearing problems, vision issues, or DSI.
45 Utility of the Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) in Pediatric Stevens-Johnson Syndrome Patients
Authors: Gust Nina K B , Adams Rebecca M , Frei Ashley , Coughlin Michelle , Klein Justin D , Ridelman Elika , Shanti Christina M 
Published: April 2024

Abstract

Introduction
The Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) is a scoring system that seeks to predict in-hospital mortality for disorders affecting skin integrity. The scoring system has been validated and is widely utilized in the adult population, but not for pediatric patients. This study aims to determine the accuracy of the SCORTEN in pediatric patients.

Methods
A retrospective review of pediatric patients admitted at a verified pediatric burn center with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) from 2008 to 2022 was performed. SCORTEN risk factors were calculated.

Results
Twenty-seven eligible SJS/TEN patients were identified. Three patients were excluded due to incomplete data, allowing twenty-four patients to be analyzed. Ten patients had 0-1 risk factors (3.2% mortality rate), thirteen had 2 risk factors (12.1% mortality risk) and one had 3 risk factors (35.1% mortality risk). No patients received points for age over 40, presence of malignancy, blood urea nitrogen (BUN) greater than 28 mg/dL or glucose greater than 250 mg/dL. Zero patients died during initial admission. There was no correlation between initial BUN, bicarbonate, glucose, or initial heart rate on the length of ICU stay or ventilator days. Hospital length of stay and feeding tube days were positively correlated (p &lt; 0.001) along with length of stay and maximum TBSA (p &lt; 0.05). Student T-tests were performed comparing the 0-1 vs. 2 risk factor groups. Those with 2 risk factors had significantly higher TBSA affected on admission and maximum TBSA recorded (32.72 ± 20.55 and 44.97 ± 24.25 vs 8.26 ± 13.55 and 16.28 ± 22.19, p = .0005 and p=0.011). Interestingly, hospital length of stay, intensive care unit (ICU) length of stay, and ventilator days were not statistically significant between those having 0-1 and 2 risk factors.

Conclusions
Most SCORTEN variables (age over 40, presence of malignancy, BUN, and glucose) were not helpful in our patient population, as zero patients received points in these categories. Additionally, initial BUN, bicarbonate, glucose and heart rate showed no correlation to ICU or ventilator days. A higher SCORTEN category did not correlate to a longer hospital stay, ICU days or ventilator days. This study suggests that the SCORETEN system is not accurate in pediatric patients. A different scoring system is needed to estimate the severity of disease in pediatric SJS/TEN patients.

Applicability of Research to Practice
This data suggests that SCORTEN does not have utility in a pediatric SJS population and therefore a different scoring system is necessary. In practice, it would not be valid to use SCORTEN to predict mortality or severity of disease in the pediatric SJS population as it has not been found to be accurate.
52 Thermal Fuse Mandate Is Cost-effective for Home-oxygen Users in Prevention of Morbidity/mortality and Property Loss
Authors: Sheckter Clifford C , Coffey Rebecca 
Published: April 2024

Abstract

Introduction
Smoking tobacco products while using home oxygen can lead to fires and explosions which cause cutaneous burns, death, and loss of property. Thermal fuses interrupt the propagation of ignited oxygen-lines and significantly reduce the risk of explosion and death. Mandating thermal fuses for all home oxygen users is costly due to the number of people affected and distribution of these resources. On the other hand, the cost of burn care and property loss may exceed the summed device cost. Prior to mandating thermal fuses for all home oxygen users in the US, cost-effectiveness analysis should be performed.

Methods
A Markov model with annual cycling was constructed for the entire US population currently using home oxygen for chronic obstructive pulmonary disease (COPD). The probability of burn, death, and property loss were derived from a systematic review of literature. Societal and Medicare perspectives were adopted evaluating the costs of a federal policy including purchasing and shipping thermal fuses to all home oxygen users. Additional costs included the healthcare required to treat burn patients and the cost of prolonging these lives in advanced COPD. Cost savings included the avoided property loss in 2023 US dollars. Effectiveness was measured in gains in quality adjusted life years (QALYS) based on utilities derived from burn survivors and persons living with COPD. Deterministic and probabilistic sensitivity (10,000 Monte Carlo simulations) analysis was performed for key parameters including the cost of thermal fuses, mortality reduction from thermal fuses, and number of home oxygen fires per year. Discounting was 3% per year.

Results
In the status quo, the 10-year societal cost was $28.67 billion compared to $28.36 billion in the policy mandate (saving $305.40 million at ten years). 1,812 QALYs were gained with the policy mandate, yielding and ICER of -$160,317. For the Medicare payor perspective, the incremental cost-effectiveness ratio (ICER) was $64,981. Deterministic and probabilistic sensitivity analyses showed little variation in the ICER under multiple scenarios. The discrepancy between the dominant ICER for societal perspective and cost-effective ICER for Medicare perspective reflected savings from averted property loss not realized by Medicare.

Conclusions
A national policy mandating and paying for thermal fuses for all home oxygen users is dominant from a societal perspective and cost-effective from a Medicare perspective. The US federal government should adopt such a policy.

Applicability of Research to Practice
This rigorous model demonstrates overwhelming support for a policy that mandates thermal fuses for home oxygen users including direct shipping the device to individuals. Federal and state governments should adopt this policy.
80 Donor Skin Reduction in Full-thickness Wounds Using Autologous Cell Harvesting Device with Meshed Autograft
Authors: Shupp Jeffrey W , Rae Lisa , Bell Derek , Chin Theresa L , Cordova Alfredo C , Foster Kevin N , Castanon Lourdes 
Published: April 2024

Abstract

Introduction
The Autologous Cell Harvesting Device is a medical device designed for regenerative medicine applications. Its primary function is to enable clinicians to prepare an autologous skin cell suspension (ASCS) from a small sample of a patient's skin at the point of care. This innovative approach allows for the use of a patient's own skin cells in various medical procedures. The ASCS device received Food and Drug Administration (FDA) approval in September 2018 for the treatment of acute thermal burn wounds, demonstrating ASCS as an effective tool for promoting tissue regeneration and wound healing while significantly reducing donor skin requirements. This study was designed to evaluate safety and effectiveness of ASCS in conjunction with widely meshed autografts in patients undergoing reconstruction of full-thickness, non-thermal skin defects such as those resulting from trauma and surgery.

Methods
This prospective, randomized, within-subject study enrolled patients ≥5 years of age with acute non-thermal full-thickness skin wounds requiring autografting. Investigators were responsible for their respective autografting plans for closure in alignment with their stand of care. Comparable treatment areas of &gt;80 cm2 each were randomized to receive autografting treatment per investigator’s pre-identified plan (Control), or ASCS treatment in combination with a more widely meshed autograft than that of the Control. Co-primary effectiveness endpoints included 100% healing at (or prior to) 8 weeks post-treatment confirmed at 2 consecutive study visits at least 2 weeks apart, and the ratio of donor site to treatment area expansion ratios.

Results
Of the 65 patients enrolled, 63% (n = 41) had surgical skin defects while 37% (n = 24) had traumatic skin defects. Week 8 healing of the ASCS-treated areas (65%) was non-inferior to the Control areas (58%) (p &lt; 0.025) and donor skin sparing in the ASCS-treated was superior to the Control area, using 27% less donor skin, on average (p &lt; 0.025), meeting both co-primary endpoints.

Conclusions
ASCS application combined with a widely meshed autograft for the treatment of non-thermal full-thickness wounds required significantly less donor skin for closure and had comparable healing outcomes when compared to standard of care. The Autologous Cell Harvesting Device demonstrated its effectiveness in soft tissue wound repair by reducing the amount of donor skin and maintaining consistent healing outcomes.

Applicability of Research to Practice
The Autologous Cell Harvesting Device offers a clinically advantageous approach to autografting by reducing the amount of skin needed for closure without compromise to healing outcomes.
502 Long-term Renal Recovery in Burn-related Acute Kidney Injury Requiring Continuous Renal Replacement Therapy
Authors: Gordon Travis D , Papp Anthony , Al-Zeer Bader 
Published: April 2024

Abstract

Introduction
Acute Kidney injury (AKI) is a common complication of severe burn injury associated with significant morbidity and mortality. Continuous Renal Replacement Therapy (CRRT) is the modality of choice int he treatment of burn-related AKI. The purpose of this study was to look at long-term renal function of burn survivors who required CRRT during their acute stay in ICU as a result of burn-related AKI.
The hypothesis of this study is burn patients who develop burn-related AKI requiring supplemental CRRT during their hospitalization, have return or normal/baseline renal function long-term.

Methods
A retrospective cohort study looking at burn patients at a single institution. Inclusion criteria includes: Adult (&gt; 18yo) burn patients with KDIGO stage 1-3 AKI subsequent to burn injury who received CRRT during ICU admission. Exclusion criteria included preceding chronic kidney disease, kidney transplant. Retrospective data was collected between January 2012 - December 2021 using the institutions Burn registry, and ICU and Renal databases. Renal follow-up was collected up to 3 years post discharge. Statistical analyses was done using Microsoft Excel including T-tests, and multivariate analyses.

Results
Of the 31 patients who met inclusion criteria, 22 survived their burn injuries, a mortality rate of 31.8%. There were no significant differences in demographics, comorbidities, burn characteristics, or critical care interventions between patients who survived vs. those who perished. Serum creatinine values and eGFR values on average normalized to patient baseline at discharge and remained stable through follow up for 91% of patients. 4/22 patients required dialysis after their discharge from hospital (18.2%), 3 within the first year of discharge, but none required dialysis &gt; 3 years after discharge. 5 patients died within 3 years from discharge, 4 of whom died within the first year.

Conclusions
AKI in the setting of severe burn injury is common, often necessitating the need for CRRT. Despite high rates of conversion to chronic kidney disease in the General ICU cohort who develop AKI necessitating CRRT, burn-related AKI requiring CRRT results in much lower rates of conversion to ongoing renal dysfunction. Our cohort showed a return of baseline renal function in 20/22 patients who survived their burn injury (91%) in long-term (&gt; 3years) follow-up. Mortality rates in our cohort were also lower than previously cited literature.

Applicability of Research to Practice
Within our cohort, 91% of our patients had return to baseline renal function after their burn-related AKI, and a mortality rate of 31.8% which is lower than previously cited studies. Given all survivors received CRRT, this could highlight the potential benefit CRRT offers to burn patients in the long-term. Secondly we reported unsatisfactory low rates of long-term renal function follow-up data for burn related AKI, thus highlighting room for improvements in practice.
518 A Review of the Metabolic Consequences of Illicit Simulant Use in Burn Patients
Authors: Ferrari Louis , Taylor Billy Jay , Krueger, Jr. Thomas J , Buchanan Dylon , Bay Curt C , Osborn Suzanne C , Islas Claudia , Whetten Erica , Talanki Nisha , Richey Karen J , Foster Kevin N 
Published: April 2024

Abstract

Introduction
Over the past several decades illicit stimulant (STIM) use has developed into a major, national crisis. At our urban, safety net hospital, this is evident in a consistent increase in patients with chemical evidence of methamphetamine, amphetamine and cocaine use. Adverse health consequences of STIM use are well known, however potential metabolic consequences in patients with significant burns has not been studied. Our hypothesis was that this patient population is both undernourished and hypermetabolic when compared to those who test negative for stimulants.

Methods
This was a retrospective chart review of burn patients over a 6-year period who suffered a burn injury ≥ 20% TBSA and had both toxicology and indirect calorimetry testing completed. Patients were stratified into 2 groups according to toxicology results, positive for stimulants and negative for stimulants. Descriptive statistics were calculated for demographic and outcome data.

Results
A total of 332 patients were admitted over the 6-year period with burn injuries of ≥ 20% TBSA. Among those 140 had both toxicology and indirect calorimetry testing completed. When stratified by toxicology results 34 were positive (POS) and 106 were negative (NEG). There was no significant difference between groups for age 43.21 years POS vs 47.26 years NEG, % TBSA 34% POS vs 35% NEG, or BMI 27.5 kg POS vs 29 kg NEG. Likewise, there were no significant differences in RQ, 0.94 POS vs 0.93, REE 2513 POS vs 2412 NEG or COVAR 5.87 POS vs 5.54 NEG. There was no significant difference in mortality between the two groups 12% POS vs 23% NEG (p=.220).

Conclusions
We were unable to reject the null hypothesis in this study. Nearly two thirds of patients admitted during the study period did not have toxicology testing done and this may have prospectively introduced a selection bias into our retrospective study. Uniformity and protocolization of toxicology testing are necessary to avoid selection bias in order to meaningfully study the potential effects of illicit drugs on the outcomes of burn patients.

Applicability of Research to Practice
While we were unable to demonstrate a significant impact of stimulant use on patient metabolism and nutritional status with this study, it remains our hypothesis that such a relationship exists.
542 Comparative Analysis of Unhoused vs. Housed Individuals in the Burn ICU
Authors: Kantor Paul 
Published: April 2024

Abstract

Introduction
Decreasing LOS by one day can decrease the cost of a hospital stay by 3% (Taheri et al., 2000). Several factors contribute to LOS in the BICU, including, but not limited to, age, comorbidities, acuity, treatment, exit strategy, and housing situation. The purpose of this study is to identify LOS differences between housing situations amongst BICU patients. Housing situations can delay or assist with LOS; unhoused individuals may experience a more complex exit strategy as compared with housed individuals, leading to greater LOS.

Methods
A retrospective analysis utilizing the national burn database to gather information about discharged patients from TMMC BICU between 2018-2023. Factors such as age, gender, degree of burn, amount of burn (Total body surface area % [TBSA%]), and living situation were all considered.
Average LOS was calculated based on the patient’s documented housing situation. The total number of hospital days was divided by the number of patients in that category to calculate the average hospital days per patient. LOS Without Surgery population (n) total 475. LOS 2018-2023 n = 317.

Results
A comparative analysis of Burn Registry data showed burn inpatients had longer LOSs compared to other inpatient burn groups LOSs of unhoused BICU inpatients averaged 2.8 days longer than housed patients.

Conclusions
The cause of the prolonged LOS in unhoused populations is difficult to ascertain. Difficulties in arranging wound care and placement is a difficult task to complete by case management. Psychiatric and/or complicated medical histories contributed to delays in discharge, prompting opportunity for future research (Ikebuchi et al., 2008). Literature fails to provide consistent causative/correlational data for the length of stay amongst the burn population in the hospital setting. Current studies show that age, socioeconomic factors, comorbidities, antibiotic use, and burn severity/TBSA contribute to LOS in the burn population (Chukamei et al., 2021).

Applicability of Research to Practice
Discharge planning should be initiated on the date of admission; special populations should be monitored more closely. Delays in discharge medication, wound care plans, and wound care supplies are intricate in these populations; research should be conducted into what causes these delays and what communication break downs between nursing, surgeons, and other ancillary staff prevent discharge. Involving a multidisciplinary approach would augment a safer and more expedited discharge for these complex patient populations. Future causative research is needed exploring reasons for discharge delays by examining interdisciplinary workflow communications that may contribute to delayed discharges.