bluuebunny/crossref_metadata_2025_split huggingface dataset:
127 The Teen-Aged Life Impact Burn Recovery Evaluation Profile: Initial Development
Authors: Patel Khushbu F , McGwin Madeleine , Slavin Mary D , Surette Kate , Gladstone Alexandra R , Palmieri Tina L , Branski Ludwik K , Schneider Jeffrey C , Stoddard Frederick J , Murphy Michael , Kazis Lewis E , Ryan Colleen M 
Published: April 2024

Abstract

Introduction
Outcome measures are critical to assess interventions, establish evidence based practice guidelines, and ultimately support the needs of teenage burn survivors’ integration into the community. Only one condition- and age-specific instrument exists to monitor burn recovery. A more granular instrument with advanced technological capability (i.e., computer adaptive test (CAT)) is needed. The current study developed a preliminary conceptual framework and item pools as first steps to create a new instrument for teen burn survivors.

Methods
The International Classification of Functioning, Disability, and Health Child and Youth Version informed the conceptual framework. Initial candidate items were reviewed qualitatively through binning and winnowing. A team of experts reviewed sets of items in four rounds from March through June 2023, such that each set was reviewed twice. Experts rated each item as “keep, omit, modify, or revisit”. To identify outcomes important in assessment of recovery, focus groups of clinicians, teenagers, and parents were conducted until thematic saturation was reached. Each transcript was analyzed using deductive and inductive approaches to identify and categorize content. Findings were used to validate the framework and ensure adequate domain coverage.

Results
Initial candidate items (n=5,472) from 178 generic and burn-specific assessments previously published were grouped into two domains of the conceptual framework – activity and participation. At the end of round four, experts had modified item content for 29.8% of items. Activity item pools (n=128) included mobility, physical self-care, general tasks, experience of self, and learning and applying knowledge. Participation item pools (n=73) included major life areas, interpersonal relationships, and engagement. The recall period was set to “currently”. A five-point Likert scale format for responses was assigned based on the item measurement of agreement (n=124), difficulty (n=23), or frequency (n=54) of behavior. Eighteen participants completed the study. Clinicians mean age was 48.4 years with 90% female and 80% White; teens mean age was 13.8 years with 63% female and 75% white. Burn size ranged from 0.25 to 60% TBSA. Examples of themes included body image, self-esteem, and social relationships.

Conclusions
The preliminary item pool (n=201) was developed containing domains of activity and participation. The next step is to conduct cognitive interviews and refine item content prior to field-testing for the calibration and validation of the CAT.

Applicability of Research to Practice
Clinical and research use of the Teen-Aged12-19 LIBRE (Life Impact Burn Recovery Evaluation) will facilitate optimization of interventions, allow for more efficient allocation of resources and care for teenagers with burn injuries.
520 Are Predicted Protein Recommendation Adequate When Unable to Utilize Nitrogen Balance Testing?
Authors: Patton Lacey , Mueller Scott W , Wiktor Arek J , Gibson Cameron 
Published: April 2024

Abstract

Introduction
Evidence based practice on providing adequate protein for burn patients is limited. Recommendations range from 20-25% of overall caloric needs deriving from protein, or 1.5 – 4 grams (g) per kilogram (kg) of body weight. Our American Burn Association (ABA) verified burn center uses both indirect calorimetry (IC) and urine urea nitrogen balance (UUN) as a guide for patient specific caloric and protein needs. The objective of this study was to evaluate protein requirements based on 25% of predicted IC caloric needs compared to urine UUN.

Methods
This was a single center retrospective analysis at an ABA verified burn center. We included patients with 10% or greater total body surface area (TBSA) burns between 3/15/23 and 9/1/23 who completed an IC and a UUN. We excluded occurrences of invalid IC results, inaccurate protein intake records, or if a UUN occurred &gt;7 days from the IC. Expected (Exp) protein requirements were calculated by 25% of IC resting energy expenditure multiplied by 1.3 activity factor. Observed (Obs) protein requirements were calculated by a collected 12-hour UUN + 4 grams for a ne positive nitrogen balance. Correlation of Exp vs Obs protein and matched mean difference with an assessment of estimate bias was conducted overall and as subgroups based on TBSA 10-19.9 and 20% or greater.

Results
After excluding 28 incomplete assessment pairs, 15 patients representing 34 IC and UUN assessments (8 with &gt;1 assessment) were included. Median age and TBSA were 31 years (30, 52.5) and 20% (13.6, 33.1), respectively. Total cohort Exp and Obs protein requirements were 198 and 157 g (matched mean difference 41 g, p&lt; 0.001), and did not correlate (Pearsons coefficient 0.06, p=0.73). In those 20% TBSA or greater, 8 patients (median TBSA 31.1%; 21.7, 59) had 23 assessments. Exp vs Obs protein requirements were 205 and 160 g (matched mean difference 45 g, p=0.001) and, poorly correlated (Pearsons coefficient 0.11, p=0.62). In those 10-19.9% TBSA, 7 patients (median TBSA 12.75%; 10.8, 14.75) had 11 assessments. Exp vs Obs protein requirements were 184.5 and 150.5 g (matched mean difference 34 g, p=0.073) and, weakly correlated (Pearsons coefficient 0.22, p=0.51).

Conclusions
Calculating protein demands based on 25% of IC caloric requirements may overestimate protein needs when compared to a measured UUN. Larger studies and continued research in nutrition support are needed to improve accuracy of estimated protein requirements.

Applicability of Research to Practice
In patients with large burns (&gt;10% TBSA), burn centers should consider using UUN to more accurately determine patients’ adequate protein needs.
526 Methamphetamine Intoxication Predicts Worse Outcomes in Severe Frostbite Injury
Authors: Rayne Michelle M , Larson Nicholas J , Rhone Abigail , Lacey Alexandra M 
Published: April 2024

Abstract

Introduction
The best treatment for severe frostbite is thrombolysis with or without vasodilators, which allows reperfusion of the damaged tissue. Methamphetamine is a potent vasoconstrictor. While there is data in the burn population that methamphetamine use is associated with worse outcomes, there is no current literature on this topic in frostbite patients. It was therefore predicted that methamphetamine use predicts worse outcomes in severe frostbite injury.

Methods
This was a retrospective, single-center, observational study at a Midwest burn center. Inclusion criteria were ≥14 years of age at time of admission, severe frostbite (defined as frostbite treated with intra-arterial (IA) thrombolytics), and &gt;24hr of IA thrombolytics as an infusion. Patients were excluded if they were lost to follow up. Over a 15 year period, 165 patients met these criteria.
The primary outcome evaluated was salvage rate, using the Hennepin Frostbite Score. To obtain this score, surgeons assessed the initial angiography images to assign a score for the amount of tissue at risk (R). A surgeon then evaluated the patient’s operative notes to assign a score for the amount of tissue amputated (A). Salvage score (S) was then calculated as follows: S = R-A. Salvage rate was calculated using this score as follows: Salvage rate = (S / R)*100%.

Results
In this sample of patients (N=165), 23.6% were positive for methamphetamine on admission (N=39). Using chi-square analysis, patients who were methamphetamine positive were statistically significantly more likely to have an amputation than those who were not (P=0.0132). All patients who had a 0% salvage rate were methamphetamine positive. This was not statistically significant.

Conclusions
We found that all patients with a 0% salvage rate were methamphetamine positive. This was not statistically significant given the low N of 11, however we find this data clinically significant and represents potential evidence of a statistical association.
This study was limited by low sample size, and thus was lacking in power to predict outcomes on a large scale. Given that this is the only study to risk stratify the relationship between methamphetamine use and salvage rate, we believe this should prompt further investigation into this relationship to evaluate for statistical significance on a larger sample size.

Applicability of Research to Practice
If this relationship is again identified in a study with a larger sample size, this would indicate a need for investigation into the most effective treatment for this population and potentially indicate a need for more aggressive intervention.
537 Burned at Sea: Transport and Critical Care of Two Sailors Injured on the Pacific Ocean
Authors: Cancio Jill M , Tadlock Matthew , Cancio Leopoldo C 
Published: April 2024

Abstract

Introduction
Burns have constituted 5-10% of combat casualties from recent conflicts and are projected to become even more common during future war at sea. Advances in critical care and surgery have improved postburn mortality. Nevertheless, survivors of such massive injuries require immense efforts by an interprofessional team from point of injury through the restoration of long-term function and quality of life. Here, we documented the challenges and resources required for 2 sailors who were severely burned at sea on the Pacific Ocean and who received definitive multidisciplinary care at an American Burn Association-verified Burn Center.

Methods
In July 2022, 2 sailors from a coalition nation sustained life-threatening burns during a boiler-room fire aboard a ship at sea during the RIMPAC multinational exercise on the Pacific Ocean. Multiple naval assets including the US Coast Guard, the French Navy, and the US Navy collaborated to rescue and evacuate these patients. A Burn Flight Team transported the casualties aboard US Air Force aircraft to an American Burn Association-verified Burn Center in the United States. Both sailors returned to their home country approximately 5.5 months postburn. Unless otherwise stated, data are presented as means.

Results
Patient 1 was 27 years old with an 86% TBSA burn; patient 2 was 29 years old with a 70% burn. Both sustained concomitant inhalation injury. Transfer from point of injury to definitive care took 11 days with 7 handoffs. Mean hospital length of stay (LOS) was 101 days, ICU LOS 50 days, and ventilator days 10.5. They underwent an average of 14 major surgical operations and were transfused 78 units of blood products. They received an average of 4.4 hours of direct rehabilitation per day during inpatient hospitalization, and as outpatients, they received an average of 63 rehabilitation treatment sessions.

Conclusions
The care of these 2 severely burned sailors required the coordination of naval assets from multiple countries and lengthy resource-intense definitive care at the Burn Center. These efforts took place during peacetime and were not complicated by a combat environment to include communication and air transport challenges.

Applicability of Research to Practice
Future peer and near-peer combat operations, to include war at sea, are expected to generate greater numbers of burn casualties than were seen during recent conflicts. Properly forecasting and preparing for the substantial needs of those future casualties is an essential component of readiness.
544 Unlocking Midazolam’s Potential as a Biomarker for CYP3A4 Phenoconversion in Pediatric Burn and Surgery Patients
Authors: Basas Vincent , Grimsrud Kristin N , Sherman Emma , Palmieri Tina L 
Published: April 2024

Abstract

Introduction
Burn patients, due to hypermetabolism, organ failure, protein binding alterations, inflammatory responses, drug interactions, and other comorbidities, are particularly susceptible to experiencing altered drug metabolism, known as phenoconversion. Phenoconversion is the phenomenon in which an individual's genetically determined metabolism phenotype shifts due to non-genetic factors, such as a normal metabolizer becoming a slow metabolizer. For example, children with sepsis have been reported to exhibit decreased CYP-mediated drug metabolism, antifungals may inhibit CYP metabolism, and certain antimicrobials and antiepileptics can induce metabolism. Research has identified specific drugs that serve as biomarkers for enzymatic rate function within individual CYP pathways. Notable examples include midazolam for CYP3A4, celecoxib for CYP2C9, and omeprazole for CYP2C19. Thus, utilizing the routine administration of preoperative midazolam may serve as a biomarker for assessing CYP3A4 function.

Methods
In our ongoing clinical pharmacogenetic studies, we collected serial serum samples from pediatric burn and surgery patients and utilized liquid chromatography mass spectrometry to measure midazolam and its primary metabolite, OH-midazolam. Preliminary analysis included 80 patient datasets (60 intravenous and 20 oral) to characterize midazolam metabolism by calculating the metabolite-to-parent ratio to identify CYP3A4 pathway induction.

Results
In our initial analysis of 80 patients, eight were identified as outliers, indicating increased metabolism. The median (min-max) ratio was 0.49 (0.01-3.84) for intravenous and 1.34 (0.2-10.50) for oral administration. The patient with the most extreme abnormal midazolam metabolism had severe epilepsy and was taking three different antiseizure medications, likely contributing to induced CYP3A4.

Conclusions
These findings underscore the importance of tailoring drug doses for patients with altered CYP3A4 function. Until further research explores the effectiveness of midazolam as a biomarker for CYP3A4 metabolism, the pursuit of precision medicine will not fulfill its promise in ensuring that all patients receive medication optimized for their dynamic metabolic rates.

Applicability of Research to Practice
This study highlights the potential of midazolam as a clinically valuable biomarker for identifying CYP3A4 phenoconversion.
551 Improving Outpatient Access and Reducing Length of Stay Through a Burn Treatment Nurse Pilot Program
Authors: tonkinson tracey , Powell Taylor , Chambers Mona , Sandidge Charles , Orton Caitlin M , Pham Tam N 
Published: April 2024

Abstract

Introduction
To address a growing volume of both external referrals and follow up needs within a regional burn center, the outpatient burn clinic tested the feasibility and potential benefits of a Burn Treatment Nurse (BTN) Program. This pilot utilized a full time RN position to perform wound care for inpatient and outpatient anesthesia assisted procedures (AAP’s), and to independently evaluate acute burn referrals and post discharge patients with a quick turnaround time. This analysis reports on the first 6 months results by service level utilization and performance of initiative.

Methods
The BTN program was implemented following a collaborative effort among the outpatient clinic, the burn service line and hospital administration. As part of the BTN QI tracking, we prospectively collected newly generated clinic revenue, number of independent RN visits, length of inpatient length of stay (LOS) on acute care and collected feedback from provider stakeholders.

Results
At the conclusion of the first 6 months, the BTN program has allowed for an additional 357 patient visits. It generated an additional revenue of $286,129, a 19% increase in revenue for the burn clinic. The BTN also contributed to an overall decrease in LOS on acute care. Pre implementation, mean LOS was 9.2 days, after implementation mean LOS was 6.8 days (Figure 1). Not only did BTN provide positive outcomes for the clinic and hospital, anesthesia and nursing providers expressed an overall feeling of success and strong support for the continuation of the BTN program.

Conclusions
The BTN capability has expanded critical access for those needing expedited outpatient care. This innovative program has improved outpatient access and contributed to decreased inpatient LOS for our regional burn center.

Applicability of Research to Practice
Burn centers with a growing outpatient volume should consider implementing a nurse with flexible inpatient/outpatient roles to improve both outpatient and inpatient access efficiency.
558 Implementation of a Nurse Driven Approach to Early Mobilization of a Cultured Epidermal Autograft Patient
Authors: Snyder Emily , Kastner Kara M 
Published: April 2024

Abstract

Introduction
Early mobilization in those who suffer burn injuries is a vital part of recovery. Early mobilization can decrease length of stay, promote independence, minimize weakness and increase range of motion (ROM) (McGillicuddy et al., 2022). The use of cultured epidermal autograft (CEA) can often limit early mobilization in the burn patient due to the risk of graft loss/shearing. A nurse driven early mobilization protocol was implemented on a single patient with 45% TBSA who received two rounds of CEA.

Methods
Nurse driven early mobilization was completed on a single patient after the risks/benefits were discussed with the burn physician. Preceding the surgical application of the CEA, a collaborative multidisciplinary approach was taken to create a mobilization schedule for the patient.
The Burn Educator (BE) provided 1:1 early mobilization education, a daily patient schedule, and a helpful tip handout for the RN team to reference with a goal of preventing graft loss/shearing.
The first stage of CEA was placed to the patient’s back and thighs. Beginning on post-operative day (POD) four, the Burn Nurse Supervisor, BE, and bedside RN began mobilizing per the schedule. The patient was assisted to the edge of the bed (EOB) utilizing an inflatable positioning mat. The patient would then stand and walk inside the room. During the drying time, the patient would alternate positions between sitting EOB, chair, and/or prone in the bed with the assistance of the RN or therapy team. On POD six, the patient returned to the operating room for additional CEA placement to bilateral arms. The patient continued to mobilize every day after POD six, increasing his standing and walking time each day.

Results
Early Mobilization of this patient did not compromise the integrity of the CEA. Some slight sheering to the back on one thigh was noted due to the patient moving up in the chair without RN assistance. The patient was discharged home from the hospital after 48 days, not requiring transfer to a rehabilitation facility.

Conclusions
In this single case study review, it was concluded that with proper education and collaboration with a multidisciplinary burn team, a nurse driven early mobilization protocol resulted in no significant graft loss/sheering. Additionally, it aided in the prevention of complications associated with prolonged immobility, allowing the patient to discharge home and eliminating the need for inpatient rehabilitation.

Applicability of Research to Practice
Early mobilization can be applied to patients who have received CEA without risking harm to the graft sites. However, clear communication and planning is necessary to be successful.
References:
McGillicuddy, J., Bello, G., Bergeron, K., & Lee, J. (2022). 71 burn intensive care unit early mobility competency based orientation. Journal of Burn Care & Research, 43(Supplement_1), S48–S48. https://doi.org/10.1093/jbcr/irac012.074
569 Insurance Payor Increases the Incidence of Depression and PTSD in Burn Patients
Authors: Pezzopane Laura K , Loftus John , McGuire Beth , Bean Toni , Fornalski Nicole , Bernal Nicole P 
Published: April 2024

Abstract

Introduction
Intriduction: Work-related burn injuries have the added stress of dependence on a third-party payor. Patients using Bureau of Worker’s Compensation (BWC) report frustration and dissatisfaction with the claim coverage process. In 2021, based on our initial study's result, we began using the Patient Health Questionnaire-9 (PHQ-9), a 9-item DSM-IV-based self-reported depression screening tool. We added the PTSD Checklist (PCL-5), a 20-question self-administered screening tool to screen for Post-Traumatic Stress Disorder (PSTD). We hypothesized that there is a correlation between insurance type and increased scores on the PHQ-9 and PCL-5. We hypothesized that the risk of depression and PTSD is affected by a patient’s access to care, referral approval, and financial burden of treatment, and differs based on payor.

Methods
Method: A retrospective review of our outpatient database was conducted of burn clinic visits with a completed PHQ-9 and PCL-5 between 7/1/2021-6/30/2023. This was considered exempt by the IRB (Institutional Review Board) committee based on use of deidentified database. The PHQ-9 is completed at initial visit and then once every 2 weeks; the PCL-5 on initial visit and then once per month. This data was recorded in the EMR (Electronic Medical Record) flowsheet and then transferred to the deidentified database. Additional information analyzed included total body surface area (TBSA) and need for admission and/or surgical procedure.

Results: Results
1401 visits with PHQ-9 and PCL-5 collection were reviewed. The average scores for both the PHQ-9 and PCL-5 were higher with patients that had BWC as their payor with a significant difference in the PHQ-9. (Table 1) The TBSA was significantly higher in the patients that underwent surgery and/or admission. This group of patients, those that required surgery had significantly higher PHQ-9, and a trend toward higher PCL-5 scores. (Table 2) When divided into the payors, the BWC group has the highest PHQ-9 and PCL-5 scores, but total patients are too small in each group to establish significance.

Conclusions: Conclusions
Compared to the preliminary study, we can say with confidence that patients with BWC are at higher risk for depression and PTSD. The limitation of this study design does not allow us to determine causality, and patient reported outcomes would be necessary. There is an additional increased risk of depression and PTSD if the outpatient requires surgery with or without admission.

Applicability of Research to Practice: Applicability of research to practice
This research is designed to identify specific needs in work-related injuries in hopes of BWC changing this practice.