bluuebunny/crossref_metadata_2025_split huggingface dataset:
6 A Multicenter Outcome Analysis of Vancomycin Dosing Strategies in Burn Patients
Authors: Boyd Allison N , Hill David M , Santos Richard M 
Published: April 2024

Abstract

Introduction
Current guidelines support an area under the curve (AUC)-based dosing strategy for vancomycin. Previous literature evaluating dosing in burn patients consistently reports that higher doses and/or more frequent intervals are required in patients with thermal injury. However, optimal empiric dosing recommendations and monitoring are not well defined and burn patients are often excluded from studies driving guideline recommendations. The objective of this study was to evaluate both AUC and non-AUC-guided dosing strategies in a multicenter analysis. The primary hypothesis was that therapeutic drug monitoring via AUC-guided dosing would result in 25% higher clinical success compared to trough-based dosing (TR) in patients with burn or inhalation injury.

Methods
This was a multicenter, retrospective study including 14 burn centers. Patients admitted to one of the study sites from 1/1/17 through 8/31/22 with a cutaneous burn or inhalation injury who received intravenous vancomycin for at least 48 hours were included. Patients were excluded if they lacked at least one steady state trough concentration, experienced an acute kidney injury within 24 hours of vancomycin initiation, were treated for an infection with a known vancomycin MIC greater than or equal to 2, or received continuous infusion vancomycin. Patients were evaluated for clinical success and grouped according to method of monitoring: AUC vs. TR. Clinical success was defined as a composite of absence of 5 criteria: 1) AKI 2) lack of resolution 3) relapse 4) therapy change or 5) death.

Results
A total of 486 patients receiving 517 courses of vancomycin were included. Select patient demographics are included in Table 1. Primary and secondary outcomes are included in Table 2. There was no difference in clinical success between dosing strategies. This remained true after controlling for center, burn severity, and primary infection source. There was no difference in target attainment. The TR group had significantly higher rates of AKI, with concomitant piperacillin/tazobactam remaining significant after multivariate regression analysis.

Conclusions
No differences in clinical success were seen between AUC vs. TR dosing strategies and both groups had high attainment of therapeutic concentrations. AUC-guided dosing may reduce rates of AKI in burn patients with a history of kidney disease, kidney injury on admission, or when vancomycin is being administered with concomitant nephrotoxic medications.

Applicability of Research to Practice
To our knowledge, this is the first multicenter study to evaluate vancomycin dosing strategies in patients with thermal or inhalation injury.
66 Mental Health Support Is an Unmet Need for Long-Term Burn Survivors
Authors: Cobler-Lichter Michael D , Ramsey Walter A , O'Neil Christopher F , Ishii Mary , Satahoo Shevonne S , Kaufman Joyce I , Pizano Louis R , Koru-Sengul Tulay , Szapocznik Jose , Schulman Carl I 
Published: April 2024

Abstract

Introduction
A National Trauma Research Action Plan identified the involvement of burn survivors as critical informants to determine the direction of research and clinical progress in the field. This study surveyed a nationwide sample of burn survivors to identify gaps in care and assess the importance of long-term challenges reported by survivors.

Methods
We prospectively surveyed burn survivors ages ≥18 from around the United States from March-June 2023. Survivors were reached through social media and email contact with the Phoenix Society for Burn Survivors. We elicited demographic info, burn history, continued impact of various symptoms on quality of life, treatments used, long-term difficulties faced, unmet needs, and advice for other survivors. Statistical analysis was performed to test our hypothesis that lack of access to mental health support/professionals would be identified as an unmet need in long-term burn survivors.

Results
Of 178 survey respondents (60% Female, 78% White) the majority were at least ten years removed from the date of their burn injury (n=94, 53%). Compared to those with less than 3 years from their burn injury date, individuals with greater than 10 years, were at least 5 times more likely to note lack of access to mental health support [11-20 years OR 8.7, p&lt; 0.001; &gt;20 years OR 5.7, p=0.001] (See Table 1). Of note, despite a small number of Spanish speaking respondents, 60% of Spanish speakers reported lack of access to support groups was among their greatest unmet needs, compared to 37% of English speakers (p=0.184).

Conclusions
This study highlights the need for ongoing access to mental health resources throughout the entire lifespan of burn survivors. Our findings emphasize that burn injury is not just an acute ailment, but a complex condition that evolves into a chronic, multifaceted disease. Additional studies should focus on the experiences of Spanish-speaking burn survivors, as this group has a clinically meaningful lack of access to support groups and was poorly represented in our sample.

Applicability of Research to Practice
This research calls for increased mental health support for long-term burn survivors. Providers must consider the chronic physical and psychological aspects of burn injury, striving to better equip patients for the future.
99 Empowering Emergency Responders to Treat on Scene Alleviates Hospital Strain During Disaster Events
Authors: Ivanko Anastasiya , Schoen Jonathan E , Lacy Elizabeth , Flores Carl A , Kearns Randy D , Phelan Herb A , Carter Jeffrey E 
Published: April 2024

Abstract

Introduction
Disaster events can cause prolonged losses of electricity, leaving individuals to utilize alternative sources of energy such as fossil fuel generators, which in turn can lead to burn injuries and/or carbon monoxide (CO) exposure. The purpose of this study was to examine the impact of generator-related burn injury and CO poisoning (COP) following a region-wide disaster, and the effects of empowering EMS providers to treat many of these injuries on-scene.

Methods
Utilizing data gathered from Emergency Medical Services (EMS) provider agencies, we constructed three cohorts related to Hurricane Ida’s landfall: PRE-IDA (07/08/21 - 08/25/21), MID-IDA (08/26/21 – 09/08/21) and POST-IDA (09/09/21 – 10/31/21). We analyzed EMS calls, dispatches, and transports for primary complaints indicating COP or burn injury during these time periods. Statewide emergency response network representatives were contacted regarding and pre-hospital care and coordination during disaster responses.

Results
PRE-IDA EMS averaged 15.4 calls per day indicating COP or burn injury. 1.4 (9%) of these calls were due to burn injury (61% of which were transported to nearest ED), while 13 (91%) were due to suspicion of COP (98% of which were transported to nearest ED). The mean turnaround time from dispatch to EMS being back in service was 63 (±36) minutes. MID-IDA EMS averaged 20.9 calls per day. 3.3 (16%) of these calls per day were due to burn injury, and 16.7 (84%) of these calls per day were due to COP. Of the MID-IDA calls, 73% of burn patients and 78% of COP patients were transported to the nearest ED. The mean turnaround time from dispatch to EMS being back in service was 64 (±31) minutes during MID-IDA. During POST-IDA, the mean calls per day to EMS decreased to 10.6 (16% of which were burn injury, 84% of which were suspected COP). Of the POST-IDA dispatches, 61% of burn patients and 97% of COP patients were transported to the nearest area hospital. The mean turnaround time from dispatch to EMS being back in service was 69 (± 49) minutes. Lastly, there were no fatalities from COP in patients transported to the burn center and only one patient required hyperbaric therapy for isolated COP.

Conclusions
At the peak, EMS had 90 calls each day per parish for COP requiring implementation of disaster plan. Our data shows an increase in CO related EMS dispatches during MID-IDA with fewer patients transported to regional area hospitals, but overall stable transport times from household to area hospitals amongst the three time periods. This study demonstrates the collaboration of a verified burn center and the EMS community when responding a to natural disaster.

Applicability of Research to Practice
This study demonstrates that empowering EMS to treat smaller burn injuries, and clinically mild CO exposures, on scene during a disaster event decreases strain on area hospitals’.
529 Laser Scanner Size Effect on Treatment Time
Authors: Muir Cassidy , Mittal Rohit , Kahn Steven A 
Published: April 2024

Abstract

Introduction
Patients may develop debilitating scars that cause psychological trauma, chronic pain, hypersensitivity, or limit function following burns or other soft tissue trauma. CO2 laser treatment improves the function and appearance of scars and is an integral step in reconstruction. These treatments are performed under sedation or general anesthesia. Decreasing operative time without compromising outcomes potentially reduces cost and anesthesia related complications, while increasing the number of patients treated. This study compares the treatment time per surface area for two CO2 lasers with 10mm and 15mm scanner sizes. The authors hypothesize that the 15mm scanner size laser is faster and treats more square centimeters per second than the 10mm scanner size laser.

Methods
A single institution, retrospective study of prospectively collected data looked at time to perform laser treatment for an area with 15mm or 10mm lasers by two experienced burn surgeons over 7 months. Injury characteristics, total area treated, and time elapsed during treatment were tabulated. Next, this information was used to calculate the speed of treatment in cm²/s, and the median speeds between lasers compared. A subgroup analysis was performed on a subset of patients who were treated with both lasers and served as internal controls. A two-tailed Mann-Whitney U statistical analysis (p&lt; 0.05) was utilized to compare medians of the two cohorts.

Results
There were 18 and 16 patients treated with the 15mm laser and 10mm laser, respectively. The average speed of the 15mm laser was 3.2 cm²/s while the 10mm was 1.2cm²/s (p &lt; 0.00001). Five patients had the same wounds treated with both lasers, with a median speed of 2.39 cm²/s using the 15mm laser and 0.93 cm²/s with the 10 mm (p&lt; 0.01208). The average energy used with the 10mm laser was 144.1mJ vs 190.2mJ for the 15mm laser (p = 0.05614) while the average density was 2.6 and 3.3 respectively (p&lt; 0.00001).

Conclusions
Using the 15mm laser as compared to the 10mm laser resulted in a 2.67-fold faster operative time per cm² treated while there was no significant difference in energy. As one might anticipate, the larger scanner size was faster.

Applicability of Research to Practice
This information offers information to support decision making for hospital systems to create, support, and expand laser-scar programs. Future studies will be focused on determining the efficacy of the two lasers. These will focus on differences in scar outcomes based on objective scar measurements and identify any differences in depth of penetration, energy and density between the two lasers.
555 Implementing BNCI Guided Burn Nurse Competency Education at Kessler Burn Trauma Step down Unit
Authors: Palacio Rhoda M , Moynihan Holly 
Published: April 2024

Abstract

Introduction
The Burn Nurse Competency Initiative (BNCI) at the American Burn Association developed a robust Burn Nurse competency national standard that shaped the culture and competence of burn nurses across the country. Upon close analysis of our current practice, it was determined that there are no competency guidelines specific to burn nursing care available for nursing staff during the on-boarding process as well as annual nursing competency assessment available to maintain and sustain staff’s learning needs. The development and implementation EBP Burn Nurse Competencies (BNC) education and its application into our current practice is an important quality improvement initiative that will greatly improve the current standard of care, provide standardization in the process of orientation, and enable sustainable learning opportunities to all nurses in a verified burn center, as well as improve treatments and therapies from admission to discharge that will allow the best possible outcomes for our burn patients.

Methods
The initial needs assessment survey was sent out to our current staff prior implementation of BNC education. The result has shown 76% of staff feels that they received sufficient education on the care of burn patients. The BNC education was also developed through utilization of the cumulative input from the burn program interdisciplinary team and integration of their individual department’s standard of care for burn patients. The BNC was created with two parts: a comprehensive burn/wound care management and the BNC education which defines the specific domain of BNCI competency standard. All of the eleven domains were also integrated in the performance criteria assessment tool. This tool was developed and utilized to ascertain knowledge gained and also as a means to validate competence and confidence level of nurses as they apply the skills/knowledge gain in our clinical setting. The BNC education was implemented to the current staff and is also currently being used to onboard newly hired nurses as the foundation of their orientation process.

Results
The results of this evidence-based practice quality improvement project will be gathered and analyzed at the end of this year when all current newly hired RN will be off orientation.

Conclusions
The conclusion of this quality improvement project will be analyzed at the end of the year for our new hired RN’s orientation process. A survey will be sent out to these group of nurses to ascertain the effectiveness of the BNC education which was implemented July of this year.

Applicability of Research to Practice
Research studies have shown the significance of identifying practice gap related to nursing competencies in practice, assessing the need of nursing competencies, the development of accompanying educational tool and evaluating the effectiveness of nursing competencies as crucial in preventing poor patient outcome, near-miss events, and preventable hospital-acquired conditions.
607 Cultured Epidermal Autografts versus Spray Keratinocytes for Massive Burns—a Cost Effectiveness Analysis
Authors: Yesantharao Pooja , Patel Heli , Gunturi Aditya , Nazerali Rahim , Sheckter Clifford C 
Published: April 2024

Abstract

Introduction
Massive burn injuries are challenging to treat surgically due to limited donor skin. Autologous epidermal grafts such as cultured epidermal autografts (CEAs) and spray keratinocyte suspensions are successful strategies for wound closure when donor sites are limited. There are no investigations to date that describe the differential outcomes or costs between these competing strategies. Cost-effectiveness analysis is required to guide payors, hospitals, and policy makers in determinations of care.

Methods
A cost-effectiveness analysis compared CEAs with spray keratinocytes in adult burn patients with &gt;50% total body surface area deep partial thickness burns. Hybrid Monte Carlo simulation and Markov modeling studied cost-utility from the payer perspective. Study data were derived from randomized clinical trials and cohort investigations of CEAs and spray keratinocytes. The time horizon was 1 year with 1 month cycling. Model costs included the product, surgery (both physician and facility fees), and hospitalization. Surgical costs were derived from Medicare reimbursement fee schedules. Costs of epidermal autografts were determined using currently available marketing material. All costs were inflated to 2023 US dollars, with a standard 3% discounting rate. Model utilities were derived from the Vancouver Scar Scale (VSS) with 1 as the best outcome and 0 as the worst outcome. The incremental cost-effectiveness ratio (ICER) was derived from the cost difference between the two strategies divided by the difference in adjusted VSS. Deterministic and probabilistic sensitivity analyses were performed varying all model parameters.

Results
CEAs achieved successful wound closure in 73% of simulations compared to 88% for spray keratinocytes. Compared to treatment with CEAs, treatment with spray keratinocytes resulted in cost savings of $254,743, with no compromise in overall utility of treatment based on VSS. As such, spray keratinocyte treatment was the dominant strategy. This finding was robust upon sensitivity analyses.

Conclusions
Spray keratinocyte suspensions were a dominant strategy to CEAs (i.e. cost saving without compromising utility).

Applicability of Research to Practice
Payers and providers should consider the cost utility of spray keratinocytes as the dominant treatment strategy for massive burn epidermal grafting. CEA manufactures may want to consider cost reductions to be more economically competitive with alternative strategies.
724 Palliative Care Consultation in an Urban Burn Center
Authors: Haslam Miranda , Anderson Jeffrey 
Published: April 2024

Abstract

Introduction
There is growing evidence supporting early palliative care consultation in many surgical patient populations; however, current literature regarding palliative care consultation in the burn population is limited. Given the significant morbidity and potential mortality associated with burn injuries, especially large total body surface area (TBSA) burn injuries, there is likely benefit to increased utilization of specialty palliative care in the burn patient population. In this study, we investigated current practice patterns of palliative care consultation at our burn center.

Methods
A retrospective chart review was performed at our American Burn Association verified burn center of patients admitted from 2020 to 2023. Inclusion criteria included patients who presented with greater than or equal to 30% TBSA burns or experienced in-hospital mortality. Comparison was made between patients who did and did not receive palliative care consultation during their hospitalization. Student’s T-Test and Chi-Square Test were used for categorical and continuous variables, respectively.

Results
A total of 38 patients met our inclusion criteria. 13 of the 38 patients (34%) received a palliative care consult during their admission, with an average of 10.2 days between admission and consultation. There was a trend towards older age and higher TBSA in patients who received a palliative care consultation (52.9 years vs. 49.2 years, 53.4% TBSA vs. 50.4% TBSA), though these differences were not statistically significant (p = 0.56, 0.33). There was no significant difference in likelihood of palliative care consultation based on presentation characteristics of intubation or inhalation injury. There was also no significant difference identified between patients who did and did not receive palliative care consultation in transition to comfort directed care, in-hospital death, or length of stay. In a subgroup analysis of patients who survived hospitalization, rates of home discharge were higher in those patients who did not receive palliative care consultation (p= 0.005).

Conclusions
Opportunities exist for increased integration of specialty palliative care in the burn patient population. This study represents one of the first reviews of palliative care consultation utilization in an urban burn center patient population. Understanding of current practice patterns relating to palliative care consultation is an essential first step in developing practices to increase utilization of palliative care in the burn patient population.

Applicability of Research to Practice
Significant opportunities exist for improved integration of specialty palliative care in the burn patient population. This research will be used to inform development of triggers for palliative care consultation at our burn center.
728 REsource Support to Optimize REcovery (RESTORE) Study Scoping Review: Care Transition Resources for Burn Survivors
Authors: Velasquez-Cano Mariana , Carnevale Camille , Shepler Lauren , Tenney Diana L , Kazis Lewis E , Ryan Colleen M , Schneider Jeffrey C , Slavin Mary D 
Published: April 2024

Abstract

Introduction
Burn survivors report limited available resources to assist in their transition to the community after hospital discharge. This literature scoping review is designed to increase our understanding of the current burn aftercare landscape. Aims were to identify resources as well as assess barriers and facilitators available to burn survivors and their families aftercare.

Methods
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) served as a guideline to examine the following databases: PubMed, EMBASE and Web of Science. The search terms used included: burn(s), health resources, aftercare, after treatment, follow-up care, patient discharge, delivery of health care, ambulatory care, mental health and functional status. Criteria for inclusion were: burn injury diagnosis, outpatient or inpatient resources related to post-discharge burn recovery, location of resource delivery (burn center, outpatient clinic or other hospital setting), adult population, publications from 2012 to 2023 and in the English language. The International Classification of Functioning, Disability and Health (ICF) provided a conceptual framework to organize findings.

Results
Of the 385 articles that were screened, 27 met inclusion criteria (Figure 1). Studies reported health resources within the following ICF Component (domains): Body Function (emotional function), Activities and Participation (work and employment, mobility), Environmental Factors (family and societal attitudes, social security and health services, education, general products related to technology such as telehealth. Implementation strategies included early planning and coordination of a multidisciplinary burn team to connect family and burn survivors with available resources. Educational materials to engage patients with outpatient care were also recommended. Examples of successful resources and services include: work accommodation, telehealth, peer support, web-based community online chat rooms and aftercare reintegration programs.

Conclusions
This review provided an overview of current practices used to support burn survivors following discharge. Classification of these resources using the ICF framework fosters an understanding of the bio-psycho-social needs of the population and outlines an approach to design comprehensive aftercare services. This literature review is the initial step to develop a map of the resources currently offered to burn survivors and their families. Future qualitative work will build upon these findings and expand our understanding of the barriers and facilitators to meet the long term needs of people living with burn injury.

Applicability of Research to Practice
This review highlights the breadth of post discharge resources currently described in the literature, providing a foundation for future long-term care recommendations.