bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Antenatal Care Utilisation on Birthweight: Evidence from Ghana
Authors: Bawuah Alex , Appleton Simon , Li Yang , Song Lina 
Published: April 2024

Abstract
In 2015, about 20.5 million babies were born with low birthweight (LBW), with the majority from low- and middle-income countries. The use of antenatal care (ANC) is a recommended health policy measure to reduce the risk of LBW. However, there is limited evidence for its effectiveness in reducing LBW in sub-Saharan Africa, although the region accounts for almost one-quarter of LBW babies, second only to Asia. Moreover, while the number of LBW in other regions is reducing, the number of LBW babies in sub-Saharan Africa is increasing. We therefore use data from Ghana (a sub-Saharan African country with a high incidence rate of LBW) to investigate the effect of using ANC on birthweight. The number of ANC visits and the month of ANC initiation were used as indicators for ANC utilisation. We applied an extended linear regression technique to deal with the potential sample selection bias and endogeneity associated with the use of ANC. The results from the study indicate that early ANC initiation and having more ANC visits are both associated with an increase in birthweight; however, the estimated effect of an early ANC visit is larger than having an additional visit. Therefore, we recommend that policies aimed at tackling the problem of LBW should mostly be geared towards promoting ANC utilisation, especially early ANC initiation. We also find that estimating the effect of ANC on birthweight without accounting for sample selection bias and endogeneity of ANC underestimates the effect of ANC on birthweight.
29 Virtual Reality to Reduce Patients’ Procedural Pain and Anxiety
Authors: Blacker Hayley , Thomas Mini , Grywalski Maria Michelle M 
Published: April 2024

Abstract

Introduction
Patients undergo multiple anxiety-inducing and painful procedures when admitted to the hospital setting. Virtual reality (VR) offers an interactive, nurse-driven adjunct to analgesia or anxiolytics. Our burn unit implemented VR as a non-pharmacological opportunity to reduce a patient’s perceived pain and anxiety via dissociative distraction, thereby promoting holistic patient-centered care. After introducing the novel technology to staff, we specifically focused on the potential for virtual reality to improve a patient’s experience during uncomfortable wound care procedures.

Methods
A protocol was developed for the use of VR in the patient care setting with appropriate inclusion/exclusion criteria. Once the protocol was developed, the burn unit nursing staff was in-serviced and encouraged to engage in hands-on practice to increase familiarity. A post-procedure patient survey was developed with two parameters: numeric pain scale and the institution's integrative nursing anxiety scale. Both scales were previously validated and active in the institution’s electronic charting record. This quantitative data was then collected from 20 patients’ individual pain and anxiety perceptions during wound care without VR over the course of one month. Then, the following month, data was collected from 20 patients’ individual pain and anxiety perceptions during wound care with VR implementation. For the VR intervention group, a third parameter was added to the survey that inquired if the patient would recommend VR to other patient’s undergoing wound care.

Results
Patients' average pain score dropped from 4.9 in the control group to 3.8 in the experimental group. Patients' average anxiety score dropped from 2.1 in the control group to 1.8 in the experimental group. These patient-reported survey responses demonstrate that the implementation of VR resulted in a 23% reduction in pain and a 15% reduction in anxiety during wound care procedures. In regards to the third parameter applicable only to the experimental group, 100% of patients reported that they would recommend VR to other patients.

Conclusions
Virtual reality is a nurse-driven, non-invasive modality that reduces a patient’s pain and anxiety during wound care procedures. Furthermore, patients enjoyed their experience with virtual reality as shown in the unanimous response to recommend to other patients.

Applicability of Research to Practice
Virtual reality is a vast realm with exponential opportunities. This low-risk intervention has the potential to optimize a patient’s hospital experience by acting as a modality that reduces patient’s pain and anxiety related to a variety of procedures and therapies led by a multidisciplinary team.
40 Inflamm-aging, Burns and the Gut-lung Axis in Mice
Authors: Kovacs Elizabeth J , Boe Devin M , Frank Daniel , Idrovo Juan-Pablo , McMahan Rachel H , Walrath Travis M , Najarro Kevin M 
Published: April 2024

Abstract

Introduction
The elderly have a heightened basal state of inflammation, known as “inflamm-aging,” which predisposes them to aberrant immune responses and may reduce their ability to withstand burn trauma. We and others believe that a combination of factors released from the burn site in the aged host trigger the gut to become more permeable and, along with shifts in fecal microbiota, sets the stage for excessive systemic and pulmonary inflammatory responses and poor prognosis after injury.

Methods
We used our well-established, clinically relevant murine model of burn injury in which young and aged mice are subjected to a 12% total body surface area dorsal scald burn or sham injury. At 24 hours after injury, mice were humanely euthanized and lungs, blood, ileum and feces were collected for analysis including histopathology, RNA sequencing, 16S rRNA gene sequencing, and real-time PCR.

Results
There were no differences in distribution of lung myeloid cell populations between groups; all samples were composed of &gt;97% CD45+Ly6g-CD11c+SiglecF+ alveolar macrophages (AM). However, there were profound changes in transcriptional profiles of these cells both before and after injury. Compared with AM from young sham mice, AMs from young, burned mice displayed diverse and complex transcriptional changes, totaling 964 differentially expressed genes (cut-off p &lt; 0.01; FDR &lt; 0.05). In contrast, injury produced fewer changes in mRNA expression of AMs from aged mice relative to that of sham age-matched controls, with changes in only 216 genes. The genes differentially expressed with age included those involved in endosomal/lysosomal trafficking, antigen presentation, tissue remodeling, and receptors or secreted factors related to immune responses, possibly altering their ability to respond appropriately to invading pathogens. Since the gut is a motor of critical illness, we also examined the intestine in the same experimental groups. The fecal microbiota of aged-injured mice had significantly less Shannon alpha-diversity when compared to other groups (p &lt; 0.05). This included a dramatic loss in gut-protective bacterial taxa, including Akkermansia muciniphila, in the microbiota of aged-injured mice relative to all other groups. Moreover, there was an 18-fold increase in gut leakiness, using orally gavaged FITC-dextran, when compared to other groups (p &lt; 0.05).

Conclusions
Taken together, these findings suggest that the post-burn loss of protective commensal bacteria and the breach of the intestinal epithelial barrier in aged mice could contribute to the changes in AM gene expression and alter responses to lung infections.

Applicability of Research to Practice
Future studies will explore whether supplementation of protective bacteria, such as Akkermansia muciniphila, after burn injury could restore intestinal and pulmonary homeostasis and AM function in burn patients of all ages.
85 Sole Propofol Use in Burn Patients Is Associated with Better Postprocedural Outcomes Than Using Propofol-Ketamine
Authors: Ramgopal Yash , Richter Christopher G , Krishna Sunskruthi , Shah Suhaib , Segura Carolina , Obias Isabel B , Amador Dalton , Durand Jean pierre , ayadi Amina E I , Golovko Georgiy , Song Juquan , Wolf Steven E 
Published: April 2024

Abstract

Introduction
Propofol and its combination with ketamine have been used as sedatives in burn patients undergoing operative procedures such as surgical debridement and wound care. Although research has been conducted on comparing the complications of propofol-ketamine and sole propofol use in the emergency department (ED), limited research is available on the use of these sedatives specifically in burn patients who are in a hypermetabolic state. Our study aims to bridge this gap by comparing the postprocedural outcomes of using propofol-ketamine and propofol alone during operative procedures in pediatric and adult burn patients.

Methods
Data for this study was obtained from a national database of de-identified medical records. Two burn patient populations undergoing operative procedures were identified based on sedative use: propofol-ketamine and propofol alone. Patients with a past medical history of respiratory and cardiovascular conditions were excluded. Cohorts were balanced using propensity score matching of covariates: age at index, sex, race, and ethnicity. Five complications were studied 0-14 days post-administration of sedative: anxiety, hyperkalemia, renal failure, hypotension, and respiratory failure. Statistical analysis included risk differences with a significance value of p &lt; 0.05.

Results
We identified 7,993 patients who were administered only propofol during operative procedures and 7,148 patients who were administered the combination of propofol and ketamine. Propofol-ketamine use had a statistically significant higher incidence of anxiety (2.91% vs 1.62%, p &lt; 0.0001), hyperkalemia (1.19% vs 0.81%, p = 0.0402), renal failure (2.58% vs 1.83%, p = 0.0037), hypotension (1.56% vs 1.10%, p = 0.0247), and respiratory failure (3.40% vs 2.80%, p = 0.0488).

Conclusions
Our study indicates that sole propofol use in burn patients undergoing operative procedures is associated with better postprocedural outcomes than using a combination of propofol and ketamine. Indicators of propofol infusion syndrome (hyperkalemia and renal failure), which is a life-threatening rare complication of the sedative, are higher with the use of propofol-ketamine. Future directions of the study include analyzing the relationship of burn severity (measured by % total burn surface area) on outcomes in the two cohorts.

Applicability of Research to Practice
Wound dressing changes and surgical excision in burn patients often provoke considerable pain and anxiety, hence sedatives such as propofol and ketamine are routinely used to ease their concerns. The findings from this study have the potential to help physicians choose the right sedative by balancing patient comfort and the risk of adverse effects.
95 Moral Injury and Four-Quadrant Approach to Ethics Issues in Burn Care
Authors: Regel Eva 
Published: April 2024

Abstract

Introduction
The presentation will address the post-pandemic changes that take place in current healthcare in general and burn care specifically, such as dramatically increased rates of burnout and staff turnover. Particular attention will be given to introducing and discussing the concept of moral injury and its relevance to the everyday work in the Burn unit; the presentation will address and discuss the impact and causes of moral injury on nursing staff and clinicians in the context-specific Burn care setting. Particular attention will be devoted to the effects of moral injury on the paradigm of the “four-quadrant approach” commonly used in ethical decision-making in burn care. The presentation will offer a discussion of the moral underpinnings of moral injury and moral responsibility and the relevance of these complexities on providers’ ability to employ the “four-quadrant approach " will be discussed. The current research on moral injury and distress will be highlighted in the presentation.

Methods
Discussion

Results
Results will be based on a literature review.

Conclusions
Several possible solutions to mitigate the effects of moral injury will be offered. Specifically, changes to nursing curriculums and medical schools will be proposed.

Applicability of Research to Practice
Direct application as recognition and mitigation of the effects of moral injury can have a direct effect on decision making process as well as sustainability and resilience of staff on the Burn unit.
505 Fusarium Isolates in Burn-injured Patients: Clinical Characteristics and Susceptibility Patterns
Authors: Young Sierra R , Stoianovici Robyn N , Louie Erin L 
Published: April 2024

Abstract

Introduction
Fusarium species are ubiquitous in the environment and can cause opportunistic infections in burn-injured patients. Patients with larger burns, prolonged lengths of stay, concomitant antimicrobial use and invasive lines are at higher risk for Fusarium infections. Little data exists on clinical characteristics and in vivo antifungal susceptibilities in burn-injured patients.

Methods
All positive Fusarium species cultures were retrospectively identified between November 2017 to June 2023 at a regional burn center. Demographic, clinical and microbiologic susceptibility data was collected from the electronic medication record. Descriptive statistics were used to describe the cohort.

Results
A total of 18 patients had positive Fusarium wound cultures during the study period. The average age was 38.4 ± 11.9 years. The average %TBSA was 54.5 ± 23.4 % and R-Baux score of 92.9 ± 29.3. The most common mechanism of injury was thermal burn (17 patients, 94%). This cohort experienced prolonged ICU (68.9 ± 31.9 days) and hospital (73.6 ± 38.2 days) lengths of stay. The average time from burn injury to positive Fusarium cultures was 19.6 ± 9.0 days. Mechanical ventilation was prolonged (46.1 ± 23.3 days). The average central line duration prior to Fusarium infection was 9.8 ± 10.2 days. Susceptibility data was obtained for voriconazole in 15 patients and for amphotericin in 14 patients. For voriconazole, 5/15 tested isolates had an MIC of 4, 1/15 had an MIC of 8, and 9/15 (60%) isolates returned with MIC ≥ 16. A majority (13/14, 93%) of the MICs tested for amphotericin were ≤ 1. Patients were taken to the OR for source control in all cases. Ten of 18 patients with Fusarium positive infections survived to hospital discharge (55%). The most common cause of death was multi-system organ failure and sepsis (88%). Recorded adverse drug events possibly due to voriconazole and posaconazole included transaminitis (4 cases), QTc prolongation (1 case), and hallucinations (1 case). Amphotericin was suspected of contributing to an acute kidney injury in 1 case.

Conclusions
This case series reports the clinical characteristics and susceptibility data on Fusarium isolates in a burn-injured population. This cohort was critically ill based on the %TBSA, R-Baux score, and high rate of mechanical ventilation. The MIC results obtained for voriconazole demonstrated a majority of isolates with relatively high MIC values ≥ 16. A majority of the MICs for amphotericin were &lt; 1. It is important to note that no established breakpoints exist for Fusarium species and clinical outcomes are dependent on a variety of factors beyond the susceptibility data.

Applicability of Research to Practice
Empiric double coverage with voriconazole and amphotericin or amphotericin monotherapy should be considered when Fusarium is a suspected primary pathogen.
527 Combination Treatment for Hypertrophic Burn Scars Utilizing Fractional Ablative and Continuous Wave CO2 Laser
Authors: Lee Punhae 
Published: April 2024

Abstract

Introduction
Hypertrophic scars remain a devastating consequence of severe burn wounds, producing anatomic deformities, as well as functional impairment. Fractional ablative CO2 laser treatment has shown scar - reducing effects. In this study, we compared the outcomes of combining two different CO 2 lasers or fractional ablative CO2 laser alone in treating hypertrophic burn scars.

Methods
Forty patients with hypertrophic burn scars were included in one of following two groups: fractional ablative CO2 laser combined with continuous wave CO2 laser (group 1) or fractional ablative CO2 laser alone (group 2). Three plastic surgeons rated the hypertrophic scars according to observer-rated Vancouver Scar Scale (VSS) before and after treatment (at least 6 months after the last laser) and by patient-completed questionnaires after treatment (at least 6 months after the last laser).

Results
Forty patients completed the laser treatment. Group 1 showed significant improvement in vascularity, pliability, and height than group 2 (p &lt; 0.05) but not in pigmentation. Time-dependent analysis of total VSS scores suggested that group 1 experienced more improvement during a shorter treatment period than group 2 (p &lt; 0.05). For patient-reported outcomes, group 1 showed significant improvement than group 2 in scar appearance, scar thickness, pain, and pruritus (p &lt; 0.05).

Conclusions
Observer-reported VSS outcomes showed that combining laser treatment resulted in more improvement of vascularity, pliability, and height indices for hypertrophic burn scars. Patient-completed outcomes showed that combining laser therapy was considered more helpful for improving scar appearance, scar thickness, pain, and pruritus than fractional ablative laser alone. Furthermore, combination treatment appeared to produce more improvement in a shorter period of time.

Applicability of Research to Practice
The two lasers are widely used in scar treatment in South Korea, so yes this research can be applied to medical practice.
539 Do Not Put Burn Education on the Back Burner - Plastic Surgery in Burn Care
Authors: Arellano Jose Antonio , Pandya Sumaarg , Liu Hilary , Alessandri-Bonetti Mario , Jeong Tiffany , Egro Francesco 
Published: April 2024

Abstract

Introduction
Burns injuries represent a leading cause of mortality and morbidity in the United States, with about 40,000 hospital admissions annually. These injuries are typically managed by burn surgeons who were trained in either plastic or general surgery. However, due to the Accreditation Council for Graduate Medical Education (ACGME)’s recent elimination of the burn surgery requirement for general surgery training, the role of plastic surgery in burn surgery care has become increasingly important. The aim of this study is to quantitively investigate the current role of plastic surgery in burn care at a single academic institution with an affiliated ABA-verified Burn Center.

Methods
A retrospective cohort study was performed of burn patients admitted to UPMC Mercy, the only comprehensive ABA-verified Burn Center and Level I Trauma Center in Western PA, from January 1st, 2012, to December 31st, 2022. Data were obtained from a prospectively maintained internal database including all patients admitted for burn related health problems.

Results
A total of 3843 patients were admitted for burn injuries, with 39.3% (n=1509) requiring surgery. Plastic surgeons were consulted for 17.5% (n=264) of these patients, performing a total of 658 procedures. Burn patients operated on by plastic surgeons received an average of 2.49±2.02 procedures. Most of the procedures performed by plastic surgeons involved severe and deep burns or anatomically challenging areas, such as the hand (n=362; 55.0%) and head/neck (n=165; 25.1%). These procedures involved either acute coverage of complex burn injuries or delayed reconstruction of post-burn deficits. For hand-related surgeries, 55.8% (n=202) were acute and 44.2% (n=160) were delayed reconstruction. Similarly, head and neck-related surgeries included 53.3% acute (n=88) and 46.7% (n=77) delayed reconstruction.

Conclusions
Plastic surgeons play a crucial role in the acute and reconstructive care of burn patients, often performing multiple procedures for patients with injuries to anatomically complex areas such as the hand and head/neck. Since burn training is no longer required for general surgery residency, it is increasingly important that plastic surgeons be trained to perform complex burn reconstruction procedures and fill the ongoing shortage of burn specialists.

Applicability of Research to Practice
Our research underscores the growing significance of plastic surgeons in burn care, particularly in light of evolving training requirements. This study emphasizes the practical need for specialized training to meet the demands of complex burn cases and addresses the current shortage of burn specialists effectively.
557 Current Assessment and Evaluation of Burn-Induced Chronic Pain
Authors: Chapin-Grabowski Chloe E , Marshall Victoria 
Published: April 2024

Abstract

Introduction
Examine the current state of the literature regarding how chronic burn-induced pain is assessed and evaluated.

Methods
Whittemore and Knafl’s integrative methodology was utilized to guide this literature review. A search of Pubmed, CINAHL, and PsycInfo resulted in nine articles included in the final synthesis. Inclusion criteria consisted of peer-reviewed studies in the English language published within the last five years. No restriction was placed on the type of burn or degree of injury. Reviewing how chronic burn-related pain is conceptualized precludes treatment modalities therefore, intervention-based studies were excluded. In addition, studies that did not evaluate long-term burn pain as a primary outcome measure were also excluded.

Results
Chronic burn pain is most often assessed using numerical/visual analog scales and Likert scales. Occasionally, patients are asked to self-report characteristics they identified as chronic burn pain. The instruments used to evaluate pain are administered by various methods including pen-and-paper assessments, interviews, mail-in surveys and retroactive chart reviews. Studies assessed chronic burn pain at both a one-time basis and at intervals commencing as early as three months and extending as long as eight years post injury. Additionally, comorbid, psychological, and physical factors were found to be associated with the development of chronic burn pain.

Conclusions
Chronic pain-related complaints remain prevalent amongst the burn population. However, further studies are warranted to assess the reliability of measuring pain via numerical/ visual analog scales and Likert scales in the burn population. Chronic burn pain is recognized as a major influence on health-related quality of life outcomes with current research prioritizing the identification of predictive risk factors.

Applicability of Research to Practice
Early interventions and the implementation of preventative measures upon the recognition of risk factors associated with the development of chronic burn pain is critical. Increased use of multi-dimensional instruments can provide a comprehensive understanding of the various dimensions chronic burn pain. Finally, in depth assessments and evaluations of chronic burn pain can contribute to the development of integrative care and lead to improved long-term outcomes for the burn population. Improved patient outcomes include prioritizing burn survivors’ psychological well-being, providing individualized care for various classifications of burn injuries and differentiating neurogenic and neuropathic pain experiences.