bluuebunny/crossref_metadata_2025_split huggingface dataset:
577 Understanding Drivers of Fire Risk with People Experiencing Homelessness
Authors: Orton Caitlin M , Gannon Mark , Mesic Aldina , Chambers Mona , Pham Tam N , Stewart Barclay T 
Published: April 2024

Abstract

Introduction
Burn injuries among people experiencing homelessness (PEH) are a major and escalating public health problem affecting a population facing issues of socioeconomic disparities, racism, comorbidities (e.g., disabilities, substance use disorders), and inequitable housing policies. Given the intensifying issue of burn injuries among PEH, it is crucial to Identify key drivers of fire risk in this already marginalized population to inform injury prevention and control initiatives.

Methods
Key informant interviews (KII) with PEH who experienced burn injuries were conducted to identify fire risks and opportunities to mitigate hazards. Transcripts were coded using deductive and inductive strategies grounded in harm reduction theory. For the deductive component, an established conceptual model was applied to group factors into the following categories: weather conditions, neighborhood characteristics, group behavior, individual behavior, dwelling characteristics, and fire sources and containment. For the inductive component, emerging themes were identified and coded.

Results
Participants from 13 KII had varied etiologies of their burn injuries (e.g., sleeping by fire, assault by fire, tent fire, car heater contact burn, propane tank explosion). The most common fire sources identified were propane, hand sanitizer, and other alcohol-based liquids. Unsafely contained open flames and improper propane tank storage were frequently expressed hazards. Participants described the interplay of environmental, social, and behavioral factors that need to be accounted for when addressing fire hazards (Figure 1). For example, participants highlighted the relationship between fire risks and acts of violence (e.g., theft of fuel sources, assault, forced relocation), as well as the multitude of considerations that impact fuel choice (e.g., accessibility, cost, smoke exposure, burn duration, flame control, weather conditions). Furthermore, participants described other specific opportunities for prevention within the intersectional context of the environments and risks they experience.

Conclusions
A variety of fire hazards were identified and amenable to harm reduction (e.g., safe stove dissemination, education on safe storage, availability of warming shelters). To be effective, implementation of fire prevention and control strategies must be evaluated for their effectiveness in complex environments (e.g., exposure to severe weather, unsafe and potentially violent living conditions, substance use, social marginalization, and poor access to injury prevention media).

Applicability of Research to Practice
Understanding environmental and socioeconomic risks and their interplay with fire hazards is foundational for collaborative injury prevention and control initiatives to be implemented by PEH, homelessness service providers, public health officials, and burn centers.
590 An Occupation-Based Review of Outcome Assessments Used in Hand Function After Burn Injury
Authors: Cancio Jill M , Stav Wendy 
Published: April 2024

Abstract

Introduction
Since over 50% of those who survive burn injury have hand involvement, one of the most important functional outcomes of burn rehabilitation is hand function. Occupational therapists leverage the use of occupation to restore function. While occupation began as the central concept of occupational therapy at the dawn of the profession, the use of occupation throughout the therapy process, including assessment, has wavered in recent decades. Knowledge of the occupational nature of assessments is important to the delivery of authentic occupational therapy.

Methods
Outcome measures that have been cited in the burn rehabilitation literature to assess hand function were included in this review and were classified into 3 categories (traditional components, performance, and patient-reported outcome measures). Psychometrics to include established validity in the burn population were also described. The extent to which each measure utilizes occupation to assess function was determined with the Occupation Based Performance Assessment (OPBA). The OBPA consists of several scales (authentic occupation, meaningful and purposeful value, and therapeutic intent) to measure the presence of occupation in assessment tools and practice patterns used in occupational therapy practice. The OPBA is interpreted along a continuum divided into 3 categories: occupation-based, intermediate, or discrete.

Results
The searches of the data bases yielded identification of 2 traditional component measures, 4 performance measures, and 4 patient-reported measures. According to the OPBA there are 3 discrete measures, 6 intermediate measures, and 1 occupation-based measure. Of the 10 assessments identified in the literature, 6 are performance-based assessment tools. None of the performance-based assessments were classified above intermediate on the occupation-based continuum. A novel occupation-based measure was identified, the Suitcase Packing Activity (SPA); however, it has not been validated in the burn population.

Conclusions
This review of outcome measures to assess hand function after burn injury revealed a paucity of occupation-based assessments in this practice area which has implications for delivery of occupation-based care. The majority of outcome measures used in upper extremity burn rehabilitation are discrete in nature and do not measure occupations of clients. The SPA, after validation in the burn population, may be a viable addition to an assessment battery to address this essential need.

Applicability of Research to Practice
There is a paucity of occupation-based assessments in this practice area which has implications for delivery of occupation-based care. Valid occupation-based performance measures in the burn population are needed.
591 Efficacy of a 3D Printed Microstomia Orthosis on Mouth Opening and Function, a Case Series
Authors: Edger-Lacoursière Zoë , Calva valérie , Schneider Genevieve , Nedelec Bernadette 
Published: April 2024

Abstract

Introduction
Microstomia, often observed following facial burn injuries, can hinder functional activities such as eating, speaking, dental care, and medical procedures such as intubation. Thus, microstomia orthoses (MO) are used to increase mouth opening and function. Various designs of custom fabricated MOs have been published, however, to the best of our knowledge, the first report of a 3D MO for mouth burns was presented at the 2023 ABA conference. This 3D MO was modified to generate additional sizes and address issues of comfort and material rigidity. The modified 3D MO (available on Thingverse) was then trialed with 3 patients at different stages of their rehabilitation and their outcomes documented.

Methods
The purpose of this case series was to evaluate the efficacy of a 3D MO on mouth opening and function when used to treat 3 adult burn survivors. The mouth impairment and disability assessment (MIDA), including measures of horizontal and vertical mouth opening, was completed before the use of the 3D MO and after 4 months of wear. All participants had previously reached a plateau on the MIDA and opening measures after the use of various commercially available MOs before starting the 3D MO. They were also asked to evaluate the comfort and whether they would modify any aspect of the MO.

Results
The total material cost of this MO ranged from 2-3 $CAD. The print time ranged between 5.5-8 hrs (depending on mouthpiece size) using a 3D printer valued at ~250$CAD. The 3 participants were male with a mean age of 40 years, mean TBSA of 9.5% and 2/3 participants received face grafts. Patients started using the 3D MO at different timepoints post-burn: 4m, 9m and 15m. The 4-month post 3D MO wear MIDAs are currently being completed. However, one patient completed the questionnaire, which improved by15 points. Another patient was able to avoid having reconstructive surgery. To date, all patients improved both their horizontal and vertical mouth opening measures (mean improvement - horizontal: 0.72 (0.52) cm range [0.16-1.2]; vertical: 0.92 (0.41) cm range [0.67-1.4]). The MOs were worn between 2 weeks-4 months for a minimum of 30 min/day to achieve these results, but data collection is ongoing. All patients reported that the MO was comfortable, and they prefer it to all the MOs they had worn previously.

Conclusions
Although data collection is ongoing, patients who had previously plateaued have improved function and oral opening after the application of this modified 3D MO.

Applicability of Research to Practice
This cost-effective solution increases accessibility of MOs for individuals who do not have access to commercially available MOs. The need for economically feasible alternatives is particularly important in developing countries where burn injuries are more prevalent.
719 Child Life Specialists in the Treatment of Acute Pediatric Burns: A Systematic Review
Authors: Knight Paige , Kore Zoe , Hynes Sally L 
Published: April 2024

Abstract

Introduction
Children undergoing acute burn care may experience pain and anxiety affecting their ability to tolerate wound care procedures. Non-pharmacological support, including Child Life Specialists (CLS), may compliment pharmacological treatments to reduce pain and anxiety. CLS support is particularly relevant in pediatric burn care; however, there is a paucity of literature on the impact of CLS interventions for pediatric burn care. This review aims to synthesize the current understanding of CLS in pediatric burn care.

Methods
A systematic review of peer reviewed databases (Embase, CINAHL, MEDLINE, Scopus) and gray literature (Google Scholar, Proquest, Papers First) was conducted up until 28 April 2023. Search terms included ‘burn care’ and ‘child life specialist*.’ Included studies focused on acute burn care and patient centered outcomes as primary outcomes, and non-clinical studies, such as reviews, were excluded. The protocol was published on PROSPERO, and PRISMA guidelines were followed. Data on study type, burn characteristics, pain, and anxiety were extracted and analyzed descriptively.

Results
Seventy-one unique studies were found. Five publications (three peer reviewed articles and two conference abstracts) were included. Across the five included publications (n=226) patient median/mean age ranged from 2.2 years to 7.8 years old. Two studies had a control group (n=121). There was incomplete reporting of burn characteristics. Mean/median TBSA ranged from 0.5% to 9.17%, with the upper extremity the most frequently reported location (up to 66.7%). CLS interventions included inpatient and outpatient settings. Three studies reported pharmacological analgesia and CLS during burn care. CLS interventions included distraction with electronics and/or toys (4/5), music (1/5), and directed play (1/5). Patient and parent perceptions of pain and anxiety were collected via validated measures. For the two studies with control groups, CLS interventions were associated with a reduction in pain. There was no statistically significant reduction in anxiety.

Conclusions
This systematic review identified few published studies on the effect of CLS interventions in pediatric burn care, with heterogeneity in patient population and outcome measures. CLS interventions were associated with reduced pain in children undergoing acute burn care. Although we did not find a statistically significant reduction in anxiety, authors reported insufficient statistical power.

Applicability of Research to Practice
Preliminary research supports the role of CLS interventions in reducing pain in pediatric burn care. Higher powered studies examining the role of CLS in pediatric burn care are needed to further elucidate the effect of CLS on pain and anxiety. We hope these findings stimulate further research to provide the evidence needed to fund CLS as a permanent member of multidisciplinary pediatric burn care teams.
746 Routinely Collected Burn Clinical Data in Canada: Determining the Knowledge Gap
Authors: Wang Sabrina , Gus Eduardo I , Malic Claudia C , Zuccaro Jennifer 
Published: April 2024

Abstract

Introduction
Unlike other developed countries that hold national burn registries to monitor burn injury and care, Canada relies on single-centre secondary datasets and administrative databases as surveillance mechanisms. The objective of this study is to determine the knowledge gap faced in Canada for not having a dedicated burn registry.

Methods
A comprehensive scoping review was conducted to identify the burn literature that has arisen from secondary datasets in Canada. Literature of all study designs was included with the exception of case reports and cases series. Once data extraction was concluded, a thematic framework was constructed based on the information that arose from nations that hold national burn registries.

Results
Eighty-eight studies were included. Twelve studies arose from national datasets, and 18 from provincial databases, most of which were from Ontario and British Columbia. Only seven studies were conducted using a combination of Canadian units’ single-centre datasets. The majority of included studies (58%) resulted from non-collaborative use of single-centre secondary datasets. Research efforts were predominantly conducted by burn units in Ontario, British Columbia, Manitoba and Alberta. A significant number of the included studies were outdated and there were several provinces/territories with no published burn data whatsoever.

Conclusions
Efforts should be made towards the development of systems to surveil burn injury and care in Canada. This study supports the development of a working group and potentially a nation-wide burn registry to bridge this knowledge gap.

Applicability of Research to Practice
Decisions regarding burn injury prevention and delivery of burn care must be informed by clinical data, in order to maximize efficacy and outreach. Canada has a publicly funded healthcare system, and yet, these decisions at present are not informed by data. The establishment of the knowledge gap that is faced by the Canadian burn community is the first step towards the establishment of a working group that will discuss how Canada will move forward to bridge this gap and increase the quality of burn care delivered across the country.
747 Important Considerations for Healthcare Outreach Missions
Authors: Smith Susan L 
Published: April 2024

Abstract

Introduction
Up to 2 million people from the United States participate in short term medical mission trips to over 1000 missions annually with approximately 500 organizations spending $250 million annually in support of these trips. Depending on the mission, a wide variety of volunteers may be needed to support the effort, from multidisciplinary healthcare teams to translators and city planners. Moving past the romantic notion of “doing good”, it is imperative that participants follow a well-organized approach to trip preparation, delivery of care, and establishment of a sustainable plan when departing.

Methods
A review of existing literature was conducting to delineate the process to prepare outreach volunteers and the host country to maximize time and efforts. Key search terms included: medical and international mission, low-middle income country, medical and international outreach, medical volunteer, volunteer abroad. PubMed®, CINAHL®, MedlinePlus®, OVID®, and Google Scholar® were searched.

Results
Pre-trip information for participants should exceed the necessary logistics of finances, telecommunication, vaccinations, and travel arrangements. Preparation should address vital aspects of the host country, such as government structure, income, available medication and healthcare facilities, religion, weather, and available food sources. Sustainability mandates knowledge of and respect for skill set and host resources. Post trip evaluation is essential for participants to debrief about the physical, emotional and educational aspects of the mission. Evaluation by the host country provides critical information for ongoing support and future outreach. Missions should not disrupt local health and social services, but work to achieve productive and foundational outcomes.

Conclusions
Whether public good, private consumption or investment exchange, serious adverse consequences can result when there is poor alignment with host country needs. Research supported that isolated brief missions often do not have any impact on local poverty and struggling healthcare systems. Prioritizing local capacity building through sustainable educational, professional and appropriate financial resources, with recurring support is essential to achieving a long term positive impact. Efforts must avoid creating a culture of dependence, thereby perpetuating a power differential.

Applicability of Research to Practice
With the volume of outreach missions conducted and the large number of organizations and individuals involved in this effort annually, there is an enormous opportunity for research analyzing outcomes at a variety of intervals form the perspective of the volunteers, supporting organizations and the host countries. This data is crucial to refining efforts to truly achieve the greatest good.
774 A Novel Facial Mask Design: A Single Case Report
Authors: Martinez Andria , Warthman Renée , Pirsig Whitney , Murray Derek , Richey Karen J , Foster Kevin N 
Published: April 2024

Abstract

Introduction
Facial scarring can impact an individual’s self-worth and confidence. Treating facial scarring often includes fabrication and fitting of custom face masks. Facial masks are generally fabricated utilizing high or low temperature thermoplastic material. Facial masks may also include a silicone component to address scar formation. At present time, facial mask fabrication has evolved from plaster molding directly on the patient to 3-D scanning and subsequent molding. Impediments to current practice may include cost, delayed prescription, and breakage which can allow tissues to change which ultimately require extended modifications. This is a report of a single patient in which a 50/50 putty facemask with a thermoplastic overlay was utilized to address facial scarring, compliance, cost, and distance from clinic.

Methods
This is a case study of a 5-year-old child who suffered deep partial thickness to full thickness burn injuries to his face for whom we created a facemask with a superimposed thermoplastic overlay to maintain the position of the 50/50 putty mask. The 50/50 facemask was fabricated in a t-shape with clearance of eyes, nose and mouth. The thermoplastic overlay was fabricated to contour the exact shape of the outer face over the 50/50 putty. The Patient and Observer Scar Assessment Scale (POSAS) was administered prior to applying the custom facemask and at day 42 to evaluate efficacy. Each item on the POSAS scale is scored from 1 to 10, with 1 being normal skin and 10 representing the worst scar possible. The total score can range from 6 to 60. There is a separate overall opinion score that is rated on the same 1-10 scale. The father completed the patient portion of the scale with feedback from the child.

Results
The custom facemask was worn 23 hours per day for 42 days. The baseline patient score was 42 and the patient overall opinion of scarring score was 7. The observer score was 43 with an overall opinion of scarring score of 7. At day 42 both the patient score and patient overall opinion score had improved, 18 and 4 respectively. The observer score and observer overall opinion score also improved, 21 and 3 respectively.

Conclusions
Utilization of a 50/50 putty facemask allowed for continuous wear with less incidence of modifications due to material composition. Utilization of a 50/50 putty facial mask accommodated tissue modulation without risk of erythema in a way that thermoplastic material is unable to achieve. The facemask utilized in this single case study provided standard of care treatment while increasing ease of management for patient, decreasing cost, and allowed for same day use following initial fabrication.

Applicability of Research to Practice
Utilization of this type of facial mask whether exclusively or as an adjunct to a thermoplastic mask, may provide standard of care treatment and expedite scar management.
778 Development of Medical Play Protocol for Pediatric Transparent Facial Orthosis Fabrication
Authors: Moore Amanda , Knight Deborah 
Published: April 2024

Abstract

Introduction
Until 2021, when fabricating custom Transparent Facial Orthoses (TFO), the Occupational Therapists at our facility utilized a 3rd party to produce 3-D molds of patient faces. In order to maintain HIPAA compliance, the level of digital security needed could no longer be provided by this third party, and our therapists had to revert to a more labor-intensive process. This process, which involved casting the face with plaster strips, can feel invasive and often produces high anxiety and fear for pediatric burn survivors with facial scars. Within the Child Life domain, the benefits of medical play have been well documented and well researched. Medical play provides increased mastery, control, comfort, and understanding which all lead to improved compliance and positive coping. By incorporating medical play in the TFO fabrication process, Child Life and Occupational Therapy were able to collaborate in order to develop a protocol through which pediatric burn survivors could perform the steps of casting a doll’s face. This allowed the patient to manipulate the materials, learn the process of the intervention, and rehearse coping skills prior to receiving this intervention. Through the development of this protocol, the interdisciplinary team was able to complete 8 successful TFO fabrications within a 9 month period.

Methods
Identification of need for custom fabricated TFO for pediatric burn survivors under 10 years of age, or 10 years or older with a documented history of maladaptive coping Successfully completed Child Life/Occupational Therapy medical play/TFO mold fabrication with 3 year-old patient, then continued the same process with an additional five children Interdisciplinary team assessment of TFO mold fabrication process with foundational medical play Protocol developed Protocol followed on additional two pediatric burn survivors with successful outcomes

Results
Based on our assessment of five successful and one unsuccessful TFO custom mold fabrication processes, we developed a medical-play based protocol to guide the interdisciplinary team. The implementation of this protocol has reduced the anxiety and fear experienced by pediatric burn survivors with facial scars. It has also improved rapport and buy-in with caregivers and has minimized procedural time for the interdisciplinary team.

Conclusions
Managing pediatric anxiety during interventions that involve close proximity to the patient’s face and restrict movement of the mouth and sometime the eyes can be challenging for the interdisciplinary pediatric burn team. By incorporating medical play as a standard of care protocol prior to these types of non-invasive but anxiety provoking procedures we have seen greater compliance and improved patient coping both in the fabrication of the TFO as well as in the ongoing wearing and usage of this method of scar management.

Applicability of Research to Practice
Pediatric protocol development to improve scar management compliance