bluuebunny/crossref_metadata_2025_split huggingface dataset:
593 Pilot Study: Self-scheduling Therapy Increases Burn Patients' Activity Tolerance and Compliance
Authors: Bell Kara L 
Published: April 2024

Abstract

Introduction
During a hospital visit, patients often lack autonomy in making decisions for aspects of their patient care (e.g., meal times, medication management, procedures, dressing changes, labs/vitals, etc.). Prior research shows that patient autonomy in clinical decision making can yield positive results in treatment related-decisions (Jonsen et al., 2002). The purpose of this pilot study was to study the effect of having patients schedule their own therapy timing on PT/OT activity compliance and tolerance in a burn population.

Methods
This is a prospective pilot study conducted on weekdays from January through March of 2023. Study participants consisted of all adult burn admissions with TBSA &gt;5%. Patients with necrotizing fasciitis, Stevens Johnson syndrome, and toxic epidermal necrolysis with therapy consults were also included. Patients were excluded if intubated and re-assessed following extubation once alert and oriented. All aspects of the study were completed by the Burn Coordinator on staff. As part of this pilot project, each patient was evaluated by PT/OT and given the opportunity to choose a therapy time for all following visits as appropriate. Therapy schedules were subject to be adjusted based on medical holds and restrictions. Once the therapy time was determined, a laminated sheet was placed on each patient’s door identifying the therapy time for the day to coordinate with other disciplines. Next, a therapy log was compiled and audited weekly by the Burn Coordinator. Nursing staff were also educated at shift change by the Burn Coordinator. The Burn Coordinator maintained a printed schedule with patient times and had the ability to adjust scheduling due to time conflicts, admissions, and discharges. Patients not requiring a co-treatment were seen sequentially by PT/OT to maintain consistency with a self-scheduled timeline. Participant’s PT/OT compliance and tolerance post-pilot will be compared to their compliance and tolerance pre-pilot (October-November 2022) where therapists were responsible for patient scheduling per their availability.

Results
Participant’s PT/OT compliance and tolerance was compared to the prior standard of care at the institution. Prior to the pilot study, there was a higher incidence of declining therapy services for PT/OT when the provider chose the time. During study there was a decrease in decline of therapy services, increased time tolerated during session, increased total number of visits, and increase in early mobility. The number of therapy visits pre vs post study was found to be statistically significant.

Conclusions
Patient autonomy in therapy selection time leads to increased tolerance and compliance in a burn patient population.

Applicability of Research to Practice
-Identifies the need for self scheduling to increase functional outcomes
-The project empowered the burn patients to have autonomy within their acute care stay
611 Comparison of Autologous Skin Cell Suspension to Conventional Surgical Treatment in Burn Patients
Authors: King booker , Carter Elisabeth A , William Dabbs , Agala Chris B , Chrisco Lori , Williams Felicia 
Published: April 2024

Abstract

Introduction
In 2018, a device was approved for the treatment of burn injuries. This autologous cell harvesting device is used for the delivery of a regenerative cell suspension, utilizing a patient’s own skin. The study aims to examine outcomes of the device compared to conventional surgical treatment in adult burn patients.

Methods
A retrospective study of burn outcomes in burn patients, admitted from 2015-2022 to a single burn center, was conducted investigating the clinical performance of the autologous skin cell suspension (ASCS) to conventional surgical treatment. Patients ≥18 years of age, with a total body surface area (TBSA) of ≥20% were included. Data were collected utilizing the burn registry and chart review. Patients were divided into two groups: those who received ASCS and those who received conventional surgical treatment (control). We used Fisher’s exact and chi square tests to compare categorical variables, Wilcoxon rank sum test for continuous variables to conduct between-group comparisons, and generalized linear models to assess associations between predictors and outcomes.

Results
A total of 229 patients were identified, 78 were treated with ASCS, and 151 patients received control. Baseline characteristics were comparable in the two groups. The average cost for the ASCS group was $1,244,219 while the control group was $866,072 which was statistically significant. Mean post-hospital plastics clinic visits in the ASCS group was 6.1 and 6.7 in the control group. The mean burn clinic visits was 4.2 among ASCS patients, compared to 3.7 in control group. After adjustment from baseline characteristics, the ASCS group were less likely to be on a ventilator (OR: 0.31, 95% CI: 0.13-0.70); had 1.2 times the number of burn clinic visits than control (IRR: 1.2, 95% CI: 1.03-1.39); LOS for the ASCS group was 0.86 times that of the control group (IRR:0.86, 95% CI: 0.83-0.89); and wound healing was lower (0.82 times) than that of control (IRR:0.82, 95% CI:0.79-0.84); shorter ICU LOS (IRR: 0.56, 95% CI:0.53-0.59); fewer plastics clinic visits (IRR:0.84, 95% CI: 0.70-0.99); fewer vent days (IRR:0.55, 95% CI: 0.52-0.58); 7% higher hospital cost (IRR:1.07, 95% CI: 1.07-1.07). There was no difference in mortality between the groups.

Conclusions
The findings of this study show that receipt of ASCS may be beneficial to some patients by reducing the likelihood of ventilator dependence, quicker wound healing, shorter ICU stay, shorter hospital LOS, fewer plastics clinic visits and slightly higher hospital cost, but no difference in mortality.
There is a need for a multi-center, retrospective study to better understand the benefits of using an autologous skin harvesting device in the treatment of large burns.

Applicability of Research to Practice
Further understanding the impact of surgical interventions will assist in better surgical outcomes in the burn population.
715 Initial Use of PLA Skin Substitute at a Large Public Safety-Net Hospital
Authors: Delamater Jessica , Shagabayeva Larisa , Cobler-Lichter Michael , Collie Brianna L , Lyons Nicole B , Satahoo Shevonne S , Kaufman Joyce I , Pizano Louis R , Schulman Carl I 
Published: April 2024

Abstract

Introduction
The loss of available xenograft as a skin substitute posed significant problems for our burn patients with partial thickness burns and the inability to transition to outpatient wound care or with intractable pain. This led to increasing length of stay and increased utilization of resources. The public hospital system was also challenged with additional unique patient problems that were left without a good solution. We hypothesized that the introduction and use of a PLA skin substitute had decreased costs and utilization of resources after its introduction into a large public safety-net hospital.

Methods
We began using a PLA skin substitute in April 2022. The hospital length of stay for patients admitted to the burn floor was compared for 3 months before and after the introduction of the PLA skin substitute. To account for the transition and ramp up of use, January through March were compared to June through August, thereby excluding April and May as a transition period. In addition, the utilization of enzymatic debridement and its cost were also compared for 3 months before and after the PLA skin substitute was introduced.

Results
The number of tubes of enzymatic debridement went down from 308 to 142 with an associated cost savings of $38,000. Additionally, the length of stay decreased from an average of 13.5 days to 8.9 days. Given the cost of a single hospital day this extrapolates to a yearly savings of over $200,000. It was also noted that certain patient populations that traditionally had a difficult time transitioning to outpatient care, such as homeless patients and international patients, were more quickly discharged after PLA skin substitute placement.

Conclusions
This study demonstrated a decrease in both resource utilization and costs very quickly after the introduction of a PLA skin substitute in a large public safety net hospital. Future studies need to look at longer times before and after the introduction of the skin substitute to validate that these reductions are sustained.

Applicability of Research to Practice
These findings suggest both patients and health care systems may benefit from more widespread use of a PLA skin substitute in the treatment of burn patients.
739 Epidemiology of Accidental Burn Injuries: National Trends in Hospitalizations and Emergency Department Visits (2017-2022)
Authors: Little Darby , Mason Stephanie A 
Published: April 2024

Abstract

Introduction
Understanding the evolving epidemiological trends of burns is essential for informing prevention strategies and healthcare resource allocation. While previous studies have described these trends within specific provinces, a comprehensive analysis of country-wide data is lacking.

Methods
We conducted a national retrospective population-based study of all burn-related emergency department (ED) visits and hospitalizations over a 5-year period (2017-2022). Data were extracted from a national repository of health administrative data. Injuries due to assault and suicide attempt were not included.

Results
Over a 5-year period there were 13,795 burn-related hospitalizations. There were four burn injury mechanisms identified in the database, from least to most common being related to electric current, explosion, fire and flame, and hot substances. The incidence of burns requiring hospitalization in the country remained constant over the 5-year period at 0.007%, though the absolute number of admissions generally increased over time. ED visit data were only available for 6 provinces in which there has been an overall decline in burn-related ED visits. The overall incidence of burns presenting to the ED decreased from 0.13% to 0.12% over the study period. Furthermore, the proportion of ED visits requiring hospitalization has increased over time from 5.4% to 6.4%.

Conclusions
In summary, this national population-based study of burn injuries from 2017-2022 has demonstrated that while the incidence of burn-related ED visits in several provinces has decreased, the national incidence of burn-related hospitalizations in the country has remained stable. These findings shed light on the changing landscape of burn injuries and underscore the need for continued monitoring and targeted prevention strategies.

Applicability of Research to Practice
This study offers important insights into the epidemiology of burn injuries from 2017-2022 and provides a foundation for evidence-based decision-making in burn injury resource allocation.
754 Venous Thromboembolism Incidence and Risk Factors in Burn Patients
Authors: Stanton Eloise , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2024

Abstract

Introduction
In burn care, there is a noticeable lack of comprehensive studies on the incidence and risk factors related to Venous Thromboembolism (VTE) in burn patients. Understanding VTE in this context is crucial, as it can lead to severe complications and patient morbidity/mortality. This abstract investigates VTE incidence and risk factors in burn patients in hopes of informing VTE prevention measures and improving overall patient care in the field of burn medicine.

Methods
We conducted an analysis of the US National Trauma Data Bank (NTDB) spanning from 2007 to 2021 to identify burn-injured patients. Our primary focus was on determining the incidence of VTE. As predictor variables, we considered factors such as age, sex, smoking status, history of anticoagulation use, diabetes, and prior history of stroke. We abstracted comorbidities using event codes within the database.

Results
442,623 patients were identified who had sustained burn injuries within the NTDB between 2007 to 2021. Among this cohort, 7,384 individuals (approximately 1.7%) experienced a VTE event during their hospitalization. Of these, 4,138 (56.0%) were deep vein thromboses and 1,504 (20.4%) were pulmonary emboli. Patients with VTE were significantly older than those without (37.7 versus 35.2, p &lt; .001) and were significantly more likely to be male (82.5% vs. 78.9% p &lt; .001) and obese (7.4% vs. 3.4% p &lt; .001). Patients with VTE also had significantly higher %TBSA burns (16.5% vs. 13.2%, p &lt; .001). Patients with VTE were also significantly more likely to be smokers (28.9% vs. 26.5%, p=.025), have preexisting hypertension (9.0% vs. 8.1%, p=.002), have a previous myocardial infarction (7.5% vs. 4.8%, p &lt; .001), have alcohol use disorder (14.0% vs. 6.6%, p &lt; .001) or have substance abuse (31.7% vs. 20.1%, p &lt; .001). There were no signficant differences between the two cohorts in regard to history of stroke, peripheral vascular disease, diabetes mellitus, steroid use, or renal disease (Table 1).

Conclusions
This study sheds light on several risk factors, including age, obesity, male sex, and comorbidities such as hypertension, myocardial infarction, and substance use disorders, which merit attention in clinical practice when selecting VTE prevention strategies. Addressing these factors and developing tailored interventions can help improve patient care, mitigate complications, and enhance outcomes. This study underscores the importance of considering VTE risk in burn patients as an integral component of comprehensive burn care.

Applicability of Research to Practice
By identifying specific risk factors and highlighting the incidence of VTE among burn patients, healthcare providers can implement more targeted VTE prevention and management strategies. This knowledge empowers clinicians to make informed decisions, ensuring that patients receive timely and tailored interventions, ultimately enhancing the quality of care and patient outcomes in the management of burn injuries.
756 Key Characteristics and Best Practices for Burn Patient Education: A Modified Scoping Review and Comparison
Authors: Smith Grace E 
Published: April 2024

Abstract

Introduction
Within the Western industrialized countries, the incidence of burns is roughly 40,000 per year in the United States. There are currently 69 verified burn centers in the United States. Providing optimal burn care requires centers to provide an intensive team, increased knowledge, and various equipment.1 Because of the high incidence of burn injuries in the United States, educational material is provided to patients during their recovery. However, 36% of the United States adult population has limited health literacy skills, likely, many patients don't understand all of the written materials they receive. Individuals with a lower health literacy are more likely to be readmitted to the hospital after discharge. Adapting patient education materials to meet personalized characteristics can increase patient’s recovery.
Adapting patient education materials may address diversity, equity, inclusion (DEI), trauma-informed care (TIC), and health literacy.

Methods
A modified scoping review and PRISMA guidelines5 were used to answer two questions: 1. What are the key characteristics and best practices in DEI, TIC, and Health Literacy in patient education for established burn centers? 2. What are the characteristics of patient education in established burn centers in DEI, TIC, and Health Literacy?

Results
A Key Characteristic Chart was developed, and a sample of best practice recommendations for mental health, gender neutral, language, and grade level based on the literature. After, two collections were reviewed using the Key Characteristic Chart. A sample of DEI, TIC, and Health literacy characteristics provides data on two collections.

Conclusions
This comparison of the two collections revealed multiple characteristics relating to DEI, TIC, and health literacy. Continuation of developing adapted patient education from the two collections may improve patient-centered care relating to DEI, TIC, and health literacy.

Applicability of Research to Practice
Providing patient-specific rather than general information can increase knowledge and satisfaction and decrease anxiety.6 Healthcare professionals need in-service training on providing patient education through multiple teaching strategies. There should also be a focus on minimizing trauma to burn survivors from the earliest point of contact and throughout the recovery journey. This includes providing patient education that shows characteristics of TIC to emphasize safety from physical and emotional harm and re-traumatization.
760 Simulation Enhances Resident Performance Using Autologous Skin Cell Spray
Authors: Schulman Carl I , Satahoo Shevonne S , Pizano Louis R , Kaufman Joyce I 
Published: April 2024

Abstract

Introduction
Surgical simulation has been shown to improve efficiency, performance, and shorten time to mastery for complicated operative procedures. Newer technologies used in the operating room can add to this complexity, especially in a training environment. Simulation training is not always considered when introducing a new medical device or product into the operating room. We hypothesized that simulation training would improve confidence and performance when using Autologous Skin Cell Spray (ASCS) in surgery residents during their burn rotation.

Methods
The training was performed at the Surgical Training & Education Center at a large academic medical center. Residents were asked to read the instructional materials and watch the training videos before coming into the simulation lab. During the lab training, the resident performed each step of the process themselves while proctored by the burn attending and the simulation lab director. The process was allowed to proceed as slowly as necessary while answering all questions and providing feedback to the resident on their performance. A qualitative survey using a five-point Likert scale (strongly disagree, disagree, neutral, agree, strongly agree) was administered after their burn rotation.

Results
Eight PGY3 residents completed the training and subsequently used ASCS in the OR. The survey evaluated their perceptions about the training program and its translation into performance in the OR. The program was felt to be of appropriate length (4.5/5) and thoroughness (4.625/5). There was very high agreement that the simulation training improved their confidence (4.25/5), independence (4.75/5) and performance (4.75/5) when using ASCS in the OR. Each resident used ASCS an average of 2.5 times during their 2-month rotation.

Conclusions
Integrating simulation training improved self-reported confidence, independence, and performance for surgical residents using ASCS. Simulation training has the potential to decrease the time to proficiency and independent use of new technologies in the burn operating room. It may also increase efficiency and decrease operative time, especially in academic training programs. Further research is needed to quantify these real-world benefits.

Applicability of Research to Practice
This study enhances our understanding of using simulation to enhance resident performance using complex new technologies on burn patients.
777 The Impact of Cutaneous Functional Unit Concepts on Myoelectric Prosthetic Training Following Electrical Injury
Authors: McGillicuddy Jennie , Lee Jeanne , Hinchcliff Katharine Moss 
Published: April 2024

Abstract

Introduction
Myoelectric prosthetics are an emerging technology assisting those affected by limb loss with resuming functional use of a dominant side. Functional arm use involves action in a variety of planes. Traditionally Range of Motion (ROM) is evaluated and treated from an arthrokinematic standpoint. However in cases of limb loss with significant compromised tissue, such as electrical burns, prosthetic training may be optimized if a cutaneokinematic approach is utilized, with regard to Cutaneous Functional Units (CFU).

Methods
A 23-year-old man presented to Occupational Therapy after sustaining an electrical injury necessitating trans-radial amputation and skin grafting of the dominant arm. The treatment plan included training of muscle sites of the forearm with electrodes placed over the muscles of grafted areas for myoelectric prosthesis operation. The client identified meaningful tasks and terminal device (TD) grips including handshake grip for interviews, cylindrical grip for moving a water bottle to a desk, lateral grip for tablet carrying, and 2 point pinch for shoe tying. Practical application of CFU concepts were introduced early. The grasp of the TD was measured at table top height and during actual tasks. Percentage of accuracy with full electrode connectivity for operation of the TD with 5 repetitions was measured over 12 weeks.

Results
Training in functional planes in consideration of CFU required more overall time as related to electrode connectivity for muscle site activation of a TD (Table 1). This time was necessary for client-centered care.

Conclusions
Skin recruitment shifts due to burn scars, impacting electrode connectivity specifically during function as compared to at a tabletop height. Factors such as muscle site strength, endurance and signal separation, as well as positive changes in soft tissue from scar management interventions are considered as related to results. However it is apparent that early incorporation of CFU principles results in functional long term gains. The ability to shift CFU concepts from principles into practice over the continuum of care is a valuable tool for increasing efficacy of targeted training.

Applicability of Research to Practice
As CFU principles transition to be a focus of care, further study is needed on the direct impact of CFU on function with more participants following electrical injury and limb loss, which may assist with guiding and shifting treatment approaches.
Preclinical development of EXT608, an investigational parathyroid hormone derivative with extended half-life for the treatment of hypoparathyroidism
Authors: Hall Daniel B , Kostyla Caroline H , Hales Laura M , Soliman Tarik M 
Published: April 2024

Abstract
Hypoparathyroidism, a deficiency of parathyroid hormone (PTH), results in hypocalcemia, hyperphosphatemia, and hypercalciuria. The disease is poorly controlled by calcium and vitamin D supplements or native PTH(1-84) replacement therapy. A version of PTH is being developed using D-VITylation technology, whereby vitamin D is conjugated to a therapeutic peptide, which confers a long plasma half-life by virtue of binding to the abundant vitamin D binding protein (DBP). D-VITylation of PTH caused no reduction in activity at the PTHR1 receptor, and resulted in a plasma elimination half-life of 7–15 h in rats and 24–32 h in cynomolgus monkeys. Analysis of steady-state pharmacokinetics as a function of dose showed flat profiles with smaller peak:trough ratios at low doses, indicative of slower subcutaneous absorption. In thyroparathyroidectomized (TPTx) rats, PTH(1-34)-vitamin D conjugates restored serum calcium and phosphate levels into the normal range over the 24 h dosing period, and increased bone turnover markers and reduced bone mineral density. Urinary calcium was initially elevated, but normalized by the end of treatment on day 27. In healthy monkeys, a single dose of PTH(1-34)-vitamin D conjugates elevated serum calcium levels above the normal range for a period of 24–48 h while simultaneously reducing urinary calcium. Therefore, the lead compound, EXT608, is a promising candidate as a therapeutic that can truly mimic the endogenous activity of PTH and warrants further study in patients with hypoparathyroidism.