bluuebunny/crossref_metadata_2025_split huggingface dataset:
19 Influence of Co-morbid Modifiable Risk Factors on Adipose-Derived Stem Cell Paracrine Factors in Burn Patients
Authors: Robinson Jared M , Dennis Jenna , Trinh Sophia , Fontenot Cameron , Phelan, III Herb A , Carter Jeffrey E , Schoen Jonathan E , Smith Alison A 
Published: April 2024

Abstract

Introduction
Delayed post-operative wound healing contributes to complications resulting in significant morbidity, mortality and healthcare costs. Co-morbid conditions can act as modifiable risk factors (MRFs) in post-operative wound healing, and their influence has previously been described. However, comparisons of subcellular impacts are less well understood. Adipose-derived stem cells (ADSCs) stimulate a repair response in burned tissue using paracrine signaling factors to alter the surrounding cellular environment. In this pilot study, we tested the hypothesis that the paracrine factor profiles secreted by ADSCs isolated from damaged adipose tissue at the time of burn injury would be altered with differing combinations of MRFs.

Methods
Adipose tissue was collected from adult patients (N=15) with severe burn injuries (&gt;20% total body surface area) and non-severe burn injuries (N=2) at the index operation. ADSCs were extracted and cultured in vitro. Supernatants were harvested 30 hours after plating and used for cytokine determinations by Multiplex assay. Fluorescence activated single cell sorting () confirmed their phenotype with markers CD 90, CD 166, and CD 73. Analysis of variance (ANOVA) and Tukey’s postestimation were performed to compare cohorts with and without comorbid substance use disorder (S-MRF), cardiovascular disease (V-MRF), nutritional deficiency (N-MRF), or a combination of concurrent MRFs (SVN-, SV-, SN-, and VN-MRF).

Results
Profiles from the VN-MRF cohort showed a significant difference (p &lt; 0.05) in IL-6 concentrations from V-, N-, SVN-, and SV-MRF cohorts and IL-8 from S-, V-, N-, SV-, and SVN-MRF cohorts. Profiles from the SV-MRF cohort showed a significant difference (p &lt; 0.05) in IFN-y concentrations from S-, V-, and N-MRF cohorts and IL-17 from V-MRF cohorts. No significant differences in supernatant concentrations of IL-1 beta, IL-4, IL-10, IL-13, TGF-a, TNF-a, FGF-2, MCP-1, VEGF, or MRF were observed (p&gt;0.05).

Conclusions
This study suggests ADSC paracrine factor expression at the time of a burn injury may vary with different combinations of comorbidities and potentially in demographics with a higher burden of chronic illness.

Applicability of Research to Practice
Future studies are needed to examine how modifiable risk factors impact wound healing and post-operative outcomes in burn patients.
27 Streamlining the Discharge Process
Authors: Coffey Rebecca , Salazar Elizabeth , Ewing Amber , Faris Janie J , Ruiz Alina , Terry Michelle 
Published: April 2024

Abstract

Introduction
Survival rates of burn patients are increasing but the challenges for hospital discharge are numerous and require a comprehensive approach for a successful discharge. The unit-based council of a regional burn center identified two reasons for readmissions; inadequate education and preparation prior to discharge. The purpose of this quality project was to evaluate the discharge processes, identify opportunities and improve patient outcomes.

Methods
Data was collected on readmission rates and discharge instruction accuracy prior to implantation of the new discharge process (NDP). After development of the NDP education was provided to all burn team members. All discharged patients during the evaluation period from 6/1 to 8/31/2023 were reviewed. Data collection included: readmission rates, number of patients receiving discharge phone calls (9/1/2023 – 9/28/202), and the use of the new discharge instructions.

Results
A total of 478 discharges occurred during the evaluation period. New discharge instructions were used 38.5% versus old instructions 61.5%. Twenty-eight patients (100%) received discharge phone calls; all patients understood wound care instructions. One patient had difficulty completing wound care, 2 patients did not receive supplies, and 3 patients did not pick up the prescription medications. Readmission rates improved to 7% with, wound care (30.7%), cellulitis (30.7%) and uncontrolled pain (7%) as the most common reasons for readmission. All burn patients received the new discharge education folders with references to the newly completed wound care videos.

Conclusions
A systematic multidisciplinary approach to the discharge process will provide safe and effective discharge for the burn patient. Education of all team members is imperative for successful change.

Applicability of Research to Practice
Identifying gaps in the discharge process will improve long term outcomes for patients.
28 Substance Use Disorder: A National Survey
Authors: Van Dobbe  , Bay Curt C , Richey Karen J , Foster Kevin N 
Published: April 2024

Abstract

Introduction
Substance use disorder (SUD) involves an individual’s inability to control their use of drugs, alcohol and/or medications. Our burn center provides care to over 1,400 inpatients and 5,000 outpatients a year, and we see numerous patients with this disorder who have complex and challenging needs that can affect staff member perspectives on providing care. To establish a broader outlook on the relationship between burn center staff and patients with SUD, a survey was conducted within our center in 2022 and the same survey was sent to burn centers nationwide in 2023.

Methods
A modified version of the 11-item Medical Condition Regard Scale was distributed via SurveyMonkey to burn professionals across the country. It was requested that they distribute to team members as appropriate. An additional 6 burn specific questions were asked. Participants were asked to respond on a 6-point Likert scale. There were both positively (POS) and negatively (NEG) phrased questions. No personal or professional demographic data was collected to ensure anonymity. Binary frequencies were calculated.

Results
A total of 60 individuals responded. When responding to POS questions, the majority agreed that insurance coverage should be equal to other conditions (88%), would not mind being called in to care for this population (53%), felt they could find something to help the patient feel better (67%), and found working with SUD patients satisfying (50%). The majority did not enjoy giving extra time to burn patients with substance use disorder (60%). When asked NEG questions, 38% responded it was difficult to work with these patients, 25% reported irritation, 23% preferred not to work with SUD patients, 20% felt there was little they could do to help, and 7% felt it was a waste of medical dollars. When asked POS burn specific questions, 68.3% felt current practice to manage withdrawal symptoms was effective, 65% felt that these patients experienced more anxiety, had other mental health disorders (86%) and that pain management was particularly difficult (90%). When asked NEG burn specific questions 48% felt the care they provided was appreciated, and only 58% felt safe when providing care.

Conclusions
Overall response rate was low. Similar to the 2022 survey, the national survey indicated that staff were willing to help these patients yet reported difficulty in working with this population. Likewise, nationwide survey responses identified management of pain and withdrawal symptoms as areas of care requiring improvement. Of interest in our original survey 65% of staff feel compassionate toward burn patients with substance use disorders while 2023 survey results indicate 43% of staff feeling compassionate toward burn patients with SUD.

Applicability of Research to Practice
Survey results can be used to develop protocols and improve patient outcomes as well as patient and staff satisfaction.
71 Burn Camp Outcomes: Capturing Changes in Pediatric Quality of Life
Authors: Mikolaj Kerry , Jackson Brad , Schiffer Nichole , Boulter Trudy J , Kierulf Genevieve 
Published: April 2024

Abstract

Introduction
The Pediatric Quality of Life Inventory (PedsQL) is an outcome measure used to assess health related quality of life in children and adolescents. This tool is used in healthy, acute, and chronic health conditions to assess physical and psychosocial functioning. We applied this measure with our pediatric burn survivors and their caregivers. Within a burn camp setting, we evaluate progress towards programming goals relating to physical functioning, emotion regulation, social skill challenges, and academic participation. In order to further assess the impact of burn camp experiences on quality of life, we are in the process of collecting PedsQL data from patients in the burn clinic who have not attended burn camp.

Methods
PedsQL surveys were sent to campers ages 8-18 years old and their caregivers prior to burn camp and again 3 months post-camp from 2018-2023. Surveys consisted of questions relating to physical, emotional, social, and school functioning. Survey data were coded and average scores for each functioning scale were used to generate a total score, psychosocial health score, and physical health score for each subset of surveys.

Results
PedsQL scores increased following burn camp among both camper and caregiver reports for all outcomes measured. High scores are indicative of a better quality of life rating (see Tables 1 & 2).

Conclusions
PedsQL surveys were trialed as a measure of burn camp outcomes from 2018-2019, showing positive changes among quality of life measures post-camp for both campers and caregivers. Since 2019 we have significantly expanded our data set, showing similar trends, and now plan to compare PedsQL scores of campers with those of burn injured children seen in our burn clinic, who did not attend camp.

Applicability of Research to Practice
The PedsQL is a validated outcome measure used to assess quality of life in children with a wide range of medical conditions. Our research supports the use of this tool in evaluating the success of medical specialty camps.
79 Diagnosis and Management of Orbital Compartment Syndrome in Burn Patients —a Systematic Review
Authors: Makarewicz Nathan , Perrault David , Sheckter Clifford C 
Published: April 2024

Abstract

Introduction
Orbital compartment syndrome (OCS) is a recognized yet poorly understood problem in the acute management of major burns. Proposed risk factors including large volume resuscitation and deep burns to the orbital region, though OCS has been described in less severe burns. Diagnosis remains inconsistent in terms of pressure thresholds, and management is controversial regarding indications for surgical decompression. A systematic review is necessary to understand OCS in greater detail and guide management.

Methods
A systematic review of the literature discussing OCS in burn patients was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane Library, and Embase were searched from inception of literature until June 2023. All primary literature publications were considered. Animal studies were excluded. Study quality was assessed using two validated scoring systems.

Results
303 unique articles were identified of which 8 met inclusion criteria. All studies were retrospective. 5/8 studies measured intraocular pressure. 2 studies defined OCS at IOP&gt;40mmHg, 2 studies defined OCS at IOP&gt;30mmHg, and one defined OCS at IOP&gt;30-40mmHg. A total of 60 unique cases with OCS were reported. The weighted mean total body surface area (TBSA) of burn was 58%. The weighted mean percentage of patients with orbital burns was 85%. The mean weighted 24-hour resuscitation volume was 6.64cc/kg/TBSA. Surgical treatment was always a lateral canthotomy, and some authors added cantholysis. When post-canthotomy pressures were taken, they normalized in every case. Long-term outcomes such as vision were not consistently reported. Further, reconstructive management was not described. Mortality ranged in the studies between 8-67%. The methodological index for non-randomized studies (MINORS) rated three studies as good, one as fair, and four as poor.

Conclusions
The most common patient with OCS is a large surface area (&gt;55% TBSA) burn with facial involvement undergoing resuscitation that exceeds 6cc/kg/TBSA. A precise decompressive threshold remains conflicted though all studies agree on a 30-40mmHg. Surgical decompression consisted of lateral canthotomy with the addition of cantholysis if pressures did not normalize.

Applicability of Research to Practice
Burn practitioners should be aware of risk factors for OCS and measure IOP in any large TBSA burn (i.e. &gt;40% TBSA) with facial involvement undergoing resuscitation exceeding 4cc/kg/TBSA. Lateral canthotomy should be performed in timely fashion with confirmation of normalization of IOP. Persistently elevated IOP should be treated with cantholysis.
81 Effectiveness of Simultaneous Intense Pulsed Light and Fractional CO2 Laser Therapy in Hypertrophic Burn Scars
Authors: Elkady Djoni , Larson Brandon M , Sharma Steffi , Lou Richard B , Khandelwal Anjay 
Published: April 2024

Abstract

Introduction
Hypertrophic burn scars present challenges for patients and clinicians. Intense Pulsed Light (IPL) and Ablative Fractional CO2 Lasers (AFCL) have shown promise in scar treatment by targeting vascular structures and promoting collagen production. While IPL-AFCL has been used in managing hypertrophic scarring in various dermatological conditions, limited data exist for burn scar treatment. In addition, scar vascularity can frequently limit the depth of penetration and density of AFCL yielding delayed results. The author's conducted a study assessing the efficacy of simultaneous IPL-AFCL therapy on hypertrophic burn scars using the Modified Vancouver Scar Scale (MVSS). To the author's knowledge, this is the first reported case series of simultaneous laser treatment in the treatment of hypertrophic burn scars.

Methods
In this retrospective study (April 2021 to July 2023), data from patients (pediatric and adult) receiving at least two IPL-AFCL treatments were analyzed. Demographics, burn details, and complications were collected. Linear regression assessed the impact of time from burn to first treatment on MVSS scores. Unpaired t-tests compared pre/post-MVSS scores for partial-thickness (PT) and full-thickness (FT) burns, and paired t-tests evaluated pre/post-treatment MVSS score differences after IPL-AFCL treatment.

Results
The study involving 33 patients (11 PT burns, 22 FT burns), the mean pre-MVSS score was 12.09 ± 2.77, and post-MVSS score was 6.24 ± 2.96. IPL-AFCL significantly reduced MVSS scores by a mean of 5.85 ± 0.43 (p &lt; 0.0001) with an average of 3.70 ± 1.69 IPL-AFCL treatments per patient. Significant reductions were also observed in pigmentation (p=0.001), vascularity, pliability, height, pain, and pruritus (p &lt; 0.0001). Linear regression analysis showed that the duration from burn injury to the first laser treatment significantly influenced pre-MVSS scores (p=0.008) but not post-MVSS (p=0.062). No significant differences were found in pre-MVSS (p=0.186) and post-MVSS (p=0.233) scores between PT and FT burns. As for complications, 4/33 patients experienced blistering following treatment which did not result in any long-term consequences.

Conclusions
Our study demonstrated that IPL-AFCL treatment effectively improved hypertrophic burn scars. MVSS scores did not significantly differ between PT and FT burns, but the time from the initial burn to the first treatment significantly influenced pre-MVSS scores.

Applicability of Research to Practice
Simultaneous use of different light/laser modalities is safe and effective and may offer advantages with symptomatic, functional and cosmetic benefits.
82 Free Flap Failure and Contracture Recurrence in Delayed Burn Reconstruction: A Systematic Review and Meta-analysis
Authors: Arellano Jose Antonio , Liu Hilary , Alessandri-Bonetti Mario , Kasmirski Julia , Stofman Guy M , Egro Francesco 
Published: April 2024

Abstract

Introduction
Free tissue transfer is often considered a last resort in burn reconstruction due to its complexity and associated risks. Free flap and contracture recurrence outcomes in delayed burn reconstruction remain unclear as reported in the literature, and a comprehensive review on free flap outcomes in delayed burn reconstruction is currently lacking. The study aims to evaluate the available evidence on the failure and contracture recurrence rates in free flap delayed burn reconstruction.

Methods
A systematic review and meta-analysis was conducted and reported according to PRISMA guidelines. The protocol was registered on PROSPERO (CRD42023404478). PubMed, Embase, Web of Science, and Cochrane Library databases were queried. The results were limited to English-language literature with extractable data relating to microsurgical delayed burn reconstruction only. The measured outcomes were free flap loss and contracture recurrence rate.

Results
Of the 1262 retrieved articles, 40 qualified for inclusion, reporting on 1026 free flaps performed in 928 patients (50.3% male, 49.7% female). The mean age was 29.25 years [95% CI: 24.63, 33.88]. Delayed burn reconstruction was performed at an average of 94.68 months [95% CI: -9.34, 198.70] after initial injury, with a follow-up period of 23.02 months [95% CI: 4.46, 41.58]. Total flap loss (TFL) rate was 3.80% [95% CI: 2.79, 5.16] (Figure 1) and partial flap loss (PFL) rate was 5.95% [95% CI: 4.65, 7.57]. Interestingly, burn contracture recurrence rate was 0.62% [95% CI: 0.20, 1.90] (Figure 2).

Conclusions
This systematic review provides a comprehensive evaluation of the free flap outcomes in delayed burn reconstruction. The flap loss rate was relatively low, given the complexity of the procedure and potential risks. Furthermore, burn contracture rate was found to be extremely low. This study demonstrates that free flaps are a safe and effective option for delayed burn reconstruction.

Applicability of Research to Practice
The findings of this systematic review suggest that free flap procedures are a viable and relatively safe option for delayed burn reconstruction, with low rates of flap loss and burn contracture recurrence, providing valuable insights for researchers exploring reconstructive options in burn injury cases.
96 The Influence of Consulting Child Protective Care Services on Patients’ Length of Stay in Burns
Authors: Mikhael Marian , Koussayer Bilal , Nehila Timothy , West, III William , Morris Julia A , Le Nicole K , Whalen Kristen , Buller Kristina , Parikh Jeegan , Ayzenshtat Luba , Troy Jared , Laun Jake 
Published: April 2024

Abstract

Introduction
Child endangerment commonly involves abuse, including burns. Healthcare professionals may feel that consulting Child Protective Services (CPS) unnecessarily prolongs a patient’s length of stay (LOS), as most cases are determined to be not significant for abuse. This study was conducted to determine the relationship between CPS consultations and patients’ LOS.

Methods
We conducted a retrospective cohort study of pediatric patients under the age of 18 years that were admitted at our tertiary healthcare institution between 2020-2021 for burns. We examined the LOS for patients in which CPS was not consulted (Control), CPS was consulted without evidence of child endangerment (-CPS), and CPS was consulted with evidence of child endangerment (+CPS). A secondary analysis was conducted only on patients who required inpatient burn care by removing patients that did not undergo surgical intervention.

Results
Of the 158 patients admitted, 33 patients had CPS involved. There was no significant difference between LOS in the control and CPS consultation (- for abuse) patients (p=0.086). There was also no significant difference between LOS in the control and CPS consultation (+ for abuse) patients (p=0.150). These findings persisted controlling for age, total burned surface area (TBSA), and number of surgeries for burns.
In the secondary analysis, 104 patients did not undergo surgical intervention and were removed. The effect of consulting CPS on LOS in the remaining 54 patients did not change (p&gt;0.05).

Conclusions
This study demonstrates that CPS should be consulted when there is any suspicion of child endangerment without concern for unnecessarily increasing the patient’s LOS.

Applicability of Research to Practice
CPS plays a vital role in burn consultations for pediatric patients by identifying risk factors for endangerment, ensuring the welfare of children, and providing legal protection. No previous studies have explicitly examined the relationship between CPS consultation and LOS in pediatric burn patients or in any other child abuse victims due to other etiology. In some instances, there may be a hesitancy to contact CPS when there is doubt about non-accidental trauma and concern for unnecessary hospital admission, however our study results suggest that CPS involvement does not affect the LOS of patients. Early identification and intervention can help protect these patients, and establishing standardized protocols for reporting suspected child abuse cases is crucial to ensure that at-risk patients receive the proper consultations in a timely manner.