bluuebunny/crossref_metadata_2025_split huggingface dataset:
701 Effect of Methamphetamine Use on Transthoracic Echocardiographic Findings in Burn Patients
Authors: Sojka John H , Jbeily Elias , Silva Taylor , Rukmangadhan Samveda , Heard Jason , Sen Soman , Palmieri Tina L , Romanowski Kathleen S 
Published: April 2024

Abstract

Introduction
Methamphetamine use adversely effects the cardiovascular system leading to pulmonary hypertension and heart failure (HF) due to non-ischemic dilated cardiomyopathy with reduced ejection fraction (EF). Despite this, many methamphetamine (MA) users with HF have preserved EF and the adverse effects of their MA use may be overlooked. Subclinical cardiac dysfunction associated with MA use may become clinically apparent in patients experiencing a significant physiological stress like burn injury. We hypothesize that transthoracic echocardiogram (TTE) findings and outcomes of MA positive patients will be worse than those of MA negative patients.

Methods
Following IRB approval, data was collected on all patients admitted for burn injuries who had admission TTEs between January 2015 and December 2019. Patients were divided into two groups based on admission drug screen positivity for MA. Data collected included TTE findings, patient demographics, percent total body surface area (%TBSA) burned, length of stay (LOS), hospital charges, and mortality. The two groups were then matched based on age and burn %TBSA. Analysis on the total population and the matched data set was conducted with SAS statistical software using Chi-square, Fisher Exact, and Wilcoxon 2-sample tests.

Results
A total of 417 patients with TTEs were included, 295 MA negative and 122 MA positive (29.3%). In the total population, MA positive patients were younger (p&lt; 0.0001), had larger burns (p=0.003), more inhalation injury (p=0.002), less aortic regurgitation (p&lt; 0.0001), higher left ventricular EF (p=0.01), higher hospital charges (p=0.003), and lower mortality (p=0.02) than their MA negative counterparts. In the group matched for age and %TBSA, there was no significant difference in inhalation injury, sex, race, or BMI between groups. The MA negative group had significantly more patients with aortic regurgitation (p=0.02). All other TTE findings were not significantly different. No significant differences were found in LOS (p=0.25), operations (p=0.08), charges (p=0.19), or mortality (p=0.14). The circumstances of burn injuries were significantly different (p=0.03), where MA positive patients were more likely to be burned as a result of suspected assault or self-injury and MA negative patients were more likely to have accidental workplace related burns.

Conclusions
Patients who tested positive for MA on admission were younger and had larger burns. When controlled by matching, there were no differences in TTE findings or clinical outcomes related to testing MA positive.

Applicability of Research to Practice
Admission drug screen positivity for methamphetamine alone may not be an indication for obtaining TTE.
718 Predictors of Lengthened Admission in Elderly Burn Patients, a Secondary Analysis of 529 Cases
Authors: Zhu Xi Ming , Tedesco Diana , Shahrokhi Shahriar , Jeschke Marc G 
Published: April 2024

Abstract

Introduction
Existing research has examined the relationship between the amount of total body surface area (TBSA) burn and length of stay (LOS) for older adults. As a result, the conventional ratio of 1 day LOS/1% TBSA ratio has been updated to 2 days LOS/1% TBSA. In this study, we aim to elucidate patient and injury characteristics that affect our prognostic indicator, leading to a prolonged LOS.

Methods
This was a secondary analysis of a cohort study of surviving patients admitted to a tertiary adult burn center between January 1, 2006, and June 30, 2021. Older adult patients aged 60 and over were stratified into expected LOS (&lt; 2.0 days/%TBSA) and greater than expected LOS (&gt;2.0 days/%TBSA). Patient demographics, TBSA, inhalation injury, pre-admission co-morbidities, and in-hospital complications were tabulated. Logistic regressions were performed using IBM SPSS Statistics 29 and Stata Statistical Software: Release 18.

Results
529 patients with a mean age of 71 years were included for analysis of the older adult population. 266 patients had the expected LOS/TBSA ratio, and 263 exceeded this ratio. Univariable analysis indicated patients with greater age [1.03 (1.01 – 1.05) p = 0.002], hypertension [1.72 (1.22 – 2.42) p = 0.002], diabetes [1.95 (1.30 – 2.93) p = 0.001], respiratory disease [2.22 (1.40 – 3.53) p = 0.001], cardiac disease [1.75 (1.24 – 2.47) p = 0.002], psychiatric illness [1.75 (1.04 – 2.96) p = 0.035], and those who experienced complications (such as infection, graft failure, pneumonia, sepsis) [1.62 (1.14 – 2.30) p = 0.007] during admission were more likely to exceed their predicted LOS.
Multivariate analysis found that inhalation injury [3.73 (1.62 – 8.57) p = 0.002], diabetes [1.69 (1.04 – 2.77) p = 0.035], respiratory disease [1.86 (1.04 – 3.29) p = 0.035], psychiatric illness [1.50 (1.01 – 1.87) p = 0.04], alcohol use [2.18 (1.04 – 4.58) p = 0.04], and complications [3.63 (2.27 – 5.80) p &lt; 0.0001] were contributing factors that increased the likelihood of patients exceeding predicted LOS. Diabetes was not a statistically significant contributor.

Conclusions
Progress has been made to identify patient and injury factors that increase the likelihood of increased LOS for older adult patients with burn injuries. This provides valuable data for physicians to better assess their patients and improve their quality of care.

Applicability of Research to Practice
Identification of key burn patient characteristics aids in prognostication. Determining length of stay aids with coordination of patient care with the multi-disciplinary team.
749 Clinical Decision Support Systems, Electronic Health Records and Fluid Resuscitation: Harnessing the Power of Technology
Authors: Pan Bowen , Richerbach Stacey , Menodiado Floredes , McGuire Robert , Hockenberry Tiffany , Richey Karen J , Foster Kevin N 
Published: April 2024

Abstract

Introduction
Electronic Health Record (EHR) raw data, in conjunction with analysis via Clinical Decision Support Systems (CDSS) has great potential to enhance bedside decision-making and improve patient outcomes. However, technology systems are often siloed, limiting interoperability, and creating inefficient workflows. Proprietary software is costly, lacks transparency and limits customization. The purpose of this project was to incorporate a custom burn fluid resuscitation CDSS into our existing EHR and evaluate safety and efficacy.

Methods
Following Institutional Review Board approval, a team was formed of representatives from the EHR vendor, local health informaticists, burn surgeons, burn nurses, and research staff. An initial equation using the Parkland formula as a starting point was created and run in the background during resuscitation of patients over the course of several months. The formula went through a feedback-based refinement cycle to better align with historical datasets and expert opinion. Following implementation, safety data was analyzed after each patient and then cumulatively compared to historical controls.

Results
A total of 17 adults were resuscitated using the CDSS, excluded from analysis were patients that had comfort care initiated within the first 12 hours. There were no significant differences for age, weight or TBSA between CDSS (n=13) and controls (CON) (n=138). The average ml/kg/TBSA in CDSS was 5.43 vs 6.49 CON (p=.259) and duration of resuscitation was 26.31 hours CDSS vs 31.83 hours CON (p&lt; 0.0867). Mortality between groups was not significantly different CDSS 23% vs CON 24% (p=0.125). Several process improvements were realized, including availability of CDSS data at all workstations, full integration of data within the EHR thus providing one “source of truth,” the capability to have uninterrupted resuscitation across domains of care, enhanced efficiency in documentation by nursing, and the ability to have ongoing monitoring of safety and efficacy.

Conclusions
This proof-of-concept project demonstrates the feasibility of developing tools, namely burn fluid resuscitation, within the EHR that are user-centric and have fully integrated workflows. To date, no safety signals have been detected. Holding creative rights to the algorithm enables us to continue to refine the formula based on evolving evidence. With the future in mind, the CDSS is designed to incorporate data from automated IV infusion and urine output monitoring systems. The project provides a framework for the customization of additional Clinical Decision Support System projects, providing a powerful platform to drive quality improvement initiatives.

Applicability of Research to Practice
The framework for this project has outstanding potential to revolutionize how burn resuscitation care is provided and documented at the bedside.
755 Utilizing a Structured Critical Care Rounding Tool for Retrospective Morbidity and Mortality Review
Authors: Libraro Kaitlyn M , Heffernan Jamie M 
Published: April 2024

Abstract

Introduction
This 20-bed Burn ICU (BICU) previously reported on the creation and implementation of a methodical daily rounding tool for critical care burn patients. The initial goal of the tool was to improve interdisciplinary communication and investigate the characteristics of burn induced hypermetabolic response and systemic inflammatory syndrome (SIRS), a well-known and ever-challenging differential noted in the burn population. These rounding tools were completed on all critical care burn patients and ensured that necessary assessment points were evaluated the same way despite the provider on call. The quality RN then collected the tools for data collection and quality improvement review. Since its introduction, the tool has expanded its applicability from its original intention as a daily methodical rounding tool for improved interdisciplinary and MD to MD communication, to a retrospective quality tool enhancing morbidity and mortality quality reviews.

Methods
The rounding sheets are completed by a resident caring for a critical care patient based on that provider’s bedside assessment and recent chart review and are then presented to the team during rounds. The rounding Attendings evaluate the information as provided and make amendments to the document as needed. Following rounds, the Attending’s completed rounding tool is provided to bedside nursing and the quality RN. During morbidity and mortality reviews, the rounding sheets are retrospectively reviewed by the quality team to evaluate potential opportunities for improvement.

Results
The rounding tool has been utilized for the retrospective Quality review of 13 mortalities and 3 morbidities. The most utilized portion of the rounding tool has been the Burn Sepsis Screening Tool (BSST) section. In real time, the BSST assists in early identification of SIRS vs. hypermetabolic response. When utilized retrospectively, this tool plays a valuable role in evaluating opportunities for improvement specifically for timely diagnosis and treatment.

Conclusions
Modern medicine is reliant on the use of technology and Electronic Medical Records (EMR) in recording the information of a patient’s care and management. Similarly, retrospective morbidity and mortality quality reviews are highly dependent on the data entered by the provider into the EMR. A significant limitation of the EMR is a lack of subjective provider input and clinical judgment in the time surrounding certain decision making and diagnosis. Use of the rounding tool for retrospective review has proven beneficial to this burn center’s quality review process.

Applicability of Research to Practice
Directly applicable
758 Identifying the Gaps of the Inpatient to Outpatient Transition: The Role of the Patient Navigator
Authors: Kim Anika , Rutter Cindy , Chacon Daniel W , Flores Elizabeth , Gillenwater Justin , Gonzalez Karla Anel , Mojarro-Huang Elizabeth , Yenikomshian Haig A 
Published: April 2024

Abstract

Introduction
Patient navigators (PNs) are members of the community who help with the transition from inpatient to outpatient care. PNs have demonstrated efficacy in enhancing patient engagement and addressing care gaps in fields such as cancer and vulnerable populations, such as urban, low socioeconomic-status populations. Despite the long-term care needs of burn patients, the role of PNs in the aftercare of burn injury has not been studied. This research investigates the current use of PNs in burn care at a safety-net hospital and sheds light on potential areas of improvement.

Methods
This was a retrospective observational cohort study conducted from November 2022 to August 2023. Data regarding patient contacts, needs identification, and associated referral requisites were collected. The PN role was filled by a representative from a local nonprofit community center. The PN checked in with outpatients after their discharge and inpatients nearing discharge to identify their needs and facilitate appropriate referrals to the relevant community services.

Results
Over eight months, the PN liaised with 658 burn unit patients, comprising 406 outpatients and 252 inpatients. A focused examination of non-COVID services requested reveals that only 3.2% of outpatients requested referrals to community resources. This contrasts with inpatients, where a significantly larger fraction of 10.3% requested similar community service referrals. Figure 1 shows the breakdown of services requested.

Conclusions
While PNs are progressively integrated into various healthcare domains, the newly implemented program in burn care yielded low utilization rates, particularly among outpatients. The disparity between inpatient and outpatient engagement indicates the need to optimize the role of PNs in the transition process from the hospital to outpatient care in burn patients.

Applicability of Research to Practice
The aftercare for burn injuries is complex and extends beyond hospital discharge, requiring effective coordination between various healthcare and community resources. This study highlights the untapped potential of PNs in enhancing outpatient care in the setting of burn injury. Tailoring the PN training to meet the specialized needs of burn patients could enhance their role and improve patient outcomes, particularly for those who face barriers to engagement with the healthcare system.
801 Post-Burn Breast Reconstruction: A Systematic Review of Techniques
Authors: Marlar Riley , Lagziel Tomer , Ku Ying , Bishop Sarah N 
Published: April 2024

Abstract

Introduction
Breast burns, whether thermal, chemical, or electrical, represent a significant subset of burn injuries. The psychological and physical implications of these burns can be profound, particularly given the breast's anatomical and socio-cultural significance. Post-burn breast reconstruction is not only crucial for functional recovery but also for emotional and psychological rehabilitation. With evolving techniques over the years, there is a pressing need to systematically assess and consolidate information to guide future therapeutic directions.

Methods
A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted following PRISMA guidelines, including studies published up to September 2022. Inclusion criteria comprised articles focusing on surgical techniques, outcomes, and complications of breast reconstruction following burn injuries. Data extraction included study characteristics, patient demographics, burn details, reconstructive techniques, outcomes, and complications. A qualitative synthesis was performed due to the heterogeneous nature of the included studies.

Results
The search yielded 80 relevant studies, emphasizing a myriad of reconstructive options including autologous tissue transfer, acellular dermal matrices, tissue expanders, and implant-based reconstructions. Flap-based reconstructions were exemplified for optimal aesthetic and functional outcomes with reduced donor site morbidity. However, each technique's success is contingent upon the burn’s extent, location, and patient-specific factors. Complications were varied, with infection, flap failure, and contracture being prevalent. Notably, advancements in regenerative medicine and bioengineering, such as tissue engineering and fat grafting, have shown promising results in restoring breast contour and improving scar quality.

Conclusions
This systematic review sheds light on the multifaceted domain of post-burn breast reconstruction. The key takeaway is the importance of individualized treatment plans, factoring in patient needs, burn characteristics, and available resources. The advent of regenerative techniques is certainly promising, emphasizing the need for continuous research to refine and innovate reconstruction methodologies further.

Applicability of Research to Practice
The evidence underscores the versatility of available reconstructive techniques, aiding clinicians in tailoring interventions based on individual patient needs, burn extent, and aesthetic considerations. This insight enables practitioners to refine surgical strategies, optimize outcomes, and mitigate complications. The highlighted advancements in regenerative medicine provide a framework for integrating innovative solutions in clinical practice, enhancing the scope of holistic burn management and improving patient quality of life.
806 Autologous Skin Cell Suspension Demonstrates Successful Outcomes in the Treatment of Burn and Wound Sites
Authors: Draper Brian , Austin Cindy , Sodade Oluwafolaranmi 
Published: April 2024

Abstract

Introduction
A new treatment paradigm increasing among burn and wound providers is the application of Autologous Skin Cell Suspension (ASCS). This system is a point-of-care therapy spraying on the patient's own cells promoting epidermal regeneration while reducing the amount of skin harvested for donor sites. Literature reports on the use of ASCS but there is a paucity of data describing the application of ASCS with temporal dermal substitutes and donor sites. The purpose of this study is to evaluate complex wound sites due to burns and other etiologies treated with ASCS solely or in combination with wound care applications. Also, a review of ASCS applied over donor sites is reported. We hypothesize the application of ASCS on complex wounds, burns and off-label usage on donor sites to demonstrate acceptable outcomes.

Methods
A retrospective chart review of burn and wound patients (N=53) treated with ASCS between 2019-2022 at a tertiary care center. Data was extracted from the electronic medical record. Treatments evaluated included ASCS only, ASCS with or without autologous split-thickness skin graft (STSG), and polyurethane bioabsorbable matrix (PBM) placement prior to ASCS. Wound healing results were collected on the off-label use of ASCS applied to donor sites. Each individual wound site was measured (cm2) and failure rate was calculated based on size of dermal substrate or graft loss. Statistical analysis software was used to summarize data which included descriptive demographics, wound type/size, graft fail size, percent total burn, adjunct procedures, comorbidities, systemic/ local wound infection rate, complications, length of stay, and overall patient outcome summary.

Results
A total of 53 burn and wound patients were included, 46(87%) and 7(13%), respectively. The mean age was 44.3 (SD 20.6) years with 35(66%) patients being male. The mean total burn surface area was 30% (SD 23.8%). The most common comorbidities were hypertension, coronary artery disease and kidney disease. Highest complication was infection n=26 (49%), 11 local, 7 systemic and 8 both. A total of 577 injury sites were evaluated. The fail rate for PBM+STSG+ASCS, STSG+ASCS, ASCS+ non-donor site, and ASCS on donor site was (2.9%, 0.4%, 0.0%, 0.5%), respectively. No complications were reported with ASCS on donor sites. The percent fail of STSG’s without ASCS was 6.6% and reduced to 0.4% when used in combination with STSG+ASCS.

Conclusions
The findings of this study data demonstrate the successful application of ASCS even in the presence of infection on burn and complex wounds used alone or in conjunction with PBM. The results support the off-label use of ASCS on donor sites.

Applicability of Research to Practice
This study demonstrates the effectiveness of ASCS on wounds as well as the use on donor sites. This study adds to the growing literature evaluating the use of ASCS on burn wounds.
810 Development of a Porcine Burn Wound Model
Authors: Singer Adam J , McClain Steve 
Published: April 2024

Abstract

Introduction
Deep partial thickness burns generally require more than 2-3 weeks to heal often resulting in hypertrophic scarring and patient morbidity. Because the skin of pigs most closely resembles that of humans, the pig is often used as an experimental burn wound model. We describe the development of a reproducible burn wound model in Yorkshire pigs.

Methods
We created standardized 5 x 5 cm burns on the backs and flanks of anesthetized domestic pigs (30 kg) using a radiant heating device set at 600 degrees C and applied to the animal’s skin for 5, 10, or 15 seconds. Full thickness 4 mm punch biopsies were obtained from the burns at 4 and 24 hours for burn depth evaluation. The tissue sections were stained with Hematoxylin and Eosin, HMGB-1 (a marker of necrosis) and activated cleaved caspase 3 (a marker of apoptosis). The tissue sections were viewed by a board-certified dermatopathologist blinded to duration of exposure. The primary outcome was the deepest level of injury to the blood vessels or epithelial appendices (hair follicles or apocrine glands).

Results
Exposure of the pigs’ skin to the heating device for periods of 5, 10, and 15 seconds resulted in superficial partial, deep partial and full thickness burns respectively. Average depth of dermal injury 24 hours after exposure was 0.4 mm, 1.3 mm, and 2.4 mm for exposure times of 5, 10 and 15 seconds respectively.

Conclusions
We describe a standardized porcine model for creating reproducible superficial partial, deep partial and full thickness burns.

Applicability of Research to Practice
This model is now being used to investigate novel therapies for deep burns.