bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of Oral Transmucosal Fentanyl Citrate and Oral Oxycodone for Pediatric Outpatient Wound Care
Authors: Sharar S. R. , Carrougher G. J. , Selzer K. , O'Donnell F. , Vavilala M. S. , Lee L. A. 
Published: November 2003

Abstract
Analgesia for pediatric burn wound care in the outpatient clinic is constrained by time, personnel, and/or monitoring capabilities, yet may improve patient satisfaction and comfort, clinic efficiency, and patient throughput. The ideal analgesic in this increasingly common setting should be palatable, provide potent, rapid, and brief analgesia, and require minimal appropriate monitoring. Using a placebo-controlled, double-blind design we compared oral transmucosal fentanyl citrate (OTFC, ≈10 μg/kg) and oral oxycodone (0.2 mg/kg) in 22 pediatric outpatient wound care procedures (ages 5–14 years). Pulse oximetry, vital signs, side effects, patient pain scores, and observer scores for cooperation, anxiety, and sedation were recorded. OTFC and oral oxycodone resulted in similar outcome measures and vital signs, and no significant side effects. The taste of OTFC was preferred. We conclude that OTFC and oral oxycodone are safe and effective analgesics in the setting of monitored outpatient wound care in children, and that OTFC offers the advantage of improved palatability.
Epidemiology of Childhood Burn Injuries in Fars Province, Iran
Authors: Lari Abdolaziz Rastegar , Panjeshahin Mohammad-Reza , Talei Ali-Reza , Rossignol Annette MacKay , Alaghehbandan Reza 
Published: November 2003

Abstract
Childhood burn injuries are a major environmental agent responsible for significant morbidity and mortality in Iran. Thus, the objective of this study was to analyze the epidemiology and current causative factors of hospitalized burn injuries among the approximately 1.6 million children between the ages of birth through 15 years residing in the Fars province of Iran. These data will be used as a basis for developing a targeted preventive program to protect children from burns. Epidemiologic data for 760 children, aged 0 to 15 years, admitted to the two burn centers of Shiraz University of Medical Sciences, over a 4-year period, 1994 to 1998, were collected and analyzed. The overall hospitalization rate was 11.8 per 100,000 person-years (PY). The sex ratio (boys/girls) was 1.38. About 60% were children aged 7 years or younger. Children aged 2 years had the highest burn incidence rate (36.9/100,000 PY). A total of 77.4% of the children had body surface area burns less than 40%. Scalds accounted for 46.2% of the burns, whereas 42.9% were caused by flame. Most of the burn injuries occurred at home (93%). There were 31 burns from suicide attempts among children aged 11 to 15 years (1.4/100,000 PY), showing a major public health problem for these children in our society. During the period of the study, 131 children died of the consequences of burns (2/100,000 PY). The epidemiology of childhood burn injuries in the Fars province is similar to that reported in other economically developing countries. It is suggested that a public health education campaign on this issue would help to reduce the incidence of childhood burn injuries in this region.
Changes in Bone Marrow-Derived Myeloid Cells from Thermally Injured Rats Reflect Changes in the Progenitor Cell Population
Authors: Noel J. Gregory , Valente John F. , Ogle James D. , Cornelius James , Custer David A. , Li Bing Guo , Alexander J. Wesley , Ogle Cora K. 
Published: November 2003

Abstract
Bone marrow progenitor cells develop into mature tissue myeloid cells under the influence of colony-stimulating factors. Cytokines that are elevated post-thermal injury have been shown to influence this process. We hypothesize that thermal injury alters myelopoiesis at the level of the progenitor cell. These differences should be visible after in vitro cultures that include colony-stimulating factors. Prior to culture, bone marrow at postburn day 1 (PBD1) was assessed for cell surface markers and the levels of myeloid progenitors. After culture in granulocyte/macrophage-stimulating colony-stimulating factor, the cell surface markers of the cultured cells were determined. PBD1 marrow from thermally injured rats had more progenitor cells responsive to granulocyte/macrophage-stimulating colony-stimulating factor than did sham. Cultured PBD1 marrow produced more CD90br MYbr CD45dim CD4− MHCII− CD11bdim eosinophils than did sham. Cultured bone marrow from thermally injured animals produces myeloid cells with an altered phenotype. Similar changes in myelopoiesis may take place in vivo.
A Multicenter Review of Toxic Epidermal Necrolysis Treated in U.S. Burn Centers at the End of the Twentieth Century
Authors: Palmieri T. L. , Greenhalgh D. G. , Saffle J. R. , Spence R. J. , Peck M. D. , Jeng J. C. , Mozingo D. W. , Yowler C. J. , Sheridan R. L. , Ahrenholz D. H. , Caruso D. M. , Foster K. N. , Kagan R. J. , Voigt D. W. , Purdue G. F. , Hunt J. L. , Wolf S. , Molitor F. 
Published: November 2003

Abstract
Toxic epidermal necrolysis (TEN) is a potentially fatal disorder that involves large areas of skin desquamation. Patients with TEN are often referred to burn centers for expert wound management and comprehensive care. The purpose of this study was to define the presenting characteristics and treatment of TEN before and after admission to regional burn centers and to evaluate the efficacy of burn center treatment for this disorder. A retrospective multicenter chart review was completed for patients admitted with TEN to 15 burn centers from 1995 to 2000. Charts were reviewed for patient characteristics, nonburn hospital and burn center treatment, and outcome. A total of 199 patients were admitted. Patients had a mean age of 47 years, mean 67.7% total body surface area skin slough, and mean Acute Physiology and Chronic Health Evaluation (APACHE II) score of 10. Sixty-four patients died, for a mortality rate of 32%. Mortality increased to 51% for patients transferred to a burn center more than one week after onset of disease. Burn centers and nonburn hospitals differed in their use of enteral nutrition (70 vs 12%, respectively, P &lt; 0.05), prophylactic antibiotics (22 vs 37.9%, P &lt; 0.05), corticosteroid use (22 vs 51%, P &lt; 0.05), and wound management. Age, body surface area involvement, APACHE II score, complications, and parenteral nutrition before transfer correlated with increased mortality. The treatment of TEN differs markedly between burn centers and nonburn centers. Early transport to a burn unit is warranted to improve patient outcome.
Treatment of Pain in Acutely Burned Children
Authors: Stoddard F. J. , Sheridan R. L. , Saxe G. N. , King B. S. , King B. H. , Chedekel D. S. , Schnitzer J. J. , Martyn J. A. J. 
Published: November 2003

Abstract
The child with burns suffers severe pain at the time of the burn and during subsequent treatment and rehabilitation. Pain has adverse physiological and emotional effects, and research suggests that pain management is an important factor in better outcomes. There is increasing understanding of the private experience of pain, and how children benefit from honest preparation for procedures. Developmentally appropriate and culturally sensitive pain assessment, pain relief, and reevaluation have improved, becoming essential in treatment. Pharmacological treatment is primary, strengthened by new concepts from neurobiology, clinical science, and the introduction of more effective drugs with fewer adverse side effects and less toxicity. Empirical evaluation of various hypnotic, cognitive, behavioral, and sensory treatment methods is advancing. Multidisciplinary assessment helps to integrate psychological and pharmacological pain-relieving interventions to reduce emotional and mental stress, and family stress as well. Optimal care encourages burn teams to integrate pain guidelines into protocols and critical pathways for improved care.
Effective Limitation of Blood Culture Use in the Burn Unit
Authors: Keen Angela , Knoblock Lyn , Edelman Linda , Saffle Jeffrey 
Published: November 2003

Abstract
There is little data to support the use of blood culture (BC) testing in the burn patient. Clinical signs (fever, leukocytosis) may not reliably indicate infection; moreover, BC's are expensive, invasive and plagued by false positive results. A policy of critical evaluation of lab utilization was instituted in our burn unit in 1993. By 1997 the use of blood culture testing had decreased by 50%. A retrospective analysis of our change in BC utilization was undertaken to derive practice guidelines for usage of this test. Methods: 47 patients with BC testing in 1997 were compared to a cohort of 47 patients from 1993, representing a total of 441 BC episodes. Results: Comparison of 1993 and 1997 patients revealed no significant differences in patient characteristics or outcomes. The mean white blood cell count and maximum temperature on the day of culture were identical for both positive and negative BC episodes. However, BC's drawn during a state of shock were twice as likely to be positive. Patients who experienced positive BC's had larger burns, received more antibiotics, had more indwelling catheters, and had longer lengths of ventilator support and hospital stays. Conclusions: Higher patient acuity or the presence of indwelling catheters increases the likelihood of a positive BC. Substantial limitation of BC's without observed changes in length of stay, ventilator days, or mortality suggests that this test can be safely limited without compromising patient outcomes.
Development and Initiation of Computer Generated Documentation for Burn Patient Care
Authors: Heistein J. B. , Coffey R. A. , Buchele B. A. , Gordillo G. M. 
Published: November 2003

Abstract
Burn care is costly, complex, and poorly reimbursed. Capturing evaluation and management codes is an essential step in obtaining reimbursement for services rendered. For surgeons used to billing on the basis of Current Procedural Terminology codes, this represents a significant paradigm shift. In an effort to document the care provided and increase compliance with billing standards, we created computerized history and physical examination notes and progress notes specifically for burn patients. Drop down menus are included to answer directed queries, which allows the majority of the documentation to be completed with a point and click of the mouse. The note is completed by the house staff except for the “assessment and plan,” which are entered by the attending physician who reviews and then electronically signs the note. A log of electronically signed notes is generated weekly for billing purposes. The use of these computerized documents has been reviewed and approved by the coding and quality assurance specialists within our billing organization. We believe these tools maximize the efficiency of documenting burn patient care, while minimizing the effort necessary to comply with evaluation and management guidelines. The aim of this study was to test the new computerized method at our institution to see whether it would improve documentation for evaluation and management services provided to burn patients. The results prove that this new system accomplished the goal we had set.
Use of Integra® Artificial Skin Is Associated With Decreased Length of Stay for Severely Injured Adult Burn Survivors
Authors: Ryan Colleen M. , Schoenfeld David A. , Malloy Maryanne , Schulz John T. , Sheridan Robert L. , Tompkins Ronald G. 
Published: November 2003

Abstract
Mortality and length of stay (LOS) of survivors was examined retrospectively in 270 adults with acute burns ≥20% of body surface area to determine the effect of Integra® Dermal Regeneration Template treatment on outcome. No difference in mortality was found between patients who received Integra® (30%; n = 43) and patients who did not (30%; n = 227). Surviving Integra® patients (n = 30) stayed longer, but they were more extensively injured than survivors who did not receive Integra® (n = 158), and therefore longer hospitalizations were expected. In a subgroup analysis, mean LOS of Integra® patients with two or more mortality risk factors (age &gt; 60 years, burn size &gt;40% body surface area, or inhalation injury; n = 15) was 63 days compared with 107 days in patients with two or more risk factors (n = 29) who did not receive Integra® (P = .014). Integra® use in severely injured burned adults was associated with a marked decrease in LOS.
Dermatome Setting for Autografts to Cover INTEGRA®
Authors: Fang P. , Engrav L.H. , Gibran N.S. , Honari S. , Kiriluk D.B. , Cole J.K. , Fleckman Philip , Heimbach D. M. , Bauer G.J. , Matsumura H. , Warner P. 
Published: November 2003

Abstract
Using the INTEGRA® Dermal Regeneration Template requires the outer silastic layer to be replaced with an autograft. We followed the manufacturer's directions for epidermal autografting and frequently obtained shredded, useless grafts and, therefore, it seemed important to determine the proper dermatome setting. We evaluated dermatome settings from 0.002 to 0.012 inches. First, with feeler gauges, we verified the dermatome settings. Second, we harvested skin at various dermatome settings and measured the thickness histologically. We found that 1) the dermatome settings are reasonably accurate; 2) harvesting useful sheets at 0.002 and 0.004 inches is virtually impossible; 3) the variability of histologic graft thickness is enormous; and 4) a dermatome setting of 0.006 inches yields useful grafts. We no longer use the term epidermal autografting but rather ultrathin split-thickness grafting. To harvest these grafts, we now merely set the dermatome to 0.006 inches and make whatever midcourse corrections are necessary to obtain translucent grafts.
An Assessment of Burn Prevention Knowledge in a High Burn-Risk Environment: Restaurants
Authors: Piazza-Waggoner C. , Adams C.D. , Goldfarb I. W. , Slater H. 
Published: November 2003

Abstract
Our facility has seen an increase in the number of cases of children burned in restaurants. Fieldwork has revealed many unsafe serving practices in restaurants in our tristate area. The current research targets what appears to be an underexamined burn-risk environment, restaurants, to examine server knowledge about burn prevention and burn care with customers. Participants included 71 local restaurant servers and 53 servers from various restaurants who were recruited from undergraduate courses. All participants completed a brief demographic form as well as a Burn Knowledge Questionnaire. It was found that server knowledge was low (ie, less than 50% accuracy). Yet, most servers reported that they felt customer burn safety was important enough to change the way that they serve. Additionally, it was found that length of time employed as a server was a significant predictor of servers' burn knowledge (ie, more years serving associated with higher knowledge). Finally, individual items were examined to identify potential targets for developing prevention programs.
Eczema Mimicking Child Abuse: A Case of Mistaken Identity
Authors: Heider T. Ryan , Priolo Diane , Hultman C. Scott , Peck Michael D. , Cairns Bruce A. 
Published: November 2003

Abstract
Many skin conditions can mimic child abuse by burning. Multidisciplinary evaluation of suspicious burns helps prevent both the underreporting and the misdiagnosis of child abuse by burning. We report a case of pediatric eczema mimicking an abusive burn.
The Efficacy of Honey in Inhibiting Strains of Pseudomonas Aeruginosa From Infected Burns
Authors: Cooper R. A. , Halas E. , Molan P. C. 
Published: November 2003

Abstract
Because there is no ideal therapy for burns infected with Pseudomonas aeruginosa, there is sufficient need to investigate the efficacy of alternative antipseudomonal interventions. Honey is an ancient wound remedy for which there is modern evidence of efficacy in the treatment of burn wounds, but limited evidence for the effectiveness of its antibacterial activity against Pseudomonas. We tested the sensitivity of 17 strains of P. aeruginosa isolated from infected burns to two honeys with different types of antibacterial activity, a pasture honey and a manuka honey, both with median levels of activity. All strains showed similar sensitivity to honey with minimum inhibitory concentrations below 10% (vol/vol); both honeys maintained bactericidal activity when diluted more than 10-fold. Honey with proven antibacterial activity has the potential to be an effective treatment option for burns infected or at risk of infection with P. aeruginosa.
THE 2002 CLINICAL RESEARCH AWARD
Authors: Gottschlich Michele M. , Jenkins Marilyn E. , Mayes Theresa , Khoury Jane , Kagan Richard J. , Warden Glenn D. 
Published: November 2003

Abstract
Early enteral support is believed to improve gastrointestinal, immunological, nutritional, and metabolic responses to critical injury; however, this premise is in need of further substantiation by definitive data. The purpose of this prospective study was to examine the effectiveness and safety of early enteral feeding in pediatric patients who had burns in excess of 25% total body surface area. Seventy-seven patients with a mean percent total body surface area burn of 52.5 ± 2.3 (range 26–91), percent full thickness injury of 44.7 ± 2.8 (range 0–90), and age ranging from 3.1 to 18.4 (mean 9.3 ± 0.5) were randomized to two groups: early (feeding within 24 hours of injury) vs control (feeding delayed at least 48 hours postburn). Nutrient intake was measured daily, indirect calorimetry was performed biweekly, and blood and urine samples were obtained for the assay of cortisol, glucagon, insulin, gastrin, epinephrine, norepinephrine, dopamine, triiodothyronine, tetraiodothyronine, albumin, transferrin, prealbumin, retinol-binding protein, glucose, nitrogen balance, and 3-methylhistidine throughout the study period. Three protocol violations occurred, and two patients were transferred to another hospital; these patients were excluded from the study. No patient in either group experienced tube feeding aspiration. No differences were evident in infection, diarrhea, hospital length of stay, or mortality outcomes. A higher incidence of reportable adverse events coincided with early feeding (22 vs 8%), but this was not statistically significant. The delayed feeding group demonstrated a significant caloric deficit during postburn week (PBW) 1 (P &lt; .0001) and PBW2 (P = .0022). Serum insulin (P = .0004) and triiodothyronine (P =.0162) were higher in the early fed group during PBW1. A decrease in 3-methylhistidine output (suggesting a decrease in protein breakdown) was also evident during PBW1 (P = .0138). No other significant trends in study outcome variables were noted. In conclusion, provision of enteral nutrients shortly after burn injury reduces caloric deficits and may stimulate insulin secretion and protein retention during the early phase postburn. These data, however, do not necessarily reaffirm the safety of early enteral feeding, nor do they associate earlier feeding with a direct improvement in endocrine status or a reduction in morbidity, mortality, hypermetabolism, or hospital stay. Future studies are needed to establish precise feeding implementation times that maximize clinical benefit while minimizing morbidity in the critically injured burn patient.
THE 2002 LINDBERG AWARD
Authors: Patterson D. R. , Ptacek J. T. , Carrougher G. , Heimbach D. M. , Sharar S. R. , Honari S. 
Published: November 2003

Abstract
Very little has been published on treating acute pain in children younger than the age of 3 for burns or any other trauma etiology. This study prospectively monitored the pain behavior and opioid analgesic intake of 31 pediatric burn patients (mean age = 23.71 months; SD = 15.75). Twelve of those children were randomized to conditions in which they either received opioid analgesics pro re nata (ie, as needed, pain contingent) or on a regular basis. The two groups did not show differences in demonstrable pain but, interestingly, they received equivalent does of opioid analgesics. As such, the pro re nata group was likely medicated largely on a regularly scheduled basis. For most of the remaining (nonrandomized) subjects, physicians ordered regularly scheduled opioid analgesics, suggesting that this practice has become largely institutionalized in the study setting. Information on pediatric opioid analgesic dosing and pain measurement strategies for nonverbal subjects can be derived from the findings.
Evaluation of a Peer Consultation Program for Burn Inpatients
Authors: Williams Rhonda M. , Patterson David R. , Schwenn Clay , Day Jeanette , Bartman Mark , Engrav Loren H. 
Published: November 2003

Abstract
A burn survivor may provide unique psychological support to patients who have been burned more recently and enhance their adjustment to burn injury. The purpose of this study was to describe the peer consultation/burn survivor support program at a large regional burn center in the Northwest United States. Over the course of 17 months, three specially trained peer consultants who had survived their own burn injuries in the past made 167 visits to 108 patients, who, in turn, completed evaluation forms for each visit. Findings indicated that patients reported that the peer consultants approached them in an appropriate manner, answered their questions, and provided useful support and information.
Epidemiological Study of Self-Inflicted Burns in Tehran, Iran
Authors: Lari Abdolaziz Rastegar , Alaghehbandan Reza 
Published: November 2003

Abstract
Self-inflicted burns have been considered a serious mental health problem throughout the world and especially in economically developing countries. The aim of this study was to identify the epidemiologic features and current etiological factors of suicide by burning in Tehran, Iran, to develop effective prevention programs. Over a period of 2 years from March 1997 to March 1999, of the 1,236 patients aged 14 years and older who were admitted to Tohid Burn Center in Tehran, Iran, 110 (8.9%) had attempted suicide by self-immolation. The median age was 25 years (range: 14–68 years) and the median extent of the burns was 71% TBSA (range: 20–100%). Forty-eight patients had a previous psychiatric diagnosis (43.6%). Depression was the most common psychiatric diagnosis by history. The method most commonly used was a flame with the addition of a flammable liquid (frequently kerosene). Also, most of the patients (70%) were of a low socioeconomic class. Overall, self-inflicted burns should be considered an increasing mental health problem in our society. Therefore, it is necessary to implement prevention programs and strategies to reduce the incidence rate of this problem.
Pediatric Pain Control Practices of North American Burn Centers
Authors: Martin-Herz Susanne Pelley , Patterson David R. , Honari Shari , Gibbons Janet , Gibran Nicole , Heimbach David M. 
Published: November 2003

Abstract
This study investigated pediatric pain control practices in North American Burn Centers using a mail-in survey. Questions were asked regarding pain control practices, pain assessment methods, and perceived treatment efficacy for inpatients and outpatients in four age groups. Eighty-two centers responded with 111 surveys. Intravenous morphine was the most frequently used analgesic for wound care pain. The most common background pain medications were intravenous morphine, acetaminophen with codeine, and acetaminophen alone. The use of long-acting medications increased with increasing age. Additional areas reported in the text include nonpharmacologic and pharmacologic adjuvants, treatment of itching, pain assessment, outpatient pain management, and efficacy of pain control and assessment practices. There have been great advances in pediatric burn pain control and assessment in recent years, but room for improvement remains. This study provides a basis for evaluation and comparison among burn centers. It further highlights areas that may warrant additional study and intervention.