bluuebunny/crossref_metadata_2025_split huggingface dataset:
748 Accidental Thermal Injury From Ignition of Home Oxygen: Is Burn Center Admission Advantageous?
Authors: Bailey John , Werenski Hope , Saraswat Anju , Holmes James , McEathron Rachel , Craig Christopher , Williams Jeff 
Published: May 2023

Abstract

Introduction
Home oxygen therapy is available for the supportive treatment of patients with chronic lung disease. Nevertheless, complications associated with home oxygen use have been well described. The typical injury pattern associated with the accidental ignition of home oxygen does not mandate emergent intubation. However, due to the thermal component of the injury, patients are initially directed towards admission to burn units. The recent stress applied to the healthcare system by COVID-19 has highlighted the potential benefit of flexibility in the disposition of injured patients. In particular, we wanted to determine if there is a demonstrable benefit from admission to an American Burn Association (ABA) verified burn center for patients presenting with home oxygen ignition injuries.

Methods
After obtaining approval from our local Institutional Review Board, we conducted a retrospective review of our institution's ABA-verified burn center database from January 2016 through May 2022. Individual charts were inspected for discrete data points related to the general descriptor of the patient's injuries, comorbidities, and hospital course. Using independent samples t-tests, we compared patients admitted to the burn service with those primarily cared for by non-burn service teams.

Results
We identified 49 adult patients admitted with burn injuries associated with home oxygen use during the study period. These patients were divided into those intubated at or near the time of admission and those managed without intubation. Of the 29 patients intubated on admission, the burn service managed 19 of these patients, and non-burn services managed 10. There were no identified differences in the outcomes of ventilator days, days in the ICU, total length of stay, or mortality between the two groups. Similarly, we examined the 20 patients admitted without intubation. The burn service managed 7 of these patients, and non-burn services managed 13. Again, the two groups had no identified differences in the outcomes of days in the ICU, total length of stay, or mortality.

Conclusions
This single-center review revealed no difference in outcomes between patients cared for in an ABA-verified burn center versus non-burn services for home oxygen ignition injury. From a care perspective and resource utilization, the outcomes appear similar. Further, we note that patients required only brief periods of mechanical ventilation – supportive of the opportunity to avoid intubation in these patients. Prevention efforts, like those in the burn center, need to continue, and further studies must be done to confirm these preliminary findings.

Applicability of Research to Practice
These findings are supportive of potential opportunities to wisely use Burn Center capacity.
756 Effects of Bioengineered Allogeneic Cellular Constructs on Macrophage Phenotype in the Context of Burns
Authors: Hernaez-Estrada Beatriz , Steele Lindsay , Spiller Kara 
Published: May 2023

Abstract

Introduction
The persistent inflammatory and stress responses generate in burn patients have a strong effect on the immune system. Macrophages that are activated in response to burn injuries polarize towards an immunosuppressive phenotype commonly known as M2b. Furthermore, due to sepsis, the chronic exposure to the pro-inflammatory environment also leads to an exhausted macrophage phenotype. Together these effects compromise macrophage behavior that influences the healing outcome. In clinical trials, bioengineered allogeneic cellular constructs (BACCs) have shown potential in promoting healing in patients with deep partial thickness burns. However, the mechanism(s) behind these successful effects are not totally understood yet. For this reason, the aim of this study is to investigate how the crosstalk with the BACC influence different burn-related macrophage phenotype.

Methods
Primary human macrophages (N=4 healthy donors) were co-cultured with the BACC or collagen controls. Macrophages were isolated over 6 days of co-culture and their RNA was extracted for gene expression analysis, and conditioned media was collected to analyze the secretion of proteins. To assess phenotype changes, we performed gene set analysis using single sample gene set enrichment. To investigate changes in the phenotype of macrophages relevant to burn wounds macrophages were polarized to the immune suppressive M2b phenotype or LPS-exhausted phenotypes before co-culturing them with the BACC. Undifferentiated macrophages (M0) were used as controls.

Results
Gene expression analysis revealed a shift in undifferentiated macrophage phenotype towards an M2 phenotype by day 3 and 6 in co-culture as demonstrated by an increase in the expression of multiple M2 genes, including MRC1 and CCL18. Secretory analysis revealed a decrease in the secretory of inflammatory proteins, like interleukin 6.

Conclusions
Collectively these results demonstrate that BACCs promote the transition of macrophage phenotype towards a pro-reparative M2 phenotype which may contribute to the construct’s pro-healing capabilities.

Applicability of Research to Practice
This study provides insight into the mechanism by which BACCs promote healing in the burn wound environment.
760 Building Cold Injury Prevention and Control Strategies with People Who are Experiencing Homelessness
Authors: Orton Caitlin , Gannon Mark , Stewart Barclay , Pham Tam , Mesic Aldina , Carrougher Gretchen 
Published: May 2023

Abstract

Introduction
The incidence of hypothermia and frostbite is increasing given larger numbers of people experiencing homelessness (PEH) across the country. Cold injuries create functional deficits that compound comorbidities of people who already experience disproportionate disability burdens. We collaborated with PEH to identify modifiable cold injury hazards, understand prevention knowledge and first aid techniques, and develop prevention strategies.

Methods
We conducted 12 interviews with PEH with and without lived experience of cold injury. Interviews covered domains of risk factors/hazards, utility of existing educational materials, novel strategies, and acceptable stakeholders for dissemination. Interviews were transcribed and coded by two analysts using both deductive and inductive approaches.

Results
Participants varied in the type (e.g., street, encampment, shelter) and chronicity of homelessness. Six themes emerged: i) PEH are engaged in prevention, ii) there is a need for improved awareness around synergistic risks (e.g., rain, nicotine or amphetamine use, diabetes), iii) existing materials are not sufficiently contextually specific, iv) a narrowly focused prevention and dissemination strategy will not suffice, v) prevention strategies need to be framed within the realities of living homeless, and vi) respect and kindness are integral to successful uptake (Table 1).

Conclusions
Insightful perspectives shared by PEH provided key strategies for cold injury prevention. Prevention strategies must fit into the reality of homelessness, be respectfully delivered, and need to be a collective community effort where voices of PEH are valued.

Applicability of Research to Practice
Themes and specific perspectives uncovered by this study can help clinicians, community service providers, and public health practitioners develop cold injury prevention strategies alongside people with lived experience of homelessness.
761 Albumin to Alkaline Phosphatase Ratio in Burn-Induced Liver Damage
Authors: Ketels Taryn , Hosokawa Patrick , Wiktor Arek , Kovacs Elizabeth , Idrovo Juan 
Published: May 2023

Abstract

Introduction
Liver damage following burn injury is associated with a poor prognosis. Thus, prevention, and early identification, of burn-induced liver damage will improve the outcomes of burn patients. Aspartate-aminotransferase (AST) and alanine-aminotransferase (ALT) help detect liver injury in extensive burns &gt;50% of Total body surface area (TBSA). However, their efficacy may be questionable in burns &lt; 50% TBSA. Clinical reports describe albumin to alkaline phosphatase ratio (AAPR) to predict liver injury and dysfunction more accurately than AST and ALT in pathologies like non-alcoholic fatty liver disease and primary liver tumors. However, this ratio has never been tested in burn victims. Herein, we hypothesize that the AAPR may be more useful in detecting burn-induced liver damage. Given that liver biopsies are invasive methods with several complications, we correlated liver histological findings from a burn injury murine model

Methods
Livers and serum were collected from C57BL/6 8-12 weeks female mice, 1, 2, and 4 days after a 15% TBSA scald burn, n=5/group. Histological findings were scored by a pathologist blindly. Serum liver function tests were measured with a colorimetric method. We also conducted a pilot, prospective observational study on 58 burn patients admitted to the Burn Intensive Care Unit (ICU) to follow AST, ALT, and AAPR values. Furthermore, in an initial survival model, we correlated hospital days of stay with the AAPR values

Results
In our murine model of burn injury, liver damage worsens with time. Compared to postburn day 1 the histological damage score significantly increased by 75% at 4 days postburn. AST and ALT were elevated within the first day; however, their values normalized by day 3 postburn, failing to match the progression of liver injury showed by histology. Comparing postburn day 1 the AAPR significantly decreased by 40% on postburn day 4. The enrolled patients were mostly male (74%), with a median age of 50 and an average TBSA of 9.13%. While AST-ALT did not show significant changes in the first 2 weeks after burn, the AAPR on an initial run of a linear model of day predicting ratio decreased over time by -0.08/day (p=0.006). Moreover, our statistical model detected that the likelihood of discharge from ICU increases with the AAPR ratio (Hazard-Ratio 1.18/0.01 increase ratio p =0.003)

Conclusions
AAPR showed a better correlation of burn-induced liver injury in mice than AST and ALT. AAPR decreases in burn patients and may represent postburn liver alterations. AAPR increase raises the likelihood of ICU discharge

Applicability of Research to Practice
Identification and monitoring of liver injury and dysfunction with new modalities may improve the outcome of burn patients
762 A Systematic Review of Surgical Simulation in Burn Surgery: Education, Assessment, and Management
Authors: Roohani Idean , Moshal Tayla , O'Brien Devon , Jimenez Christian , Collier Zachary , Kondra Katelyn , Yenikomshian Haig , Gillenwater Justin , Carey Joseph 
Published: May 2023

Abstract

Introduction
Proper assessment and management of burn patients requires practical knowledge and timely interventions in a high-stakes setting. Although much of burn care emphasizes critical care, nuances exist among this patient population, creating challenges for surgeons-in-training. As a result, low- and high-fidelity burn simulations have become increasingly popular means to educate burn care physicians and their teams in a safe environment without compromising care or endangering patients. The aim of this report is to systematically review the literature for existing simulations related to burn care.

Methods
A systematic review was conducted using the following databases: PubMed, Scopus, Embase, Web of Science, and Cochrane. Inclusion criteria were peer-reviewed articles about surgical simulation models related to burn care and surgery. Skills and techniques taught, assessment methods, model type, fidelity, and equipment were extracted from included studies. Conference proceedings, reviews, non-English and non-burn-specific literature were excluded.

Results
Our search criteria identified 2,585 articles, 16 of which met inclusion criteria. Simulation methods included 7 simulation courses (43.8%), 6 synthetic benchtop models (37.5%), 2 augmented/virtual reality interfaces (12.5%), and 2 iOS applications (12.5%). There were no burn-specific animal or cadaveric models. Model fidelities included 9 (56.3%) high-, 3 (18.8%) medium-, and 4 (25.0%) low-fidelity. The most common topics included in the simulations were burn wound assessment/management (n=10, 62.5%), escharotomy (n=6, 37.5%), fluid management (n=2, 12.5%), electrical burns (n=1, 6.2%), skin graft harvest (n=1, 6.2%), tangential excision (n=1, 6.2%), and cricothyrotomy (n=1, 6.2%).

Conclusions
Burn management requires an expansive breadth of intensive care knowledge and surgical expertise combined with a distinct, burn-specific skill set. A paucity exists in the literature for augmented/virtual reality and animal/cadaver models unique to burn care and surgery. Our review identified a need to expand simulator options to improve training in skin grafting, burn reconstruction, and burns-specific intensive care management.

Applicability of Research to Practice
Given the rapidly expanding emphasis on remote learning in the post-COVID era, developing accessible surgical simulation infrastructure adjacent to clinical training may better prepare global burn providers for the complexity of burn care.
763 The Cardioprotective Effects of Sildenafil, PJ34, MitoTEMPO, and ZLN005 in the Early After Burn Injury
Authors: Radhakrishnan Ravi , wen Jake , DeJesus Jana , Radhakrishnan Geetha 
Published: May 2023

Abstract

Introduction
Cardiac function has been found to decrease within the first 24 hours after burn injury and has been documented to stay depressed for up to 72 hours. Cardioprotective drugs such as sildenafil, PJ34, MitoTEMPO, and ZLN005 have been shown to counteract this dysfunction when administered 1 hour before burn injury. However, there remains limited knowledge on the effects of cardioprotective drugs in the early phase of burn injury.

Methods
Sprague-Dawley rats were divided into 6 groups. In 5 groups, a 60% TBSA scald burn was performed. Cardioprotectors Sildenafil, PJ34, MitoTEMPO, and ZLN005 were administered to 6 rats per group. A control group of 6 unburned rats was maintained in synchrony. Burned and unburned rats were sacrificed after measurement of heart function using echocardiography (ECHO, Vevo2100 echocardiograph). Heart rate (HR), left ventricular ejection fraction (LVEF), fractional shortening (FS), cardiac output (CO), intraventricular septum (IVS), left ventricular (LV) mass, left ventricular wedge pressure (LVWP) and left ventricular internal diameter (LVID) were assessed with the Vevo2100 echocardiograph software.

Results
Compared to sham control, heart rat (HR), diastolic LVID significantly increased at 3 hours post burn. CO, EF, FS, IVS in systole and diastole decreased at 3 hours post burn. LVID after administration of Sildenafil reduced heart rate at 3 hours post burn. ZLN005 restored burn-induced IVS systolic and diastolic decrease at 3 hours post burn. All drugs improved burn-induced EF, FS. Sildenafil and TEMPO recovered CO at 3 hours post burn.

Conclusions
In this study, cardiac function was found to be reduced up to 13 days after initial injury. Sildenafil, ZLN005, and TEMPO were shown to recover cardiac function at 3 hours post-injury, showing improvements in EF and FS. Sildenafil reduced HR and CO while ZLN005 restored burn-induced IVS during systole and diastole. This suggests the cardioprotective utility of these medications if administered early after burn injury.

Applicability of Research to Practice
Will help improve critical care and understanding of cardiac function.
765 When All Hell Breaks Loose: The Need for Specialized Burn Provider Expertise During Crisis
Authors: Goff Anna , Lambrix Marcie , Neading Andrew , Kohler Casey , Maluso Patrick , Gerrek Monica 
Published: May 2023

Abstract

Introduction
The COVID-19 pandemic prompted health care organizations to create or revisit crisis standards of care (CSC) guidelines. The goal of these plans is to preemptively determine the most effective way to allocate resources under circumstances in which not all patients can be treated in accordance with general standards of care. In 2020, the American Burn Association (ABA) released professional recommendations for the development of CSC guidelines. Specifically, the ABA provided triage tables that could be incorporated into organizational CSC guidelines with the intention of assisting providers by predicting mortality based on a patient’s age and burn size. These tables are often misinterpreted by non-burn providers who tend to overestimate burn size and conclude that a patient has a higher predicted mortality than they actually do. Inaccurate predicted mortalities can result in inappropriate care plans and ultimately impact patient outcomes. We argue that the ABA predicted mortality tables are helpful when used by experienced burn providers, but that there are inherent ethical risks when they are utilized by providers who lack appropriate burn care experience.

Methods
We conducted a literature review of CSC guidelines that included specific instructions for the triage of burn patients. We reviewed 15 publicly available CSC guidelines, 8 of which specifically mentioned burn patients, and examined each to see if/how they utilized ABA triage tables for predicting burn patient mortality.

Results
Of the 8 CSC plans that acknowledged burn patients, 5 utilized the mortality predictors outlined in the ABA triage tables to guide resource allocation. In the majority of plans, patients with a predicted mortality of &gt;90% were not eligible to receive treatment and/or transfer. None of the plans specified the involvement of a specialized burn provider in assessing burns.

Conclusions
Our findings indicate that the expert evaluation of burns and thus predicted mortality can be the difference between receiving and not receiving potentially life-saving interventions under CSC guidelines. If a non-burn provider overestimates a burn size, for example, a patient may be undertreated for potentially survivable injuries under some CSC guidelines. This may further perpetuate health disparities given vulnerable populations are at higher risk of suffering burn injuries and often face a higher risk of morbidity and mortality.

Applicability of Research to Practice
This project demonstrates the need for expert input from specialized burn providers in assessing burns, especially in CSC scenarios, to ensure these assessments are reliable and accurate. Involving expert burn providers in this process will help ensure ethically appropriate clinical care decisions are being made which will improve patient outcomes and resource management in crises and decrease provider distress.
766 Evaluating the Ethics of Comfort Care in Self-Immolation Burns
Authors: Pham Theophilus , Dissanaike Sharmila , Shrestha Kripa , Dhanasekara Chathurika 
Published: May 2023

Abstract

Introduction
Self-Immolation injuries, although rare, incur a high mortality rate due to the high injury burden. These patients often require a long hospital stay including extended periods of time in the ICU due to the systemic burden of their burns. They often present with active suicidal ideation leaving medical decisions to be made by their next of kin who want to see everything done to preserve the life of their loved ones. Over the past several years our burn center has taken a more holistic approach to the care of these patients involving both the psychiatry team as well as the palliative care team to discuss concurrent treatment and prognosis with both patients and their families. Previous ICU dogma often discourage earlier palliative care consultation as many providers and families see such actions as the care team no longer wishing to provide care for patients

Methods
Single patient case study and review

Results
The early consultation of a supportive care team allowed the patient's family more access to resources to better make a better informed decision that was in keeping with the patient's wishes

Conclusions
Patients who commit self immolation often present with active suicidal ideations and are deemed unfit to make their own medical decisions. It is of utmost importance to not only treat their burns but also for early psychiatric treatment of their underlying condition when possible. These patients often are not coherent or are determined to not have the autonomy to make their own medical decision. Until the patient is deemed capable of making their own medical decision, it is up to the providers to determine a surrogate decision maker. The role of the surrogate decision maker is difficult as they must use substitute judgment in order to make decisions based on the subjective wishes of the patient. The difficulty in this situation arises from the fat that the decisions although made based upon the patient’s wishes can be at conflict with the patient’s best interest. When these conflicts arise it is up to medical providers to have an open dialogue and convey all revelevent information related to prognosis and outcome with the decision maker. There have been no studies that look at the ethics of palliative care among these patients and how to best honor their wishes.

Applicability of Research to Practice
This study is to help foster a discussion around the ethics of early discussion of palliative measures in regards to the treatment of self-immolation burns