bluuebunny/crossref_metadata_2025_split huggingface dataset:
578 Impact of Acellular Fish Skin on Wound Healing in a Standardized Pre-Clinical Model
Authors: Pignet Anna-Lisa , Hofmann Elisabeth , Fink Julia , Schwarz Anna , Hahn David , Prevedel Manuel , Kamolz Lars-Peter , Kotzbeck Petra 
Published: May 2023

Abstract

Introduction
Acellular fish skin has proven to be effective in acute and chronic wound healing. Multiple human studies have to date demonstrated that products from acellular skin grafts accelerate wound healing and are efficacious, safe and cost-effective. Here we wanted to investigate the effects of acellular fish skin on wound healing in a pig model.

Methods
The primary aim of this study was to investigate the effects of acellular fish skin on wound healing progression in a full thickness skin defect pig model. The superiority of fish skin was tested in a standardized pig model and compared to normal wound healing (without acellular fish skin grafts) (n=6).
The experiments were carried out in male landrace pigs with a mean weight of 28.8 +/- 2.8 kg at the start of the study. The experiment lasted for 21 days. Wound documentation, thermography, photo-documentation and wound perfusion were carried out 5, 9, 14 and 21 days post wounding.

Results
Clinical evaluation of the wounds showed that there were no major differences between the different dressings on day 5 post wounding. On the next evaluation days ( day 9, 14 and 21 post wounding) the acellular fish skin showed rapid epithelialization with minimal wound contraction, when compared to untreated control wounds, which showed significant signs of contraction (i.e. star-like wound appearance).
Wound area measurements clearly showed that wound size upon treatment with the acellular fish skin and the untreated control rapidly and significantly decreased through contraction of untreated controls. However, wound perfusion seemed to be affected by the treatment with acellular fish skin. Thermography at day 9 and 14 showed higher surface temperature in treated wounds (d9 and d14; p = 0.0005), followed by a trend towards increased oxygenation and perfusion, analyzed by laser speckle and hyperspectral imaging.

Conclusions
Acellular fish skin seems to provide fast wound healing and counteract wound contraction. Untreated wounds showed a slight trend of faster healing, but showed significant signs of wound contraction which points towards wound healing by contraction but not by epithelialization. This contraction was not observed in wounds treated with acellular fish skin.

Applicability of Research to Practice
Standardized preclinical models give valuable insights to the mechanisms of wound healing. Porcine in vivo models are of special interest as the porcine skin is highly similar to human skin with regard to anatomical and physiological structures. Therefore, data generated in such models, as described here, show a high rate of translatability to the human situation.
702 Hydroxycobalamin is An Independent Risk Factor for Acute Kidney Injury.
Authors: Gondek Stephen , Streams Jill , Beyene Robel , Ayers Claci , Dennis Brad , Hayhurst Christina , Dale Slater Elizabeth , Summitt Blair , Wagner Anne 
Published: May 2023

Abstract

Introduction
Previous studies have reported a correlation between the use of hydroxocobalamin and acute kidney injury (AKI), but this is often attributed to the severity of their burn injury. In this study, we use a matched control group to correct for severity of injury and assess the relationship between hydroxycobalamin and AKI.

Methods
All patients receiving hydroxycobalamin over a three year period were identified. The patients were matched 1:1 based on TBSA and age to create a control group. Creatinine and change in creatinine every 24 hours for the first 72 hours were recorded and compared, with an increase in creatinine &gt;1.5 being considered an AKI. A retrospective matched cohort study was performed using the student’s T-test for continuous data and a chi squared test for categorical data.

Results
A total of 50 patients receiving hydroxycobalamin were identified and matched with 50 patients who did not receive hydroxycobalamin. The groups were no signficant differences between groups in terms of age, TBSA or baseline creatinine. Patient receiving hydroxycobalamin had a mean increase of creatinine of 0.13, 0.13 and 0.07 at 24, 48, 72 hours respectively versus 0.0, 0.04 and 0.0 in the control group (p = .09, .06, .49). Qualitatively, 15/50 patients receiving hydroxycobalamin developed AKI vs 2/50 in the control group (p &lt; .001 ), with 6/33 minor burns developing AKI with hydroxycobalamin vs 1/33 in the control group (p=.058). Five patients receiving hydroxycobalamin developed AKI lasting greater than 72 hours, two of which had only minor burns.

Conclusions
Hydroxycobalamin is an independent risk factor for the development of acute kidney injury, even in the setting of minor burns and should only be used in patients with high risk for cyanide poisoning. Empiric and protocolized use may result in harm to patients and should be discouraged.

Applicability of Research to Practice
This study demonstrates the risk of AKI with the use of hydroxycobalamin in both major and minor burns, which burn centers should consider when creating protocols regarding potential cyanide poisoning.
703 Extubation Success in Pediatric Burn Patients: A 10-Year Review
Authors: Cartie Richard , Prasad Balakrishna , Pierzchajlo Noah , Price Austin 
Published: May 2023

Abstract

Introduction
Pediatric burn care presents two unique population subsets that require distinctive care from adult and non-burn patients, respectively. While prior research has led to the creation of best practices for burned adults and non-burn pediatric patients, the standard of care regarding long-term pediatric burn intubation varies widely and deviates from accepted standards in the non-burn pediatric world. In this retrospective review, we analyze one burn center’s experience managing ventilation and extubation of pediatric patients.

Methods
We reviewed all pediatric patients admitted to the burn and wound care ICU who were intubated for more than 24 hours. Patient data was collected from 2012 through 2022. 442 patients were initially identified and 142 remained after removing screen failures. We analyzed 3 groups which included total burn surface area (TBSA), inhalation injury, and time on the ventilator.

Results
The first group broken down by TBSA yielded the most significant results in our 7 of 10 metrics. All significant metrics including mortality, length of stay (LOS), and pulmonary hypertension (HTN) were directly correlated to burn TBSA. Patients with higher TBSA were also significantly more likely to require reintubation after coming off the ventilator. Inhalation injury presented on admission was also a significant indicator for developing acute respiratory distress syndrome (ARDS). Patients who remained on the ventilator for &gt;7 days were significantly more likely to develop pulmonary HTN, however mortality and reintubation rates notably did not increase in this group.

Conclusions
There is much debate in the burn world as to whether standard practices should carry over from other specialties when treating severely burned patients. Much of our data confirms, in pediatric patients, findings of adult patients found in the literature. Mortality, LOS, and time on the ventilator expectedly increased with burn TBSA. Inhalation injury was a significant indicator for ARDS which implies that proper screening for this type of injury is a key to predicting long-term treatment. What is perhaps most notable in this data is the fact that, unlike in the adult burn population, there was no significant difference in mortality between short and long-term intubations. Additionally, patients who required reintubation (n=7) were significantly more likely to have a TBSA &gt;40%, but those who remained on the ventilator &gt;7 days were not more likely to require intubation after extubation. This implies that patients should be left on the ventilator, if necessary, without resorting to aggressive challenge breathing trials for early extubation as is common in adult population. With this data we will also identify our rare cases of pediatric tracheostomy placement and indications for its use.

Applicability of Research to Practice
This projects shows how intubation of pediatric burn patients can be maintained safely and effectively in the critical care setting.
704 Extubation Success in Pediatric Burn Patients with Neuromuscular Blockade: A 10-year review
Authors: Pierzchajlo Noah , Cartie Richard 
Published: May 2023

Abstract

Introduction
The use of neuromuscular blockade in ventilated pediatric burn patients is controversial and varied. While standard of care, including neuromuscular blockade in pediatric patients, has been long established for the non-burned population, no such literature exists for burns. We analyzed use of neuromuscular blockade in pediatric burn patients and its association of mechanical intubation and extubation success.

Methods
We reviewed all pediatric patients admitted to the burn and wound care ICU who were intubated for more than 24 hours. Patient data was collected from 2012 through 2022. 442 patients were initially identified and 142 remained after removing screen failure. We compared patients based on administration of neuromuscular blockade (n=125).

Results
Mortality (n=7) and reintubation (n=7) rates were not significantly affected by use of neuromuscular blockade. Patients who received blockade were also not significantly more likely to develop acute respiratory distress syndrome (ARDS) or pulmonary hypertension (HTN). Length of stay (LOS) in the hospital, intensive care unit (ICU), and time on the ventilator were all significantly increased with patients who received neuromuscular blockade. Patients who received blockade also had a significantly higher total burn surface area (TBSA). Conversely, patients who did not receive blockade were significantly more likely to be older.

Conclusions
Our data shows that mortality and the need for reintubation is not significantly increased with the use of neuromuscular blockade, nor are the complications of prolonged paralysis such as ARDS and pulmonary HTN. LOS in the hospital, ICU, and time on the ventilator were expectedly increased with blockade, although these patients carried more injury than their non-paralyzed counterparts.

Applicability of Research to Practice
This project illustrates how the use of neuromuscular blockade can be implemented safely and effectively in the critical care setting.
715 Ocular Complications of Facial Burns in the Pediatric Population
Authors: Teitelbaum Abigail , Craig Annmarie , Ridelman Elika , Bohra Lisa , Shanti Christina , Segar Sharmila 
Published: May 2023

Abstract

Introduction
Pediatric burns commonly involve the face and periocular areas, with a risk of impairing vision. The aim of this study is to characterize ocular injuries in burn patients and identify the patients at most risk of ocular complications.

Methods
This study is a retrospective review within a single academic, urban pediatric burn center. All burn patients under 18 years of age admitted from January 2010 to December 2020 with periorbital or ocular involvement were included. Variables analyzed included patient demographics, burn characteristics, presence of ophthalmology consultation, ocular exam findings, follow up time period, and early and late ocular complications.

Results
In the study period, 2,781 patients were admitted to our burn center, 300 of whom had facial burns involving the eyes and/or eyelids. Etiologies of burn injuries were as follows: 112 (37.5%) scald, 80 (26.8%) flame, 35 (11.7%) contact, 31 (10.4%) chemical, 28 (9.4%) grease, and 13 (4.3%) friction. Overall, 70.9% of patients with ocular burns received an ophthalmology consult. Of these patients, 61.5% had periorbital swelling and 39.8% had corneal injuries. Of the 207 patients who were followed as inpatients by ophthalmology, only 61 (29.5%) presented for a follow-up visit, as recommended, 6 of which had serious ocular sequelae including ectropion, entropion, symblepharon, and corneal decompensation, and 4 of whom had a firework-related injury.

Conclusions
While burns involving the ocular surface and eyelid margins are infrequent overall, they can lead to long-term sequelae. Ophthalmology consultation is critical, particularly in the setting of chemical and firework-related injury. As ocular and periocular burns can cause immediate as well as delayed sequelae, ophthalmologic evaluation is a key component of assessment.

Applicability of Research to Practice
This paper characterizes ocular injuries in pediatric patients with facial burn injuries and identifies patients most at risk for ocular complications. We believe this will be valuable for many burn researchers and clinicians in order to better identify patients who could benefit from ophthalmologic evaluation and those at risk for both immediate as well as delayed sequelae from periocular burns.
721 The Rising Use of Fire as a Weapon
Authors: Woods Jason , Carter Jeffrey , Conlon Kathe , Flores Carl , Kearns Randy 
Published: May 2023

Abstract

Introduction
Disaster planning and preparedness for a Burn Mass Causality Incident (BMCI) must consider both worst-case scenarios as well as most likely events that could strain a burn center (BC) resources. This study evaluates the growing threat of utilizing fire as a weapon for terrorist attacks and criminal acts in the United States.

Methods
Statistics regarding the use of fire as a weapon over a 2-year period were reviewed and summarized along with a review of significant events over 30 years. In addition, data regarding the type of weapon used in these attacks, intended target, and motives were collected and compared.

Results
According to the Cyber Security and Infrastructure Security Agency (CSISA), incidents related to arson or fire as a weapon in the US increased by 56.9% in cities with populations over 1 million people between 2019 and 2020 and 11.3% in towns with populations under 10,000. In addition, improvised Incendiary Device (IID) incidents increased by 210% at government facilities, 113% at commercial facilities, and 114% at critical infrastructure facilities during the same time frame.

Conclusions
The US continues to face complex and evolving threats from extremists, criminals, and terrorists. Methods have included attacks utilizing arson, IIDs, deliberate forest fires, and more. Assailants have used fire as a weapon to target public gatherings, individuals, and government property and as a component of complex coordinated attacks. These attacks have resulted in both large numbers of fatalities and burn injuries. The materials required to create a weapon utilizing fire are cheap, readily available, and require no formal training.

Applicability of Research to Practice
Criminal or terrorism-related incidents involving the use of fire as a weapon can result in mass causality events with large numbers of burn patients. These incidents can potentially overwhelm both first responders and local BC quickly. Therefore, BCs must have an updated disaster plan that has been evaluated and communicated with local fire and EMS, neighboring hospitals, and regional BCs.
728 A Survey of Health Professionals' Attitudes Regarding Substance Abuse Disorder in Burn Patients
Authors: Richey Karen , Dobbe Van , Kesler Natalie , Mouch Steven , Foster Kevin 
Published: May 2023

Abstract

Introduction
Substance abuse disorder (SAD) is complex, involving the continued use of drugs or alcohol despite harmful consequences. The diagnosis of this disorder carries a stigma that can bring shame to the individual, and healthcare providers are not immune to attitudes that worsen this shame. This coupled with patient behaviors can make caring for these patients challenging. We have seen an ever-increasing number of patients admitted to the burn center with this preexisting comorbidity. The purpose of this study was to better understand our own attitudes and potential bias or barriers that may be present in caring for this population.

Methods
A modified version of the 11-item Medical Condition Regard Scale (MCRS) was distributed to burn center personnel via REDCap. 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 the anonymity of respondents.

Results
A total of 52 individuals responded to the survey. When responding to POS questions, the majority agreed that insurance coverage should be equal to other conditions (96%), would not mind being called in to care for this population (75%), felt they could find something to help the patient feel better (65%), felt compassion (65%), found working with SAD patients satisfying (65%) and enjoyed giving extra time to these patients (51%). When asked NEG questions, 40% responded it was difficult to work with these patients, 25% reported irritation, 23% preferred not to work with SAD patients, 13% felt there was little they could do to help, and 2% felt it was a waste of medical dollars. When asked POS burn specific questions, the sample was split 50/50 in regard to efficacy of current practice to manage withdrawal symptoms, 92% felt that these patients experienced more anxiety, had other mental health disorders (98%) and that pain management was particularly difficult (98%). When asked NEG burn specific questions 48% felt the care they provided was appreciated, and only 62% felt safe when providing care.

Conclusions
The majority of staff reported willingness to help these patients yet reported difficulty in working with the population. Staff felt that these patients were more apt to have concurrent mental health disorders and increased anxiety. Management of pain and withdrawal symptoms were identified as areas of care that need improvement. It is concerning that 38% of staff felt unsafe in providing care. Identification of bias and barriers is the first step in an initiative to optimize protocols that will improve patient outcomes and work experiences.

Applicability of Research to Practice
Protocols specific to the burn population that suffers from concurrent SAD are needed to optimize care.
749 Does a Dedicated Burn Therapist Add Value in an Outpatient Setting?
Authors: Rainey Kristin , Rosenthal Jennifer 
Published: May 2023

Abstract

Introduction
Caring for burn patients requires specific knowledge, skill, and a collaborative team approach from multiple disciplines including occupational therapy. In the hospital system, therapists are often under direction of rehabilitative services, not nursing administration. There are specific productivity expectations within the rehabilitation department which rely heavily on time-based billed interventions. This hospital had an occupational therapist (OT) assigned to the burn clinic as well as acute care patients to help improve the therapist’s productivity. With a growing burn clinic, some patients were missed by the OT while they were providing services elsewhere in the hospital. With support and advocacy from the nursing Director of burn services, a full-time occupational therapist was hired solely for the outpatient burn clinic to improve the care of burn patients. Prior research has focused on the importance of OT in treatment of the burn patient, however no research was found in regard to the benefit of hiring a therapist specifically for an outpatient burn setting. This information is crucial for hospital administration to determine the need of having a burn-dedicated therapist. Specialized training in wound care, splinting, measuring and assessing for custom compression garments, and burn-specific evidence-based practice is required for a therapist to be competent in a burn center. Having a specialized burn therapist available is vital for the optimal care of the burn outpatient. This study analyzes the benefits of having an OT dedicated to the burn clinic compared to an OT being staffed for both the inpatient and outpatient needs.

Methods
A retrospective chart review was performed for 6 months prior to hiring a full time OT in the clinic to 6 months after.

Results
Preliminary data taken from October 2021 to present indicate a growth in OT services provided in the burn clinic from an average of 0.64 patients and 2.44 billed productive units per day to 3.9 patients and 12.4 units per day. At over 500% increase in just 3 months of hiring a full time OT, the data indicates that adding a burn therapist in the clinic increases number of patients seen. Productive units billed by the therapist also increased over 400%. Data regarding the amount of revenue are pending.

Conclusions
Having a dedicated burn therapist in an outpatient clinic increases the number of patients receiving necessary OT services and subsequently improves financial reimbursement.

Applicability of Research to Practice
Consistent availability of the OT, increased understanding of the role, purpose, and value of OT for the burn patient, increased communication with providers, and higher efficiency due to proximity to patients and providers result in increased use of OT services. Hiring a dedicated burn therapist in an outpatient setting should be considered by burn centers to increase number of patients seen and increase productive billable units by OT within the burn clinic.
751 Burn Therapy Certified Therapists Representation within Burn Society Leadership
Authors: O'Neil Audrey , Murray Derek , Warthman Renee 
Published: May 2023

Abstract

Introduction
The American Burn Association (ABA) Burn Therapist Certification (BT-C) program, developed in 2018, derived from an organizational desire to promote vetted quality burn care across the interprofessional team. Leadership positions within organizations, are responsible for formulating policy, developing education, and providing oversite to ensure the success of the association. A previous study examining interdisciplinary representation within burn society leadership for the ABA and International Society of Burn Injuries, found that rehabilitation representation within governance positions was 7% and 9% within committee memberships. In a 2022 Letter to the Editor, therapists described limited center support as a barrier for obtaining BT-C. This study aims to examine BT-C member involvement within ABA society leadership.

Methods
Official ABA society and membership websites were accessed to identify BT-C recipients who currently hold positions within society governance and committee memberships. ABA Special Interest Group (SIG) membership was also examined. The Journal of Burn Care and Research (JBCR) website was accessed to identify BT-C recipients on the editorial board. BT-C members were compared to other therapist involvement.

Results
Of 32 qualified BT-C therapists, 26 continue their ABA memberships. BT-C therapists hold 3 Governance positions (Board membership and current ABA President) and maintain 36 of the available 77 committee positions (47%). Excluding the BT-C Committee from data collection, BT-C therapists make up 44% (n=23) of therapist committee positions within the ABA. BT-C therapists hold a combined 46 SIG memberships. The JBCR currently lists 2 therapists on the editorial board, both of whom are BT-C.

Conclusions
Despite representing a fraction of the burn therapy community, BT-C therapists continue to be leaders within the burn field by participation in ABA membership, governance, and committee memberships. Current BT-C therapists serve to establish standards in research published within the JBCR. Professional and academic societies depend on qualified leaders to set standards of burn care. Promoting BT-C within individual burn centers may stimulate leadership within the center and burn professional organizations.

Applicability of Research to Practice
Definitive evidence supporting the benefits of BT-C to individuals and organizations is needed to overcome current barriers to certification.