bluuebunny/crossref_metadata_2025_split huggingface dataset:
708 Clinical Impact of a Revised Burn Resuscitation Guideline at an Adult Burn Center
Authors: Curry Dominick , Smith Susan , Hobbs Brandon 
Published: May 2023

Abstract

Introduction
The American Burn Association recommends volume resuscitation at 2-4ml/kg/TBSA; however, in practice, fluid resuscitation often exceeds these goals. Additional strategies used for burn resuscitation include the use of colloid rescue and high dose ascorbic acid (HDAA). In 2018, our institution moved from a fluid resuscitation strategy which included calculating fluid requirements using 4ml/kg/TBSA and HDAA infusion for burns &gt; 30% TBSA to a strategy that calculated fluids using a 2ml/kg/TBSA with the removal of HDAA. Additionally, the guidance for colloid rescue was updated to provide specific time points for evaluation of the need for initiation of this intervention. The primary objective of this study was to compare outcomes of the new institutional resuscitation strategy to the previous one.

Methods
This was a retrospective cohort study evaluating outcomes for acute burn resuscitation between the previous institutional resuscitation guideline with the updated guideline. This study included adult patients admitted for burn injury with &gt;20% TBSA between August 1, 2016, to September 30, 2021. The primary outcome was a composite safety endpoint which included incidence of acute kidney injury and intra-abdominal hypertension requiring intervention. Acute kidney injury was defined as a serum creatinine increase 1.5 times baseline. Statistical analyses utilized the Mann-Whitney U test for non-normally distributed continuous data and the chi-squared and Fischer’s exact test for categorical data. A p-value of &lt; 0.05 was considered statistically significant.

Results
The final analysis included 43 in the pre-group and 52 in the post-group update. Baseline characteristics between the groups were similar. The primary composite safety outcome was non-statistically significantly lower in the post-guideline update group (39.5% vs. 28.8%, p= 0.273). Total fluid volume administered (3.74 ml/kg/TBSA vs. 2.97 mL/kg/TBSA, p=0.007) and hourly urine output within the first 24 hours (1.26 mL/kg/hour vs. 0.75 mL/kg/hour, p=0.007) were significantly lower in the post-group. No differences were observed in vasopressor use (32.6% vs 36.5%, p=0.63), vasopressor duration (70.3 hours vs. 50.4 hours p=0.24), or duration of mechanical ventilation (5.1 days vs 10.4 days, p=0.113).

Conclusions
The burn resuscitation guideline update resulted in significantly lower 24 hour- fluid volumes, without negative hemodynamic consequences.

Applicability of Research to Practice
The comparison of two resuscitation protocols provides evidence for other institutions to help optimize their resuscitation practice
725 Evaluating Wound Care Compliance, Healing and Perceptions in Burn Patients Discharged to Post-Acute Care Facilities
Authors: Osborn Suzanne , Garn Kristina , Mitchell Griselda , Neal Joya , Flores Juan , Richey Karen , Foster Kevin 
Published: May 2023

Abstract

Introduction
Prior research at our center demonstrated that 51% of all patients discharged to a skilled nursing facility (SNF) or acute rehabilitation center (ARC) had deterioration of their wounds. In that review, we were unable to identify specific patient factors associated with a worsening of wounds. We postulated that there was a relationship between specific facilities and outcomes, however due to the number of discharge facilities we were unable to analyze those relationships. Following our analysis, clinic personnel increased interactions with facilities to improve follow-up and communication. The purpose of this quality improvement project was to further explore factors that may influence wound healing in SNF and ARC environments and improve patient outcomes.

Methods
The review occurred over a 3.5-month period. Burn and non-burn patients residing at a SNF or ARC at the time of their clinic visit were included in the sample. A 10-item survey was administered to patients and a 5-item survey to the clinician. Wounds overall were deemed as “Improved” (IM) or “Worsened/No Change” (W/NC) and patients subsequently divided into these cohorts for analysis. Basic statistics were calculated.

Results
A total of 55 patients completed 81 surveys. The majority, 69% (n=38) had wounds that improved and 31% (n=17) showed worsening or no change. There were no significant differences between groups in wound etiology, facility type, dressing type / frequency or the absolute number of dressing regimes/patient. Facility compliance with clinic dressing orders was mediocre with 65% compliance in IM and 57% in the W/NC (p=.484). When asked if wounds were progressing as expected clinicians responded yes 97% of the time for IM and 36% for W/NC (p&lt; .00001). When patients were asked if their facility had the needed dressing supplies, 84% (n=46) IM responded yes vs 61% W/NC (p=.029). There were no significant differences in patient understanding of wound care, if performed correctly, or ratings of pain control, appetite, restfulness, staff responsiveness, and overall care at the SNF or ARC.

Conclusions
An improvement in outcomes was noted between our first analysis and the current evaluation, this may be related to increased communication with facilities. Although the data demonstrated that prescribed wound care was not adhered to, there was no difference between groups. However, patient reports of inadequate dressing supplies at the facilities may be a factor in the progression of wound healing. While overall outcomes were improved, patients continue to experience an unacceptable rate of wound deterioration and further investigation is warranted.

Applicability of Research to Practice
Identifying interventions for patients sent to SNF and ARC facilities would improve wound outcomes.
734 A User-Centered Design Approach for a Burn Recovery Mobile Platform
Authors: Menge Kyler , Pham Tam , Carrougher Gretchen , Stewart Barclay , Kurien T Varugis 
Published: May 2023

Abstract

Introduction
People with burn injuries experience challenges in multiple domains including wound and scar management, pain/pruritus, psychosocial recovery, return-to-work, and community re-integration. Mobile software platforms can provide clear, concise, and consumable information across different stakeholder groups. These platforms require a user experience (UX) that values users’ expressed needs to maximize engagement with critical information. This study seeks to inform the UX for an outpatient mobile software platform to optimize recovery.

Methods
We performed semi-structured, in-depth interviews at a regional burn center with patients, clinicians, and carers to understand participant background, personal values, and requirements of a recovery platform. Interviews were transcribed and analyzed using grounded theory analysis and affinity mapping to surface major themes.

Results
Fourteen in-depth interviews (over 13.5 hours) were conducted with six patients, six clinicians, and two carers. Thematic analysis identified four principal themes and corresponding UX requirements: (1) Provide a clear path to recovery: need for easily understood temporal visualizations of recovery experiences in multiple domains. This includes outlining paths that list relatively individualized tasks critical for recovery. (2) Facilitate task habituation: UX to ease successful task performance such as daily schedules, reminders and integration of recovery tasks with activities of daily living. (3) Maintain motivation: recovery progress tracking, motivational messages and visualization of long-term recovery trends to maximize task adherence. Patients and clinicians identified goal-authoring and recovery progress as key motivators in performing recovery tasks. (4) Create a burn community: access to other people with burn injuries through integrated forums. Neither patients nor clinicians desired to directly communicate with each other through the platform, instead preferring existing electronic health record methods.

Conclusions
This study identified initial UX requirements for a person with burn injury-centered platform. There is strong support for temporal representations of recovery paths across multiple domains, UX design to facilitate and motivate users to stay engaged in performing critical recovery tasks, and access to the burn community.

Applicability of Research to Practice
Interviews of prospective users outlined four important features to include in the UX design of an online burn recovery platform.
735 Burns During the Pandemic: An Epidemiological Study of COVID-19's Impact on an Urban Burn Center
Authors: Choe Deborah , Won Paul , Abu-Ghazaleh Joshua , Collier Zachary , Gillenwater Justin , Yenikomshian Haig 
Published: May 2023

Abstract

Introduction
Due to stay-at-home and social distancing orders driving the advent of virtual workplaces and classrooms, we hypothesized the COVID-19 pandemic altered the epidemiology of adult and pediatric burn injuries presenting to our large urban burn center.

Methods
We retrospectively reviewed patients admitted to a metropolitan burn center during a 3-year period: one year prior to the COVID-19 pandemic (Control Year, 3/20/2019 - 3/19/2020) and the first 2 years of the pandemic (Year 1, 3/20/2020 - 3/19/2021; Year 2, 3/20/2021 - 3/19/2022). Data included burn etiology, severity, outcomes, and socioeconomic demographics.

Results
There were 404 burn patients admitted during the pre-pandemic year (Control Year). Fewer patients were admitted during the pandemic years (Year 1 = 339; Year 2 = 374). The average age of burn patients was similar across the three years (Control Year 39.9 ± 22.6; Year 1 40.4 ± 22.1; Year 2 41.8 ± 21.9 years) with an increasing percentage of males (61%; 68%; 66%) and undomiciled individuals (15%; 19%; 23%) getting burned. Rates of scald, chemical, electrical, and blast burns were similar across years with greater variations in rates of flame (35%; 40%; 37%), contact (5.0%; 8.0%; 3.8%), and friction (0.0%; 0.6%; 1.3%) burns. Survival rates (95%; 94%; 94%) and hospital length-of-stay (11.4 ± 16.5; 11.6 ± 14.4; 12.4 ± 17.7 days) were similar across the 3 years with slightly longer but variable ICU stays during the pandemic (8.2 ± 13.6; 10.1 ± 15.8; 11.5 ± 17.7 days).

Conclusions
Although the COVID-19 pandemic overwhelmed hospital systems and quarantine measures created altered home environments, our study suggests that burn severity and etiology were not significantly impacted by these changes. However, it does appear that the rate of burn injury decreased during the first year of pandemic lockdowns (Year 1) and started to increase towards pre-pandemic levels by Year 2 as lockdown restrictions were lifted. Flame, contact, and friction burns appeared to increase in frequency during Year 1 but normalized towards pre-pandemic levels by Year 2 as children returned to school. Analysis did show differences in ethnicity which may suggest the possibility of socioeconomic factors impacting who was getting burned during this time, but further studies are required to assess this potential disparity with greater nuance.

Applicability of Research to Practice
This study improves our understanding of the ongoing impact of pandemic restrictions on burn injuries in cities and may help develop better prevention, education, and intervention strategies.
739 A Review of Current Methicillin-Resistant Staphylococcus Aureus Decolonization Practices in a Pediatric Burn Population
Authors: Hockenberry Tiffany , Waterfield John , Richey Karen , Foster Kevin 
Published: May 2023

Abstract

Introduction
Methicillin-resistant staphylococcus aureus (MRSA) infections can result in severe sequela including death. Evidence-based practice guidelines exist for the universal decolonization of adult intensive care (ICU) patients. Evidence has not been established in the pediatric population, resulting in a knowledge gap regarding MRSA decolonization in children. Our practice is to test all patients upon admission for MRSA. Regardless of results, due to the immunocompromise of burn patients, all admissions are placed on a decolonization protocol that includes mupirocin ointment intranasally twice daily for five days. The repeated intranasal swabbing causes both discomfort and psychological distress for our pediatric patients. The purpose of this study was to evaluate current practice and the incidence of MRSA bacteremia in our pediatric population.

Methods
This was a retrospective review of all pediatric patients admitted to our center between January 2018 and August 2022. Patients who had mupirocin ordered for decolonization (YO) were compared to those who did not (NO). Basic descriptive statistics were calculated.

Results
A total of 508 individual patients had 519 admissions, YO 73% (n=379) NO 27% (n=140). There were no significant differences between groups for age, gender, race, ethnicity, admission diagnosis or mortality. Mupirocin was ordered at admission for 379 (73%) and administered per orders 74% of the time. YO patients were more likely to require ICU care 19% (n=73) vs 11% (n=16) (p=0.036) and mechanical ventilation 12% (n=46) vs 4% (n=6) (p=0.008). Length of stay (LOS) was longer for the YO group, 9.9 vs 5.11 days (p=0.008). The majority, 93% (n= 482) were admitted for burn injury, with a mean TBSA of YO 8.37 vs NO 5.86 (p=0.023). For YO, the mean number of doses to be administered, adjusted for LOS, was 6.71 vs actual doses given 3.8 (p &lt; .0001). Overall incidence of MRSA positive blood cultures was 0.6% in the center but when controlled for setting it rose to 3% in ICU admissions. There were no positive blood cultures in non-ICU patients or the NO group. Three YOs had blood cultures positive for MRSA and had 80-90% of doses administered. Days to positive culture from admission were 6, 7 and 15.

Conclusions
Our review demonstrated that mupirocin was frequently discontinued before a full course was administered, yet the overall incidence of MRSA bacteremia was low, with all cases occurring in the pediatric ICU setting. These findings indicate that our current protocol does not perform well in this population and needs refinement. Universal decolonization in non-ICU pediatric patients is likely unnecessary.

Applicability of Research to Practice
An evidence-based protocol for children would improve antimicrobial stewardship in a vulnerable population and decrease psychological distress.
743 Educate Before You Operate: Improving the Informed Consent Process
Authors: Piatkowski Brian , Lee Jeanne , Strait Eli 
Published: May 2023

Abstract

Introduction
The informed consent process is a daily task for providers with a surgical patient population. In the burn population, informed consent is often presented by an intern or resident physician. Consent is comprised of surgical debridement with a multitude of options for coverage of their wounds. The current state of practice is a verbal overview of all the possible procedures that may be done to the patient’s wound(s). Patients often verbalize feeling overwhelmed with the amount of information on the consent and often have questions related to their procedure just before the brief of the operative case.

Methods
An educational video was developed that detailed the surgical procedure and the potential burn wound coverings. A 3-question survey was given to patients who have already been through the informed consent process. Survey metrics examined knowledge of consent when signed, the satisfaction of verbal explanation, and if a video would increase understanding. The video was given to the same patients to watch. After the video was viewed, those patients were then again surveyed. Providers were also given a 3-question survey before viewing the video. Survey metrics examined comfort of consent, knowledge of procedures, and if the video would increase patient understanding of consent topics. The providers were then surveyed after watching the video.

Results
Initial post-implementation data shows that patients and providers have increased comfort and knowledge in the informed consent process. Patients show an 80% increase in understanding of consent, a 72% increase in satisfaction with video vs verbal overview, and a 97% increase in satisfaction with material viewed. Provider data shows a 65% increase in the comfort of consent, a 64% increase in knowledge of procedures, and a 97% increase that the video will help patients understand their consent. This shows that this evidence-based project is an improvement from the current standard of practice.

Conclusions
The informed consent process is an opportunity for providers and patients to have a moment of discussion. It is a pivotal point in which a patient and a provider determine the next step of their care. The patient must have clear communication and education regarding the procedures to which they are consenting. It is also a discussion where a provider can provide education and support at what is an overwhelming time for patients in their hospital stay.

Applicability of Research to Practice
Implementation of a standardized audio/video teaching method for burn surgical patients is an effective way to increase patient and provider satisfaction regarding the informed consent process. Implementing this educational tool is a cost-effective and simple way to educate burn patients before their surgical procedures. There is an overall improvement in patient satisfaction and increased satisfaction in the providers who obtain the consent.
745 Caring for Infants, Centenarians, and Everything in the Middle
Authors: Ha Aemilio , Rita Frek , Grywalski Michelle , Chin Teresa , Bakas Mira , Godes Natalya 
Published: May 2023

Abstract

Introduction
Age specific considerations are integral part of quality care. Several burn units care for all age groups in a single unit, needing additional resources and infrastructure to provide quality care for extremes of age.

Methods
An anonymous online survey was conducted among the multidisciplinary burn team members of a burn unit that cares for both pediatric and adults. Data for the last 4years found that 12-18% of all burn admissions were 2years or less, while 5-6% of burn admission were of over 75 years of age.

Results
45 members responded to the survey, including 56 % RNs and the remaining included therapists, pharmacist, psychologist, social worker, child life specialist, and case manager. The results showed that team members felt more comfortable caring for geriatric patients than pediatrics. Staff members reported higher importance for having intubated pediatric patient with leverage of 1:1RN assignment as well as daily rounding by pediatric intensivist and pediatric pharmacist. Majority (73%) of respondent s reported good or excellent in their assessment, skill, knowledge, and communication ability for caring pediatric patients aged and 2 and below. Elements that reported to be helpful for caring extremes of age in the order of its importance were weekly multidisciplinary rounds, burn debriefs of selected cases, monthly performance improvement meetings/ follow ups, weekly psycho social rounds and journal clubs. Low volume high acuity patient's care was kept up to date through various interventions which were prioritized by the respondents in the order of age specific continuing education classes, professional conferences, simulation/ skills day, and journal clubs.

Conclusions
The current process shows satisfactory comfort level for most of the team members to care for all age groups. Availability of pediatric and geriatric specialty professionals along with sufficient supply of age specific equipment, and ample educational opportunities were noted by the respondents as the key to providing quality care for all age groups in a single setting.

Applicability of Research to Practice
The current model may be continued with sustainment of different specialty services, educational resources, and age- specific supplies and equipment.
746 Burn Provider Perceptions Before and After Implementation of a Pain and Sedation Clinical Practice Guideline
Authors: Dryer Vince , Smith Kathryn , Paine Rosemary , Kearney Raechell , Falank Carolyne , Carter Damien , Billert Alexandra , Murray Lisa 
Published: May 2023

Abstract

Introduction
Pain and sedation management is a crucial yet challenging aspect of burn care. We sought to survey a multidisciplinary group of nurses (RN), physicians (MD), advanced practice providers (APP), and therapists (PT/OT) to determine perceptions of pharmacologic pain and sedation management before and after the implementation of a standardized clinical practice guideline (CPG) at our institution.

Methods
A 28-question survey assessing knowledge, pain and sedation practices, and therapy participation was distributed to all intensive care unit (ICU) and non-ICU burn care providers at our institution before (n=135, 2019) and after (n=185, 2022) CPG implementation. Comparison of proportions was calculated using Chi-squared test.

Results
Survey response was 61 (45%) before and 51 (28%) after CPG, with 18 participating in both. Most respondents (63%) had 0-5 years of experience caring for burn patients. Patients were perceived to have significant background pain &gt;50% of the time by 69% of RN before vs 55% after (p=0.26). Intermittent opioid boluses were preferred to continuous infusions in intubated patients before (57%) and after (59%) CPG implementation (p=0.87). Perceived utilization of multimodal pain management was high (82%) amongst all responders, except for ICU RN (53%) (p=0.05). While &lt; 30% of all providers believed analgesics were underutilized for procedural pain, non-ICU RN consistently reported patients were in significant pain 50-75% of the time during procedures (78% before vs 85% after, p=0.61). Perceptions of sedative underutilization were unchanged before and after CPG (ICU RN 58% vs 33%, p=0.15; non-ICU RN 69% vs 71%, p=0.91; MD/APP 69% vs 71%, p=0.95). PT/OT reported pain as the most common reason for nonparticipation in therapy sessions with one-third reporting underutilization of analgesics in both surveys. In the after survey, 50% agree we manage pain effectively. Areas for improvement included open communication between disciplines regarding pain and sedation plan, increased use of intermittent sedatives compared to continuous, and less IV opioid utilization with more focus on nonopioid therapy. Fifty percent of after survey respondents were aware of the CPG.

Conclusions
Implementation of a CPG did not change perceptions of pain and sedation at our institution. This may be due to limited education surrounding CPG and overall lack of utilization. Future efforts should focus on education and communication between disciplines.

Applicability of Research to Practice
Variability in provider perceptions of pain and sedation management in patients with burn injury remain despite implementation of a CPG.