bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prioritizing nutrition interventions for low-income clients receiving public health nurses’ home visiting services: a latent class analysis study of Omaha System data
Authors: Lee Jiwoo , Austin Robin R , Mathiason Michelle A , Monsen Karen A 
Published: May 2023

Abstract

Objective
This study aimed to identify phenotypes of nutritional needs of home-visited clients with low income, and compare overall changes in knowledge, behavior, and status of nutritional needs before and after home visits by identified phenotypes.

Materials and methods
Omaha System data collected by public health nurses from 2013 to 2018 were used in this secondary data analysis study. A total of 900 low-income clients were included in the analysis. Latent class analysis (LCA) was used to identify phenotypes of nutrition symptoms or signs. Score changes in knowledge, behavior, and status were compared by phenotype.

Results
The five subgroups included Unbalanced Diet, Overweight, Underweight, Hyperglycemia with Adherence, and Hyperglycemia without Adherence. Only the Unbalanced Diet and Underweight groups showed an increase in knowledge. No other changes in behavior and status were observed in any of the phenotypes.

Discussion and conclusions
This LCA using standardized Omaha System Public Health Nursing data allowed us to identify phenotypes of nutritional needs among home-visited clients with low income and prioritize nutrition areas that public health nurses may focus on as part of public health nursing interventions. The sub-optimal changes in knowledge, behavior, and status suggest a need to re-examine the intervention details by phenotype and develop strategies to tailor public health nursing interventions to effectively meet the diverse nutritional needs of home-visited clients.
Bottom-up and top-down paradigms of artificial intelligence research approaches to healthcare data science using growing real-world big data
Authors: Wang Michelle , Sushil Madhumita , Miao Brenda Y , Butte Atul J 
Published: May 2023

Abstract

Objectives
As the real-world electronic health record (EHR) data continue to grow exponentially, novel methodologies involving artificial intelligence (AI) are becoming increasingly applied to enable efficient data-driven learning and, ultimately, to advance healthcare. Our objective is to provide readers with an understanding of evolving computational methods and help in deciding on methods to pursue.

Target Audience
The sheer diversity of existing methods presents a challenge for health scientists who are beginning to apply computational methods to their research. Therefore, this tutorial is aimed at scientists working with EHR data who are early entrants into the field of applying AI methodologies.

Scope
This manuscript describes the diverse and growing AI research approaches in healthcare data science and categorizes them into 2 distinct paradigms, the bottom-up and top-down paradigms to provide health scientists venturing into artificial intelligent research with an understanding of the evolving computational methods and help in deciding on methods to pursue through the lens of real-world healthcare data.
T3 Sexual Satisfaction and Association with Psychosocial Outcomes Among Burn Survivors
Authors: Cato Liam D , Shepler Lauren J , McMullen Kara , Roaten Kimberly , Kazis Lewis E , Ryan Colleen M , Schneider Jeffrey C 
Published: May 2023

Abstract

Introduction
Sexual satisfaction is often unaddressed in clinical care despite it being an important aspect of healing and quality of life for burn survivors. Previous literature has focused predominantly on physical function rather than perceived satisfaction. This study aimed to determine the associations of sexual satisfaction with psychosocial outcomes and assess sexual satisfaction recovery over time after burn injury.

Methods
Patients consenting to provide data to the Burn Model System (BMS) National Database injured after 2015, aged greater than 18 years at the time of burn injury, and alive at discharge were included in the analysis. Sexual satisfaction was collected at six months and then every year for five years post-injury using two PROMIS sexual satisfaction items, a composite T-score was derived, where a higher score indicated higher sexual satisfaction. Analyses included sexual satisfaction scores as outcomes with mixed models that included repeated measures controlling for correlated error of the outcomes and covariates that included demographics. Psychosocial measures analyzed included: PROMIS-29 Anxiety, Depression, Fatigue and Sleep scores; VR-12 mental component score (MCS) and physical component score (PCS); and the Post-Traumatic Growth Inventory (PTGI) total score.

Results
The analysis identified 561 individuals with sexual satisfaction data for at least one time point. The population demographics included a median age of 46 years (IQR 34, 59), reported sex (female = 171 (30.5%)), and median TBSA burned 10% (IQR 3, 26). Increasing age (p &lt; 0.0001) and marital status with those ‘Divorced’ (p=0.004) or ‘Single’ (p=0.0003) were associated with lower sexual satisfaction. There was no association with TBSA burn size. Within psychosocial metrics, we found that the CIQ Social Integration score (p &lt; 0.0001), VR-12 MCS (p=0.008), PTGI Total Score (p=0.01), and PROMIS 29 Sleep Disturbance score (p=0.0004) were also significantly associated. Change in scores were associated with the VR-12 MSC (p=0.03), where an increased MCS score predicted improved sexual satisfaction by final follow-up.

Conclusions
A significant association was found between sexual satisfaction and social integration, mental health, and post-traumatic growth.

Applicability of Research to Practice
These findings suggest that interventions to improve the sexual satisfaction of burn survivors should focus on the importance of social integration, mental health, and sleep quality.
T4 Integration of PT/OT in Burn Wound Care Increases Therapist Productivity
Authors: Schwartzman Amy , Balstad Blaire , Wiktor Arek J , Mueller Scott W 
Published: May 2023

Abstract

Introduction
Inpatient physical (PT) and occupational (OT) burn therapists must balance complex patient factors such as daily wound care when attempting skilled therapy sessions, while also attaining specific productivity standards. These factors often lead to inefficient work flow and loss of productivity. The purpose of this study was to assess the productivity and feasibility of therapist integration into daily burn wound care.

Methods
A quality improvement project was initiated by the burn therapy team at our ABA verified burn center. One full time equivalent (FTE) PT or OT was assigned to the burn wound care team five days a week, involving 6 therapists (3 PTs and 3 OTs). General duties included wound assessment, functional wound dressings, and skilled therapeutic interventions. The primary outcome measure was individual therapist productivity tracked 3 months pre and 3 months post project implementation. Productivity was calculated by taking total billable patient time divided by total workday time, with a goal of 50% productivity. Billed time units were also compared to goal units. The results were analyzed using a paired t-test to measure significance and averaged. The secondary outcome measure was program feasibility, assessed by a qualitative questionnaire taken by burn staff pre and post.

Results
Overall therapist productivity increased, 49% pre implementation vs 54% post (p=0.0041). The difference of billed vs goal units increased, 5 pre vs 15.9 post (p= 0.00142). Proportion of therapists meeting target productivity increased, 57.1% pre vs 90.5% post (p=0.0052). Prior to program implementation, survey results found that 77% of burn staff (n=23 respondents) were favorable of project implementation, whereas 23% were either hesitant or indifferent. After 3 months post implementation, 95% of burn staff were favorable of therapist participation, 95% indicated ease of staffing burden, and 100% reported improved multidisciplinary communication. Furthermore, 100% of burn staff felt that the unit’s workflow had improved.

Conclusions
Full time therapy participation in wound care increases therapist productivity and increases the likelihood of meeting target productivity in the future. The majority of burn staff actively supported this pilot program and felt that it eased staffing demands, improved unit workflow, and improved multidisciplinary communication. Future efforts should focus on measuring specific patient outcomes and cost as a result of therapist participation in daily wound care practice.

Applicability of Research to Practice
All burn units should consider implementing a skilled burn therapist in wound care practice.
40 Home-Based Virtual Rehabilitation Does Not Improve Daily Walking in the First Twelve Weeks After Discharge
Authors: Sibbett Stephen , Orton Caitlin , Carrougher Gretchen , Stewart Barclay , Bunnell Aaron , Gibran Nicole , Pham Tam 
Published: May 2023

Abstract

Introduction
Restoring cardiovascular fitness can be challenging during the first months after hospital discharge for adult burn patients. Furthermore, adherence to prescribed home therapy among people with burn injury has traditionally been low. We conducted a 5-year randomized controlled trial of 12-weeks of gamified virtual home therapy compared to prescribed home exercise (usual care). We hypothesized that those assigned to the virtual therapy would log more total daily walking during the intervention period.

Methods
All English-speaking adult patients hospitalized with burn injury were screened for participation. Eligibility criteria required discharge to home, personal smartphone, and access to a television with HDMI connectivity. Participants randomized to the virtual therapy group received access to a customized exercise software program with motion sensing hardware to use for twelve weeks in addition to usual home therapy instructions. All participants were instructed to continuously wear a provided actigraphy device during the 12-week period. Wilcoxon rank sum tests were used to compare median miles walked per day between groups. Adherence to the actigraphy device was defined a priori as having wear-data for 5 days in a calendar week.

Results
Actigraphy data from 44 participants (22 control, 22 experimental) were compared. Median miles walked per day increased from 1.5 miles/day (IQR 1.0-2.7) in Week 1 to 2.85 miles/day (IQR 1.8-4.5) in Week 12. Wilcoxon rank sum testing revealed no significant difference in median miles/day between groups during any week (Figure 1). Adherence to wearing the actigraphy device was equal or higher in control participants for all weeks.

Conclusions
Home-based virtual rehabilitation did not increase total daily walking during the first twelve weeks after discharge. At Week 12, daily walking is nearly twice that of Week 1 in both groups.

Applicability of Research to Practice
Post-discharge actigraphy data from people with burn injury can inform both patients and providers about activity after hospital discharge.
57 Effect of High-Dose Ascorbic Acid in Major Burn Patients: A Systematic Review and Meta-Analysis
Authors: Pleehachinda Punthiti , Muangman Pornprom , Chinaroonchai Kusuma 
Published: May 2023

Abstract

Introduction
High-dose ascorbic acid (HDAA) plays an important role in oxygen radical elimination which is a major cause of pathophysiological derangement in burn patients. However, there was limited explicit data on the clinical effect of HDAA in major burn patients. The purpose of this study was to identify the benefit and risks of HDAA in major burn patients.

Methods
MEDLINE, EMBASE, and Cochrane database searches were conducted. An additional search of relevant primary literature and review articles was performed. All the studies related to HDAA and burn were included in the analysis. HDAA group was defined by receiving ascorbic acid 66 mg/kg/day in the first 24 hours. The primary outcome was the 24-hour fluid requirement. The secondary outcomes were in-hospital mortality, 24-hour urine output, ventilator day, hospital length of stay, and in-hospital complications. Pooled incidences and 95% confidence interval (CI) were calculated and summarized using a random effect model on Stata/MP 16.1.

Results
Of 875 studies, 7 articles (293 patients) were included in this meta-analysis. HDAA significantly reduced 24-hour fluid requirement compared with usual care (no HDAA) (SMD -0.75 ml/kg per TBSA, 95% CI [-1.38 to -0.12]). HDAA group showed a decrease in 24-hour urine output (SMD, 0.65; 95% CI, 0.41 to 0.89). However, it did not demonstrate significant increase in acute kidney injury (RR 1.37, 95% CI [0.60 to 3.13]) and the need for renal replacement therapy (RR 1.31, 95% CI [0.50 to 3.44]). In terms of in-hospital complications, there was no significant difference in abdominal compartment syndrome (RR 0.22, 95% CI [0.08 to 0.89]) and pneumonia or acute respiratory distress syndrome (RR 1.03, 95% CI [0.70 to 1.51]). Though there was a trend to decrease mortality in the HDAA group, there was no statistical difference in mortality (RR 1.27, 95% CI [0.85 to 1.91]). HDAA group had a comparable hospital length of stay (SMD 0.1, 95% CI [-0.44 to 0.63]) and ventilator day (SMD 0.03, 95% CI [-0.64 to 0.70]).

Conclusions
High-dose ascorbic acid had a clinical benefit in the significant reduction of 24-hour fluid requirement without increasing the risk for acute kidney injury or the need for renal replacement therapy. Though it did not demonstrate a significant improvement in mortality or length of stay, there were no significant reported complications from high-dose ascorbic acid. A multicenter randomized controlled trial is warranted.

Applicability of Research to Practice
The potential benefit of HDAA in major burn
60 A Retrospective Review of High-Frequency Percussive Ventilation in Inhalation Injury
Authors: Miller Emily , Zhang Xu , Huzar Todd , Harvin John 
Published: May 2023

Abstract

Introduction
Inhalation injury (II) is a major contributor to mortality in burn patients. These patients often require mechanical ventilation, but there is no clear consensus on optimal ventilatory strategy for this population. Previous studies in patients with acute respiratory distress syndrome (ARDS) demonstrated that high frequency percussive ventilation (HFPV) improved oxygenation and mobilization of airway secretions. However, HFPV in the context of II remains poorly studied. We hypothesized that for these patients, use of HFPV in addition to conventional mechanical ventilation (CMV) would reduce complications and decrease mortality compared to patients treated with CMV only.

Methods
We conducted a retrospective chart review of 200 patients admitted to a burn center from February 2008 - January 2019 with burns and/or II and ventilated either with CMV alone or with CMV + HFPV. Patients who were under the age of 18 or who received mechanical ventilation for less one day were excluded. Information including patient demographics and comorbidities, percent total body surface area burned, ventilation method, length of stay, complications, and outcomes were collected. Two-sample comparisons were performed by using score test for proportions and Wilcoxon rank sum test for continuous variables with significance defined as p&lt; 0.05.

Results
Of 200 patients studied, 84 received CMV + HFPV and 116 received CMV alone. There was no difference in mortality between groups (CMV+HFPV 39.3% vs CMV 31.0%; p=0.23). There was also similar incidence of pneumonia (CMV+HFPV 53.6% vs CMV alone 63.8%; p=0.15), pneumothorax, ARDS, and sepsis. Patients on CMV + HFPV had a greater incidence of acute kidney injury (CMV+HFPV 60.7% versus CMV alone 43.1%; p=0.014) and reduced development of wound complications (CMV+HFPV 7.1% versus CMV alone 16.4%; p=0.05). In surviving patients (n=131), length of hospital stay was not significantly different between groups.

Conclusions
These single-center results do not support the use of CMV + HFPV rather than CMV alone in patients with II. Further research in this area, including larger multi-center studies, is warranted.

Applicability of Research to Practice
This is a hypothesis-generating study that adds to the currently limited understanding of best practice for managing patients with II.
64 Worse Itch and Fatigue in Racial and Ethnic Minorities: A Burn Model System Cross-sectional Study
Authors: Won Paul , Stoycos Sarah , Ding Li , McMullen Kara , Kowalske Karen , Stewart Barclay , Yenikomshian Haig 
Published: May 2023

Abstract

Introduction
Racial and ethnic minority patients may experience worse hypertrophic scar after burn injury than Non-Hispanic, White patients. Consequently, they may encounter differences in scar-related recovery domains including itch and fatigue. We examined disparities in post-burn injury itch and fatigue in minority patients to better inform counseling and treatment considerations.

Methods
From the multicenter National Institute of Disability, Independent Living and Rehabilitation Research Burn Model System Database (2015-2019), we analyzed outcomes at three time-points (discharge from index hospitalization, 6- and 12-months post-injury) using the 5-D Itch and PROMIS-29 Fatigue measures. Multi-level linear mixed effects regression modeling analyzed associations between race/ethnicities and outcomes over time.

Results
Of 893 total patients, 149 (17%) patients were Hispanic/Latino, 603 (68%) Non-Hispanic, White, and 86 (10%) Black. Minority patients reported higher/worse itch scores at all time points compared to Non-Hispanic, White patients. Itch scores were significantly higher for Black patients at 6 months (β=1.42, p=0.03) and 12 months (β=3.36, p&lt; 0.0001) when compared to Non-Hispanic, White patients. Black patients reported higher fatigue scores than Non-Hispanic, White patients at all time points. Fatigue scores were significantly higher for Hispanic/Latino patients at discharge (β=6.17, p&lt; 0.0001), 6 months (β=4.49, p=0.0003), and 12 months (β=6.27, p&lt; 0.0001) than Non-Hispanic, White patients.

Conclusions
This study supports investigation of potential factors leading to increased itch and fatigue such as genomic scar differences, relative treatment effects (e.g., medications, cognitive processing therapy), and psychosocial impacts of these symptoms.

Applicability of Research to Practice
In the short-term, minority patients may benefit from additional counseling and focused treatments addressing itch and fatigue after burn injury.
65 Differences in Pain Experience by Race, Ethnicity, and Socioeconomic Status Among People with Burn Injury
Authors: Pacleb Maiya , Stewart Barclay , Carrougher Gretchen , Kowalske Karen , Mandell Samuel , Schneider Jeffrey , Silver Julie , McMullen Kara , Orton Caitlin , Sibbett Stephen , Ashford Nathaniel 
Published: May 2023

Abstract

Introduction
Disparities in pain experience and treatment amongst people of different races and ethnicities have been described for several conditions. However, the relationship between race, ethnicity, socioeconomic status (SES) and pain reported by people with burn injury is not well understood. This study compares pain intensity and interference with daily activities among burn-injured adults of various sociodemographic backgrounds. We hypothesized that minority and low-income populations will report greater pain intensity and interference, necessitating additional strategies to address pain disparity.

Methods
Adult multicenter national database participants with complete PROMIS® pain intensity and pain interference measures at 6 and 12 months after injury were analyzed. Linear regression models examined associations between sex, race, ethnicity, education, income, burn size and pain interference and intensity scores. Regression model diagnostics were tested, and final models used robust standard errors to account for heteroskedasticity.

Results
Data from 656 participants were analyzed, with a mean age of 47.1 ± 16.2. Racial representation was 84.0% White, 8.8% African American/Black, 2.5% Asian/Native Hawaiian/Pacific Islander, 1.9% American India laskan Native, and 2.8% other/more than one race; 80.4% were non-Hispanic and 19.6% Hispanic. Weighted regression models revealed that pain intensity at 6 mo (Ⓡ=1.25, p=0.029) and interference at 12 mo (β=6.71, p=0.013) among Black participants were markedly higher than White participants. Hispanic participants reported lower pain intensity (β=-0.86, p=0.036) and interference (β=-4.06, p=0.007) compared to non-Hispanic participants at 6 mo. Average pain intensity at 6 mo varied significantly by income (p=0.01), with the highest pain intensity (mean 3.8, SD 3.0) reported by those making &lt; $25,000/year. Females reported greater pain intensity at 6 mo than males (β=0.63, p=0.029).

Conclusions
Greater pain intensity and interference were reported by Black participants compared to White participants, while Hispanic participants reported lower pain outcomes. Lower income was also associated with worse pain outcomes. Targeted study of pre-injury pain experiences, pain management, psychosocial health, and financial toxicity are required to identify opportunities for intervention on the many dimensions and causal factors of unsatisfactory pain experiences.

Applicability of Research to Practice
Systematic screening for pain intensity and interference after burn injury may find sociodemographic groups with high pain levels and a need for interdisciplinary pain and psychosocial health management. Comprehensive pain treatment following burn injury should account for social determinants of health and impact of bias to further improve quality care for all people.