bluuebunny/crossref_metadata_2025_split huggingface dataset:
506 Review of Empiric Voriconazole Dosing in Large TBSA Burn Patients – A Case Series
Authors: Lautenslager Lauren , Boyd Allison , Hartman Brett , Spera Leigh 
Published: May 2023

Abstract

Introduction
Burn patients are significantly immunocompromised and susceptible to opportunistic fungal infections. Treatment includes aggressive surgical debridement with topical and systemic anti-fungal agents. Voriconazole (VCZ) is a systemic anti-fungal and an approved first line treatment of invasive Aspergillus and Fusarium species. Standard dosing is a 6 mg/kg loading dose twice followed by 200 mg enterally twice daily. Therapeutic drug monitoring is recommended to confirm a goal trough concentration of &gt;1 mcg/mL, once steady state is reached, approximately 4-7 days after initiation. At our institution, VCZ levels are a send out lab, averaging 4-7 days for results. We reviewed a series of three patients with invasive fungal infections and their VCZ treatment dosing to assess impact of altered pharmacokinetics and time delays with drug monitoring.

Methods
Three patients with significant burn injury (TBSA &gt;40%) and invasive fungal wound infections were reviewed. Two were treated with standard dosing of VCZ (200 mg BID). The %TBSA, weight, albumin at time of VCZ initiation, initial VCZ dosing, initial trough concentration, time from initiation to trough result and final VCZ dose was reviewed. Consideration of the subtherapeutic drug level of prior patients led to initiation of VCZ treatment at an increased initial empiric dose (300 mg BID) for a third patient, followed by assessment and review of the same variables.

Results
For the two patients treated with standard VCZ dosing, initial trough concentrations were subtherapeutic (0.4 mcg/mL and 0.9mcg/mL) and took 13 and 10 days from initiation to trough result, respectively. The albumin concentrations for these patients were 2.1 and 1.6 g/dL. Initial trough concentration for the third patient started on increased empiric dosing was therapeutic (4.9 mcg/mL), despite an albumin of &lt; 1 g/dL. (Table 1).

Conclusions
Fungal infections significantly increase the morbidity and mortality of burn patients. The time lapse from initial dose to steady state plus turnaround time of send out labs may result in 1-2 weeks of subtherapeutic treatment. Results from our case series demonstrate that standard VCZ dosing could be inadequate for large TBSA burn patients ( &gt;40%) and higher empiric doses should be considered.

Applicability of Research to Practice
Consider use of increased initial VCZ dosing for large burn patients to reach therapeutic serum levels more expeditiously.
528 Knowledge and Attitude of Health Care Staff in First Aid For Minor Burns
Authors: Doygaci Ayse Gul Atay , Abali Ayse Ebru , Unlu Elif , Santelis Santiago , Haberal Mehmet 
Published: May 2023

Abstract

Introduction
Health care professionals are supposed to be well-versed for correct and timely first aid interventions in burns. This research was conducted to evaluate their level of knowledge and attitude for first aid in minor burns.

Methods
Subjects were 402 volunteer health care staff in our university hospital. Study group involved nurses (n=163), medical technicians (n=94), technicians+patient-care support personnels (n=145). Data were collected by face-to-face interview technique using our "Introductory Characteristics of the Participants" and the "Evaluation Form of the First Aid Knowledge Levels of the Health Professionals Regarding Minor Burns" forms (p&lt; 0.005).

Results
Mean age was 29.7 yrs (minimum:20, maximum:54). Female to male ratio was 1:0,7. Of all subjects, nurses were 40.5%, 29.4% were medical technicians, 30.1% were technicians+patient-care staff. The rate of participants who stated that they have received first aid training on burns was 41.5%; but only 38.3% of the subjects stated that they could confidently provide first aid. Participants who correctly answered the form of "First Aid Knowledge Levels of Health Professionals Evaluation Form for Minor Burns" involved 76.9% of all subjects. Washing with water was preferred by 85.6% of the participants, 13.2% used additional methods following water (topical agents, remedies, ice, yogurt, egg white, cucumber, etc.), only 1.2% preferred methods other than water. High education level, receiving first aid training, and seniority in the profession and in the institution were the effective factors in providing the right first aid method (p&lt; 0.005). Female (58.5%), single (59.8%) and child-free (61.7%) subject, and the subjects who have attended first aid education programs more recently were prone to provide correct first aid than the others (p&lt; 0.005). However, knowledge about the factors affecting the severity of the burn injury was significantly high only among the subjects who received first aid training (p&lt; 0.005).

Conclusions
Many participants had basic knowledges on first aid for minor burns. However most did not have a comprehensive expertise and felt unconfident about providing first aid. Our results revealed that health care staff need education peculiar to them in addition to the basic awareness programs for burn injuries.

Applicability of Research to Practice
First aid is the initial step of an appropriate burn care. Health care staff are supposed to be well-versed for correct and timely first aid interventions. Present definitive study provides basic information about knowledge level and attitudes of health care staff and it demonstrates useful data for specifying the future educational strategies.
530 Utilization of Advanced Practice Provider for Quality Virtual Burn Care
Authors: Ayers Brittany , Bader Bryan 
Published: May 2023

Abstract

Introduction
From the plains of North Dakota to the lakes of Minnesota and beyond, for our patient population, telemedicine has grown to be an important burn care delivery method. Specialized burn care is essential to ensure successful patient outcomes from burn injury. Our institution utilizes an advanced practice provider (APP) either physician assistant or nurse practitioner to lead the telemedicine care instead of the burn surgeon. Given most of the burn care is non-operative management, an APP can deliver burn expertise and high-quality care to the burn patient.

Methods
A retrospective chart review performed via data extraction from the electronic medical record at a single ABA-verified Burn Center. Dates of review ranged from January 1, 2022, through June 30, 2022. Patient population was Regions Hospital Outpatient Burn Clinic and Telemedicine Clinic volumes. Data review included patient location, mode of visit (in-person or virtual), and time to &gt;95% healed. Inclusion was acute burns of all ages and mechanisms of injury. Exclusion was non-burn wounds, scar management and frostbite patients.

Results
A total of 1300 (87%) of all outpatient visits performed by APPs with 328 (25%) of these visits conducted via telemedicine. Varying by month, 7-13% of patients were treated exclusively via telemedicine not requiring any in-person burn care. When comparing the patient distance from the burn center (1-50 miles and &gt;50 miles) and time to &gt;95% healed, there was no correlation. Patients who were treated exclusively via telemedicine, lived an average of 205 (5-580) miles from the burn center, had an average TBSA of 2.2 (0.25-55) % and had an average of 18.3 (7-62) days until 95% healed. Compared to patients treated in-person only or combination of in-person and telemedicine, lived an average of 91 (1-631) miles, had an average TBSA of 2.5 (0.25-67) % and had an average of 24.6 (5-80) days until 95% healed.

Conclusions
A burn telemedicine program led by APPs can facilitate remote expert burn care, all while maintaining standard of care. Limitations were a narrow review window, single center retrospective analysis, and the exact date for time to 95% healed is difficult to determine due to interval follow up windows. Our goal is to further review and analyze our telemedicine and clinic data to optimize burn care delivery with the utilization of APPs, investigate quality of care indicators within telemedicine and reduce transfers and travel for specialized burn care.

Applicability of Research to Practice
APP led telemedicine improves surgeon availability to do hands on treatment in the Burn Center and allows for outreach and specialized expertise to be delivered across remote distances. It allows for the ability to triage patients and optimize burn clinic resources. Telemedicine can be performed in any location and reduce travel. Telemedicine is reimbursable. Barriers include wound care supply access, technological limitations, state licensing and institutional credentialing.
531 Utilization of a Nurse Care Coordinator to Streamline the Outpatient Experience
Authors: Neal Joya , Hockenberry Tiffany , Richey Karen , Foster Kevin 
Published: May 2023

Abstract

Introduction
Often being discharged from the hospital can be a frightening experience for burn patients who have complex and multifaceted outpatient needs. Our center found that while clinical staff were able to manage the immediate needs of the patient, they were unable to provide the level of support needed for patients to reach their full rehabilitation potential. In response to these findings, burn leadership developed the outpatient Nurse Care Coordinator (NCC) role, to ease the transition to the outpatient setting and enhance support. The purpose of this project was to evaluate the utilization and efficacy of the new NCC role.

Methods
This was a retrospective 1.5-year review of activities performed by the NCC directly relating to patient services. Five domains were chosen for monthly tracking, individual number of patients assisted, external referrals, workman’s compensation patients, compression garment orders and PTSD screenings. Basic descriptive statistics were calculated.

Results
This position has been in place for 2 years. The mean number of patients followed by the NCC was 592/month (204-723), average external referrals 43/month (11-84), average workman’s compensation patients 43.4/month (30-59), total compression garments ordered 54.8/month (21-106) and average number of PTSD screening 47.4/month (1-129). External referrals encompassed home health services, outpatient therapies, and multiple providers resulting in 1-15 interactions/patient to establish ordered services. Workman’s compensation patients required coordination with insurance, care managers, employers and adjusters including required documentation. Compression garments were tracked for progress on fulfilment, arranging assistance for financial coverage, required documentation, and coordinating measurements and delivery with patients amongst multiple providers. For patients screening positive for PTSD, the NCC provided resources and multiple options for PTSD/trauma counselors for the patient’s mental wellbeing.

Conclusions
The dedicated outpatient Nurse Care Coordinator is uniquely positioned to facilitate and optimize the care of patients in the outpatient arena. While data is not available for direct comparison prior to institution of this role, anecdotally, vendors, patients, clinic staff and providers report improved continuity and compliance with recommendations. We continue to refine and enhance the responsibilities of the NCC to better serve our patient population.

Applicability of Research to Practice
The Nurse Care Coordinator is essential in helping the survivor with complex needs, successfully navigate the complex and multidimensional outpatient setting.
537 Epidemiology of Elderly Burn Injuries – A Five Decade Single Center Retrospective Review
Authors: Emanuelli Elisa , Li Angela , Korentager Richard , Bhavsar Dhaval 
Published: May 2023

Abstract

Introduction
Age has long been known to be an independent risk factor for worse outcomes in burn patients. In comparison to younger patients, geriatric patients have higher morbidity and mortality. As the median age of the US population has increased, we have seen a greater proportion of elderly burn patients at our burn unit over the last five decades.

Methods
Retrospective chart review was performed for all burn patients admitted to our burn unit between 2000 and 2019. Demographics and outcomes data was collected for geriatric patients (age 65 and older). This was compared to historic data available for our burn unit between 1972 to 2000.

Results
Between 2000 to 2019, our burn unit admitted a total of 5881 burn patients of all ages. There were 652 (11%) geriatric patients admitted. The proportion of geriatric patients admitted statistically significantly increased over that period. Meanwhile, length of stay and mortality statistically significantly decreased in the 2000-2019 time period compared to the previous period. The main mechanism of burn injury was flame exposure. Compared to data on geriatric burn patients from 1972 to 2000, mortality has decreased substantially. In the 1970s mortality was 77% compared to 21% in the past decade. The mortality rate increased significantly with age, TBSA and inhalation injury over both time periods.

Conclusions
Though lagging behind younger age groups, overall survival and outcomes are improving in elderly burn patient due to advances in critical care and surgical burn management. Acknowledging the unique characteristics of this group of patients, such as impaired healing and multiple comorbidities, allows for improved outcomes.

Applicability of Research to Practice
Burn centers should notice and prepare for an increasing trend in elderly burn patient admission.
538 Demographic and Injury Differences Between Children with Burn Injury from the United States and Mexico
Authors: Miles Victoria , Suman-Vejas oscar , Ryan Colleen , Stewart Barclay , Carrougher Gretchen , Orton Caitlin , Kowalske Karen , Thakur Bhaskar , Solis Kyra Jeanine , Dalal Sujata 
Published: May 2023

Abstract

Introduction
A large burn data set is being used to evaluate outcomes of pediatric burn survivors, but questions remain whether this data set is generalizable to the typical population of US burn centers as only 62% of enrollees are from the US. A better understanding of similarities and differences within this data set will help in the applicability of findings from it.

Methods
This is a retrospective cohort study using data from children enrolled in a burn database. Data from 2043 children admitted for burn injury from 1994 to 2020 were analyzed. Data were stratified into children who were US residents and Mexico residents at the time of injury, all treated in US hospitals, and grouped by age into “&lt; 5 years”, “5-10 years” and “ &gt;10 years”. Sex, race, ethnicity, injury etiology, total body surface area injured (TBSA), and circumstances of injury were compared. Fisher’s exact test and Kruskal–Wallis one-way analysis of variance were used to test for differences in categorical and continuous variables, respectively.

Results
Both US and Mexico populations showed increased incidence among males as they aged. In the US population, as expected the most frequent cause of burns in patients &lt; 5 years was scald. In the Mexico population, fire/flame burns were more frequent in all ages and electric burns were more common among children &gt; 5 years. In both populations, indoor injuries were more common among children &lt; 5 years and outdoor injuries were more common as children aged. Children from Mexico had larger burns and longer lengths of hospital stay than US children across all ages.

Conclusions
Children from Mexico who were referred to the US for burn care were similar in demographic patterns to US children. While differences were seen in extent and mechanism, the difference is likely influenced by larger, more severe burns being transferred to the US for care, while low severity burns were treated locally. This suggests that children from Mexico in the database are not representative of the pediatric burn injury population of the US or Mexico more broadly. When studying datasets from US hospitals containing non-US residents, it is recommended that these populations be separately analyzed, otherwise, findings cannot be generalized to the US pediatric burn injury population.

Applicability of Research to Practice
In addition to identifying prevention needs, differences among US and Mexico resident children cared for in the US limit the utility of analyzing this population in the burn dataset.
545 Contrast and Similarities Between Self-Immolation and Self-Injury Burn Patients
Authors: Honea Ashley , Zhang Nathan , Islas Claudia , Richey Karen , Foster Kevin 
Published: May 2023

Abstract

Introduction
Self-immolation is an uncommon method of attempted suicide involving flammable substances. By contrast self-inflicted burn injuries utilize a chemical or heated object to cause injury, without suicidal intent. Both groups require psychological care post-hospitalization, but the successful rehabilitation of these populations may be compromised by availability of mental health services, patient resources and patient specific factors. The purpose of this study was to compare and contrast the two groups and evaluate post-discharge success.

Methods
This was a retrospective chart review of patients admitted over a 7-year period with either self-immolation (SIM) or self-inflicted (SIF) burn injury. Prospectively, patients were called to evaluate current status using the SF12 questionnaire. Basic descriptive statistics were calculated.

Results
A total of 90 patients met inclusion/exclusion criteria, 55 SIM and 35 SIF. Both groups were predominantly white males, and the average age was SIM=36.4 vs SIF=37.9 years (p=0.668). Flame was the most common mechanism of injury for both groups, 93% of SIM used an accelerant vs 26% of SIF (p&lt; .00001). While overall, home was the most common location for the event to occur for both groups, n=19 SIM and n=17 SIF, 17 of SIM occurred in a public place vs 4 of SIF (p=.033). Both groups SIM vs SIF, while not significantly different, had high rates of substance use 75% vs 63%, serious mental illness 42% vs 46%, Title 19 support 29% vs 26% and prior suicide attempts 62% vs 51%. There were no significant differences between groups for psychiatric history or number of individual psychiatric diagnosis/patient (µ 1.53 vs 1.54). Significant differences were found between the SIM and SIF groups for TBSA 46.1% vs 10% (p&lt; .00001), prior involvement of a psychiatric case manager 12 vs 0 (p=.003) and mortality 22 vs. 0 deaths (p&lt; .00001). Contact was successful for 5 SIM with 3 agreeing to take survey, for the SIF group 1 was able to be reached and declined the survey. The average score for SF12 physical domain was 43.06 and 44.14 for the mental domain, both below the national average of 50 points.

Conclusions
The results of this study demonstrate the premorbid psychiatric conditions in this patient population. The major differences between groups were the degree of injury and mortality. Our inability to contact patients may be indicative of ongoing social instability. There remains a significant knowledge gap, indicating the need for prospective research to identify the most successful combination of therapies to both prevent and treat these injuries.

Applicability of Research to Practice
This study highlights the need for a risk assessment tool to identify high risk groups and an integrated approach in the outpatient burn arena with dedicated behavioral health clinicians.
552 Predictions Under Pressure: The Value of Intra-abdominal Hypertension in Forecasting Associated Complications During Fluid Resuscitation
Authors: Richerbach Stacey , Richey Karen , Foster Kevin 
Published: May 2023

Abstract

Introduction
The link between burn fluid resuscitation and intra-abdominal hypertension (IAH) is long-standing. Clinicians refer to measures of intra-abdominal pressure (IAP) to guide care of patients requiring resuscitation. In the non-burned critically ill patients mean IAP is 5-7 mmHg, yet more than half of patients with large burns have IAH with a pressure &gt; 12mmHg. The purpose of this study was to determine the predictive value of IAH during resuscitation and to elucidate the prevalence of associated complications.

Methods
This was a retrospective chart review of patients requiring fluid resuscitation over a five-year period. Patient stratification was based upon IAP, &lt; 12 mmHg (NIAH) vs &gt; 12 mmHg (IAH). Basic descriptive statistics were calculated.

Results
Charts were reviewed for 138 patients with a total body surface area (TBSA) &gt;20%. There were no significant differences for age, ethnicity, race, gender, nor mechanism of injury. Mean TBSA was greater for those with IAH 44.7% vs NIAH 29.6% (p &lt; 0.0001). Diagnosis of inhalation injury was greater with IAH 37% vs NIAH 10% (p = 0.0009). Admission weight was greater in IAH 90.59 kg vs NIAH 80.34 kg (p=0.0169). Patients who arrive at our burn center sooner (IAH 105, NIAH 160 minutes; p = 0.033), were less likely to receive pre-hospital fluids (IAH 68%, NIAH 84%; p = 0.03850), and time from injury to the start of in-hospital resuscitation was lower (IAH 177 min, NIAH 245 min p = 0.02840). The average resuscitation duration was greater for IAH than for NIAH (34.4 h vs 28.04 h; p = 0.0008), as was total volume given (p &lt; 0.0001), but resuscitation volume per kg/TBSA/hour was not statistically different (IAH 6.72 mL, NIAH 6.15 mL; p = 0.321). Mean urine output per hour between the groups was not significant (p 0.7699). Patients with IAH had more hours in the optimal range for urine output (6.6 h) than NIAH (4.95), (p = 0.041). No significant difference was revealed between the groups for eventual diagnosis of abdominal compartment syndrome (p = 0.06); compartment syndrome (p = 0.8346, ARDS (p = 0.242); laparotomy (p = 0.222), open abdomen (p = 0.060). Administration of vasopressors between the groups was insignificant (IAH 15%, NIAH 7%; p = 0.186), as was the use of CRRT (p = 0.787). Temperatures for hypothermic patients with IAH were significantly lower (34.5 c) than NIAH (35.1 c), (p = 0.0186) and patients with IAH were more likely to have an escharotomy than those in the NIAH group (IAH 43%, NIAH 16%; p = 0.0014).

Conclusions
Most associated complications of fluid resuscitation were not more likely to occur with IAH as compared to NIAH. However, patients with IAH were more likely to warrant an escharotomy involving an extremity and had a lower temperature when hypothermic than the NIAH group.

Applicability of Research to Practice
Further research is needed to evaluate the relationship between measures of IAP and associated complications.
Intel Inside: The Linguistic Properties of Effective Slogans
Authors: Hodges Brady T , Estes Zachary , Warren Caleb 
Published: May 2023

Abstract
How can marketers create slogans that consumers like and remember? We answer this question by analyzing how the lexical, semantic, and emotional properties of a slogan’s individual words combine to influence slogan liking and slogan memory. Through a large correlational study with over 800 brand slogans, laboratory experiments, a biometric eye-tracking experiment, and a field study, we unearth the word properties that make slogans effective. We predict and find that linguistic properties that make a slogan easier to process (i.e., more fluent) result in slogans that are more likable but less memorable, whereas linguistic properties that reduce processing fluency result in slogans that are less likable but more memorable. Across our multi-method investigation, participants indicated a more favorable attitude toward slogans that are shorter, omit the brand name, and use words that are linguistically frequent, perceptually distinct, and abstract. In contrast, participants were more likely to remember slogans that are longer, include the brand name, and use words that are linguistically infrequent, concrete, and less perceptually distinct. We conclude by offering marketers practical advice into optimal word-choice strategies and delivering actionable guidance for creating slogans that are either likable or memorable.