bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variation in pediatric and adolescent electronic health data sharing practices under the 21st Century Cures Act
Authors: Sinha Shikha , Bedgood Michael , Puttagunta Raghuveer , Kataria Akaash , Bourgeois Fabienne , Lee Jennifer A , Vodzak Jennifer , Hall Eric , Levy Bruce , Vawdrey David K 
Published: August 2023

Abstract

Objective
To describe real-world practices and variation in implementation of the Information Blocking provisions amongst healthcare organizations caring for pediatric patients.

Materials and methods
An online survey regarding implementation practices was distributed to representatives from 10 participating US healthcare organizations located in 6 different states. The survey was followed by structured interviews conducted through video conference. Information was gathered about implementation practices at each organization, with a focus on patient and proxy portal access to, and segmentation capabilities of, certain data classes listed in the United States Core Data for Interoperability Version 1.

Results
All organizations had implemented the information blocking provisions at their institution. All organizations utilized different portal account types for proxies and users. All organizations reported the capability of sharing labs, medications, problem lists, imaging, and notes with the parent/guardian of the non-adolescent minor user with differences in how sensitive elements within the data classes were protected. Variability existed in how data was shared with the remaining user types.

Discussion
Significant variability exists in how organizations have implemented the information blocking rules. Variation in data sharing and data access between institutions can result in privacy breaches and create confusion about completeness of data for patients and families.

Conclusion
Healthcare organizations have utilized varying strategies to comply with the information blocking provisions of the 21st Century Cures Act. Increased clarity from the Office of the National Coordinator for Health Information Technology on minor, adolescent, and caregiver privacy and improved segmentation capabilities from Electronic Health Record vendors is needed.
783 Consensus Criteria for Palliative Care Consults: A Modified Delphi Approach
Authors: Grossoehme Daniel H , Brown Carrie , Brown Miraides , Friebert Sarah , Khandelwal Anjay , Lou Richard B , Teo Esther 
Published: August 2023

Abstract

Introduction
Specialist palliative care (PC) is a limited resource, best conserved by identifying persons most likely to benefit from a PC consult. Little guidance is available for clinicians on whether/ when to consult PC. The authors previously developed empirically-derived consult criteria to guide burn providers in specialist PC consultation, refining them by expert panel input.

Methods
A modified three-iteration Delphi process was employed to revise and develop consensus on empirically-derived PC consult criteria in burn patients. Eligible participants (N=202) were identified by (a) having published on burn and PC (b) presented nationally on burn and PC or (c) nomination by the study team as having equivalent expertise in the field.

Results
Forty-three individuals participated in Iteration 1; n=34 (79%) in Iteration 3, which rank-ordered three versions of criteria and invited further revisions. Consensus eliminated the most parsimonious version. Expert review panelists integrated feedback, yielding a consensus list with 6 criteria for PC consultation and 6 criteria for consideration of PC consult. Consult criteria include patient/family request; conflicted or unclear goals of care; and high modified Baux/SCORTEN scores. Criteria for consideration include no longer meeting milestones; assistance with symptom management; or cardiac arrest.

Conclusions
Consensus among burn and PC providers enhances validity and supports clinical use to guide burn providers on patients most likely to benefit from specialist PC consultation. Future research should prospectively explore whether adherence to the criteria is associated with improved outcomes and potential further revision.

Applicability of Research to Practice
Provides guidance on PC consultation and may be used to examine outcomes.
284 Effect of &lt;20-minutes of Cool Running Water &lt; 3hours on Burn Patient Outcomes: A Systematic Review
Authors: Singer Yvonne M 
Published: August 2023

Abstract

Introduction
Burn injuries are a leading cause of morbidity that can result in devastating disability and poor quality of life for survivors. This systematic review aimed to synthesise evidence regarding the effect of 20 minutes of cool running water (CRW) within three hours of injury on outcomes of patients with thermal burn injuries.

Methods
This systematic review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Multiple databases (PubMed, EMBASE, CENTRAL, CINAHL Complete via EBSCO, PROQUEST Dissertations and Theses), and the Australia New Zealand Clinical Trial Registry were searched for eligible studies published in English and Chinese, without date restriction. Meta-analyses were undertaken. Methodological quality of studies was assessed by using Downs and Black Checklist.

Results
Of 323 records, seven studies were included, with a combined study population of 11,383 patients. The majority (67%) of studies were conducted in Australia and New Zealand. The methodological quality was ranked between ‘fair’ and ‘good’. Approximately half of the study population (n=5782 [50.8%]) received 20 minutes of CRW within three hours of injury. Patients who received 20 minutes of CRW, within three hours of injury, had significantly decreased odds of requiring skin grafting or other surgical intervention when compared to patients who did not receive 20 minutes of CRW within three hours of injury.

Conclusions
There is considerable evidence demonstrating the association between the application of 20 minutes of CRW within the first three hours of injury and improved outcomes for patients with burn injury. Burns first aid guidelines and recommendations vary widely globally. Burn care organisations should reach international consensus about burns first aid best practice and provide clear, simple, and unified messaging. Burn care organisations should also engage in cross-sector collaborations with relevant jurisdictional EMS organisations to translate burns first aid evidence into pre-hospital practice.

Applicability of Research to Practice
Applying CRW after burn injury is a relatively simple procedure that can be performed at the scene by conscious patients, bystanders, firefighters, and other EMS responders. Data from the ABA burn repository shows that burn injuries in the United States (US) mostly occur in the home and most are &lt; 10% total body surface area (TBSA). Therefore, for US EMS responders responding to the burn injured, CRW is accessible in most situations, when injuries occur in the home and the medical urgency to transfer most patients with non-severe injuries (&lt; 10%TBSA) is not time critical. These contextual conditions of responding to most people with burn injuries, uniquely places US EMS responders in a window of opportunity to provide CRW at the scene, that can significantly reduce the burden of injury for patients.
290 Admission Inflammatory Cytokine Levels Are Predictive of Fluid Resuscitation Requirements in Thermally Injured Patients
Authors: Kelly Edward J , Carney Bonnie C , Keyloun John , Moffatt Lauren T , Shupp Jeffrey W , Tejiram Shawn 
Published: August 2023

Abstract

Introduction
Resuscitation of patients with major thermal injury is accomplished with crystalloid infusion-based injury size and patient weight ultimately titrated based on patient response. Estimations of fluid requirements can be imprecise and predicting responsiveness lacks precision. Previous work has demonstrated perturbations in both proinflammatory and anti-inflammatory cytokines in burn patients. However, there is a paucity of literature examining the impact of these perturbations and their usefullness to help predict resuscitation needs. This study sought to examine patient specific cytokine levels which may provide better insight into resuscitation requirements.

Methods
Burn injured patients presenting to a regional center over six years were prospectively enrolled in this observational clinical trial. Blood samples were collected on admission. Plasma cytokine levels (IL-1b, IL-6, IL-10, IL-12p70 and TNF-a) were quantified by ELISA. Crystalloid resuscitation volumes during the first 48 hours were assessed for correlation with cytokine levels after adjusting for weight and %TBSA.

Results
Thirty-eight patients were included in the analysis. Mean total body surface area (TBSA) burned was 26.7±14.4%. Elevated levels of IL-6 significantly correlated with normalized resuscitation volumes (ml/kg/%TBSA) from 8-24hrs and 24-48hrs (r=0.52, p&lt; 0.001; r=0.41, p&lt; 0.01). Elevated levels of IL-10 were also significantly correlated with normalized crystalloid volumes from 8-24hrs and 24-48hrs (r=0.55, p&lt; .01; r=0.46, p&lt; 0.001). Elevated levels of TNF-a also correlated with normalized crystalloid volumes from 8-24hrs and 24-48hrs (r=0.60, p&lt; 0.0001; r=0.57, p&lt; 0.001).

Conclusions
Predicting resuscitation volumes (and preventing over excessive crystalloid administration—fluid creep) is an integral aspect of burn injury management and there is a need for more objective methods for measurement. Phenotyping patients based on admission cytokine levels employing point of care assays may be a novel aid in predicting resuscitation needs and avoiding fluid creep.

Applicability of Research to Practice
Proper burn resuscitation is an integral aspect in the care of the burn-injured patient. Establishing adjuncts to help estimate fluid requirements or risk of over-resuscitation could be integral in establishing more individualized care.
296 A Pilot Study of Hand Autografts Treated with Autologous Skin Cell Suspension
Authors: Deville Paige , Carter Jeffrey E , Lechtenberg Madeline , Phelan Herbert A 
Published: August 2023

Abstract

Introduction
Our group has previously studied the use of autologous skin cell suspensions in conjunction with meshed autografts for the treatment of hand burns. These studies lacked scar assessments and long-term follow up, however. The aim of this study was to compare the point estimates for prospectively collected scar characteristics in hand burns treated with meshed autograft and an ASCS solution vs split thickness autograft alone (STAG). As these point estimates are unknown, this study was considered to be hypothesis-generating to aid in future power calculations.

Methods
A retrospective review was conducted to identify all subjects operated on for deep partial or full thickness hand burns at our ABA-verified burn center between April 2018 to April 2022. Eligible subjects were attempted to be contacted by phone and offered study participation. No financial enticements were offered beyond validating parking. All consenting subjects underwent measurement of scar characteristics by the Patient-Observer Scar Assessment Score (POSAS) by one of two dedicated study personnel. Two cohorts were created: those hands treated with 2:1 meshed autograft plus application of an ASCS solution (MA/ASCS) versus those hands treated with split thickness sheet, piecrust, or 1:1 meshed autograft alone (STAG). Values are reported as median and interquartile range.

Results
90 subjects fit the study criteria overall, with 20 able to be contacted (22%) and 17 of those consenting to participate (18%). The MA/ASCS group (n=8) were seen at 8 [3.75,17.25] months after injury while the STAG group (n=9) presented at 15 [9,21] months from injury. There was no significant difference in age between the two cohorts (35.5 years [29.75, 55.5] vs 51 years [45, 53], p=0.53), but the MA/ASCS group had significantly larger %TBSA burns overall (20% [5%, 10%] vs 2% [1%, 4%], p=0.01). Scar assessments were found to be comparable between the two groups as the POSAS-patient scores were 34.5 [13.5, 51] in MA/ASCS and 37 [14, 40] in STAG, while the POSAS-observer scores were 22 [20.25, 29] in the MA/STAG group and 21 [9, 25] in the STAG group. For a noninferiority trial of ASCS with POSAS-observer as the primary endpoint, an alpha of 0.05, 80% power, and a conservative noninferiority margin M of 10%, a randomized clinical trial would need 184 subjects.

Conclusions
The point estimates for scar assessment of hand burns treated with ASCS and 2:1 meshed autograft are so close to STAG alone, the resources necessary to perform a definitive RCT would require a degree of resources that are probably prohibitive. Alternative endpoints should be considered in judging the performance of ASCS in hand burns, such as the amount of donor skin needed to close the wound.

Applicability of Research to Practice
This study can provide important information in changing clinical practice for the treatment of hand burns.
300 Intraoperative Thresholds for Transfusion During Burn Surgery
Authors: Barrios Evan L 
Published: August 2023

Abstract

Introduction
Burn injury is associated with significant morbidity. Deep partial thickness or full thickness burns require surgical excision and skin grafting. This process results in significant blood loss and frequently requires blood transfusions. There is scarcity in published literature addressing intraoperative blood transfusion requirements. The relationship between blood product volume and patient characteristics has not been clearly defined. The enhanced ability to predict blood transfusion requirements would allow for improved allocation of blood products and safer overall operations.

Methods
This is a retrospective review conducted at a large academic burn center. Inclusion criteria are adult patients admitted between December 2019 and August 2020 with burns requiring surgical excision. Prisoners, children, and non-operative burns were excluded. Operative cases requiring blood product administration were compared to cases that did not require transfusion. Two-tailed student’s t-tests were conducted with p &lt; 0.05 considered significant.

Results
There were 103 total patients who underwent a total of 217 operations. Forty-eight percent (n=104) of cases required blood transfusion. As detailed in the table, the transfusion group had significantly increased percent total body surface area (TBSA) burn, along with longer hospital and ICU lengths of stay (LOS). Operatively, this group underwent more tissue excision (approximately 15% TBSA compared to 5%) with longer case lengths, coupled with higher estimated blood loss and a lower preoperative hemoglobin. Interestingly, the median time for the initiation of packed red blood cell transfusion was six minutes after incision.

Conclusions
The average estimated blood loss in cases resulting in transfusion was 907±462mL (with a median of 800mL) compared to 467±398mL estimated blood loss in the non-transfused group. Expected blood loss along with parameters such as planned area of excision (which was approximately three times greater in transfused patients) and severity of burn injury can guide the surgeon in anticipating perioperative administration of blood products. Future directions include stratification of blood volume administration by %TBSA, operative time, LOS, and percent excision.

Applicability of Research to Practice
The ability to predict blood product requirements preoperatively coupled with the incorporation of perioperative parameters can assist in the judicious and appropriate use of blood products during burn operations.
302 A Classification System and Surgical Algorithm for Pediatric Postburn Ear Deformities
Authors: Buta Martin , Bojovic Branko , DePamphilis Matthew , Driscoll Daniel N N , Ehrlichman Richard 
Published: August 2023

Abstract

Introduction
The outward projection of the external ear makes this anatomically complex appendage susceptible to trauma. Notably, up to 40-60% of facial burns involve the ear, frequently impacting function and aesthetics. Significant postburn sensory deficits and changes to the ear’s intricate architecture can markedly impair physical health, psychosocial functioning, and quality of life. Scar tissue and contracture, traumatized cartilage, and compromised blood supply and surrounding soft tissues all influence the reconstructive plan. The authors describe a new classification system and surgical algorithm for pediatric postburn ear deformities informed by both their extensive operative experience on the traumatized ear and a retrospective study of different reconstructive techniques for more severe burn injuries to the pediatric ear.

Methods
To develop the classification system and surgical algorithm, three senior surgeons with over 85 years of combined experience reconstructing ears carried out an iterative joint review of their relevant clinical cases and insights, including their personal approach to assessing postburn ear trauma and developing an operative plan. Particular attention was focused on how the type and extent of soft tissue injury affects available reconstructive options. To inform classification of the most complex ear burn cases, a retrospective review was conducted on patients aged 0 to 21 years who underwent cartilage framework reconstruction between January 2004 to January 2021 at a specialized pediatric burn center. Medical records were screened and 54 patients (61 ears) who met study criteria were identified and patient demographics, procedural characteristics, and outcomes were analyzed.

Results
For postburn ear deformities (Table 1) involving total or near-total preservation of the ear’s anatomical structural elements (Type I and Type II deformities, respectively), scar release, local tissue rearrangement, and/or skin grafting are typically sufficient for optimal reconstruction. For cartilage defects involving less than or more than two-thirds of the helix (Type III and Type IV deformities, respectively), a partial to complete ear scaffold can be successfully reconstructed using a composite graft, conchal transposition flap, costal cartilage graft, or porous polyethylene implant.

Conclusions
The proposed classification system and surgical algorithm (not shown) for postburn ear deformities facilitate a tailored approach that addresses reconstructive course duration, anticipated aesthetic results, complication potential, and patient goals and expectations.

Applicability of Research to Practice
The authors provide a new classification system to pediatric postburn ear deformities that, along with a proposed surgical algorithm, can help guide planning for reconstruction.
305 Increasing Nursing Burn Care Knowledge Through a Podcast Platform
Authors: Weintraub Brianna , Mueller Scott W , Wiktor Arek J 
Published: August 2023

Abstract

Introduction
Various educational methods and platforms have been developed to teach burn care such as Advanced Burn Life Support, Fundamentals of Burn Care, e-platforms, and supplementary lectures. However, there are nuances to each burn centers’ practices that general knowledge courses do not address. This study investigates the usefulness of using a burn unit podcast as a platform to provide educational delivery of clinical explanations aimed at improving nursing staff knowledge and understanding of clinical burn care.

Methods
A seven-episode podcast curriculum was developed at our ABA verified burn center focusing on seven core topic areas: burn evaluation; burn resuscitation; inhalation injury; wound care/pain management; psychology/nutrition; exfoliative/electrical injuries; frostbite. Each podcast ranged from 14-35 minutes led by burn attending moderators. Baseline data was obtained via an 18 question pre-test completed by participants prior to gaining access to the podcast. A post-test was administered after listening to episodes, comprised of different matched questions. Participant feedback survey was also given. A matched pair analysis of pre and post test results was performed utilizing paired t-test to measure significance.

Results
Over the course of two years, 18 nurses (RN) with varying levels of experience participated in the study. Overall post podcast test score averages significantly improved from 0.77 pre to 0.90 post (P&lt; 0.01). Specific knowledge areas of burn evaluation (0.76 pre, 0.93 post), resuscitation (0.38 pre, 0.88 post), and frostbite (0.69 pre to 0.97 post), were all significantly improved post podcast (p&lt; 0.01). Wound care/pain management (0.88 pre, 0.9 post), psychology/nutrition (0.85 pre, 0.88 post) were not significantly improved. Exfoliative/electrical injuries demonstrated non-significant decrease in scores (0.94 pre, 0.83 post). 93% of RNs strongly agreed that the podcast speaker(s) were knowledgeable and engaged. 86.66% of RNs agreed that the interactive teaching strategy enhanced learning. Additional feedback noted that the podcast was, “entertaining,” “a fun way to learn,” and “a great way to introduce new information.”

Conclusions
Unit specific podcast can improve burn knowledge while engaging the adult learner. Analysis of results can help educators focus on areas that need further attention and emphasis. Nursing feedback revealed that a flexible method of electronic content delivery engaged and entertained the learner while increasing the effectiveness of knowledge attained.

Applicability of Research to Practice
Any burn center focused on education for adult learners as an adjunct to traditional means of learning.