bluuebunny/crossref_metadata_2025_split huggingface dataset:
541 Needs Assessment among Adult Burn Survivors’ Caregivers in Korea
Authors: Hwang Se-Hee , Park So-Young 
Published: May 2023

Abstract

Introduction
Burn injuries have negative impact on both burn survivors and their loved ones. As family members usually care for burn survivors, it is very critical to understand the concerns of family caregivers and their needs for social services during the process of recovery. The purpose of this study is to assess 1) a broad range of difficulties among family caregivers of adult burn survivors, 2) the frequency of use of social service programs and satisfaction with these services, and 3) the needs of caregivers of burn survivors on the service provision.

Methods
We used a cross-sectional survey design with purpose sampling. We conducted both online and face-to-face surveys from November 2021 to February 2022. A total of 92 family caregivers aged 20 years or older participated in the survey. We measured 1) physical (e.g. chronic diseases such as pain and hypertension), psychological (e.g., family conflicts, communication issues with a burn survivor), financial (e.g., medical expenses, living costs), and social & environmental problems (e.g., living environment, education, discrimination or prejudice due to burn scars and disabilities), 2) the use of social service programs and the level of service satisfaction, and 3) the needs of social service programs (e.g., counseling services for PTSD treatment, financial support, and discharge planning). We used SPSS 24.0 for all data analyses.

Results
The most challenging problems were financial matters followed by psychological, and social & environmental ones among study participants. Study respondents used social service programs to resolve their psychological, financial, and discharge related difficulties. Those who used social service programs showed higher satisfaction with an average of 3 out of 5 points. More than 50% of study participants reported that it was necessary to receive social services on psychosocial, financial, and discharge related problems and they were willing to receive these services in future.

Conclusions
These findings imply that it is necessary to develop and provide needs-based social services for caregivers of burn survivors and that the provision of social services should be expanded further.

Applicability of Research to Practice
Findings of this study demonstrate that social service programs can relieve the burden of caregivers and improve the quality of life of both burn survivors and their caregivers.
543 Diversity in Burn Surgery Programs
Authors: Delapena Samantha , Chen Andy , Houng Abraham , Lodescar Rachelle 
Published: May 2023

Abstract

Introduction
Racial and gender disparities have been longstanding in the fields of medicine and surgery. In the literature, underrepresentation has been highlighted in plastic surgery and general surgery programs, however few studies examine this within burn surgery. Two studies describe the gender and racial disparities that exist in burn surgery leadership. This study seeks to compare and highlight the representation of minority and female surgeons in burn surgery training at a major metropolitan burn center to other surgical programs.

Methods
Applicant data were reviewed for acceptance to the clinical burn surgery fellowship program from 2008 to 2022. Self-identification was used to categorize gender as male or female and race as Asian, African American, White, and other. The gender and race of each applicant was recorded. The data was analyzed and compared to data trends in female and minority representation among physicians in other training programs. Demographic data were also obtained from newly hired staff of the same metropolitan burn center.

Results
From 2008-2022, there have been 30 physicians enrolled in this institution’s burn surgery fellowship program. Fourteen (46.7%) were female. Twelve (40%) were White, ten (33.3%) were African American, six (20%) were Asian, and two (6.7%) were of unknown racial background. From 2018-2022, there have been 277 newly hired staff members for the burn center. There were 238 females (85.9%). There were 142 (51.2%) who were White, 82 (29.6%) who were African American, 30 (10.8%) who were Asian, and 23 (8.3%) who were Hispanic or Latino.

Conclusions
In 2022, the US graduating medical class was 52% female – a proportion that has slightly increased over the last four years. Furthermore, the US graduating medical school class was 58.8% White, 25.5% Asian, 10.6% Hispanic or Latino, 8.3% Black; these proportions of minority groups have also demonstrated a slow, but steady, increase over the last four years. Previous studies have demonstrated a lack of diversity among burn surgery leadership, but do not address diversity among burn surgery fellows or among newly recruited medical staff within burn centers. This institution’s burn surgical program has aimed to maintain a diverse minority representation to serve a community that is also diverse in race, gender, and socioeconomic status.

Applicability of Research to Practice
Increasing gender and racial representation in burn surgery programs is beneficial for supporting the burn patient population, which is frequently diverse in race, gender, and socioeconomic status.
544 Creating Communities for Burn Survivors Using Metaverse Platform
Authors: Hwang Se-Hee 
Published: May 2023

Abstract

Introduction
In the post-COVID-19 era, as face-to-face activities become difficult, the psychosocial difficulties of burn survivors are increasing, and their social isolation is also intensifying. At this time, studies on the effectiveness of online intervention have been reported, and demand for the use of metaverse platforms that can supplement face-to-face activities is also increasing. Accordingly, the metaverse platform was intended to be used to prevent social isolation of burn survivors and to prepare a social support system, and their experiences were analyzed and its impact was investigated.

Methods
Among the various metaverse platforms, Burn Hospital was established on Gather Town platform, which can present or communicate on an online map and has the function of producing or sharing videos, writings, and paintings. Main plaza, auditorium, education room, exhibition room, counseling room, and play room were built on the platform, and burn survivors could access the treatment process and various information, and at the same time, they could easily access the content with their families through programs by treatment stage, age, and group. In particular, various education, workshops, and support groups were held to share burn experiences with each other and provide opportunities to benchmark each other's overcoming strategies. In addition, using Ifland, a mobile phone app-based platform, education on safety and burn awareness improvement campaigns were conducted to citizens.

Results
A total of 700 people participated in a total of 20 education and lectures held at Burn Hospital on Gather Town platform, which opened on December 18, 2021. In addition, art therapy programs for children burn survivors are underway every week. Most of the participants evaluated their experiences on the metaverse platform as new and fun, and it was positively evaluated that geographical limitations could be overcome and community support group meetings were possible.

Conclusions
It was evaluated that the establishment of communities using metaverse has a positive effect on helping the psychosocial recovery of burn survivors and their families and establishing a social support system. In particular, compared to face-to-face services, it was time-wise and economically efficient and had the advantage of being able to experience interesting factors. On the other hand, it is somewhat difficult for burn survivors who have difficulty using PC to access the platform, so digital literacy education should be preceded, and support for improving digital accessibility is needed.

Applicability of Research to Practice
Along with face-to-face services, it is expected that the community activities of burn survivors using the metaverse platform will continue to expand, and it is expected to lead to the development of digital treatments in the future by developing various digital-based clinical programs to help burn survivors to recover physically and socially.
546 Winning the Race Against Pathogens: A Regional Burn Center Experience with a Cleansing Protocol
Authors: Dries David , Miotke Sam , Popma Emily , Johnston Mark , Rogers Bradley , Obst Mary Anne 
Published: May 2023

Abstract

Introduction
The skin is the first immune defense mechanism, and it functions as a barrier against various microorganisms. Burn injury will compromise this important barrier. Infections are the primary factor contributing to burn mortality, resulting in &gt;50% of deaths in burn patients. In 2020, our Adult and Pediatric Burn Center instituted a pure Hypochlorous Acid (pHA) antimicrobial protocol to enhance skin barrier function.

Methods
We conducted a retrospective analysis on the effect of the introduction of the pHA protocol on the number of reportable infections in our Burn Center. The period of observation in this report is 2017-2021. Beginning in 2020, adults and children received topical wound care and bathing with our pHA protocol. No dilution of the product was used. The product was placed into a sterile basin and the patient was cleaned head to toe, including the genitalia and the wounds. Since invasive procedures such as placement of central venous catheters or urinary collection catheters may be a conduit of infection, the present report includes data regarding the number of patients experiencing clostridium difficile, central line-associated blood stream infection and catheter-associated urinary tract infections.

Results
From 2017-2021, our Burn Center admitted 2,223 patients. We computed a percent change in infections from before (2017-2019) to after (2021) the pHA protocol was implemented. We used 2021 because this was the first full year after the pHA protocol was introduced. We subtracted the total number of infections in 2021 from the average number of infections per year in 2017-2019 and divided by the average number of infections per year in 2017-2019. We found a 55% decrease in infections after the pHA protocol was introduced. There was no evidence of toxicity in adult or pediatric patients associated with care during introduction of the pHA protocol, including skin graft sites.

Conclusions
This analysis indicates a notable decrease in infections. The pHA procedure shows no evidence of viral, fungal or bacterial pathogens causing significant issues with the studied patient group. This analysis does not determine whether the decrease in infections is clinically or statistically significant.

Applicability of Research to Practice
Reducing infections in burn patients which can be life saving.
547 Volume-based Feeds: A Quality Improvement Project for Better Nutrition
Authors: Levine Emma , Dale Slater Elizabeth , Slutsky Hanna , Ladele Olatundun , Gondek Stephen , Wagner Anne 
Published: May 2023

Abstract

Introduction
Nutrition is a critical component to recovery in burn patients. Their heightened metabolic demand is well established. In our burn population, patients often received significantly less volume of feeds than they were prescribed, primarily due to stoppages for sedations and procedures. We, therefore, developed a quality improvement (QI) project to help improve the quantity of feeds received.

Methods
Under the direction of nursing QI leadership and our burn nutritionist, we established an outcome measure of increasing average feeds received from baseline 68% of those prescribed to greater than 75% of those prescribed. Using a process of iterative changes, we initially developed a calculator for volume-based feeds to make up the volume lost during times tube feeds were paused. Nursing staff gave feedback, and we ultimately used a chart for adjusted volumes based on the total 24 hour goal and number of hours remaining in which to make up the goal. On a bi-weekly basis, we examined the amount of tube feeds as a percent of total prescribed prior to and after the interventions.

Results
Early results have demonstrated improvements in the percent of tube feeds a burn patient is receiving. Prior to the interventions patients were receiving about 68% of the prescribed tube feeds and within 6 weeks of project initiation, patients were receiving 82% of the prescribed tube feeds (Figure 1). In addition, variability in feeds received decreased markedly, as have number of days above the target.

Conclusions
In conclusion, this has been an effective QI intervention as we surpassed our initial target within 6 weeks of initiation. Next steps are to consider increasing the target to 90% of prescribed feeds, as well as investigating adequacy of feeds using nitrogen balance in select patients. Future directions for this project include assessing outcome measures such as graft take and hospital length of stay.

Applicability of Research to Practice
Purpose is to share our methods in quality improvement to aid others efforts facing similar challenges in the care of the critically ill burn patient.
551 Reduction of Fungus-Related Complications in a Burn Center
Authors: Shingleton Sarah , Chafin Kristine , Britton Garrett , Aden James , Basel Anthony , Cancio Leopoldo 
Published: May 2023

Abstract

Introduction
Fungal wound infections (FWI) cause morbidity and increase mortality in burn patients. Our burn center experienced 44 patients with fungal wound colonization (FWC) and/or FWI between JAN 2015 and JAN 2019. In response, we undertook a performance improvement project to prevent and treat FWC and FWI.

Methods
Members of the multidisciplinary team met to develop a clinical practice guideline (CPG) for the prevention and management of FWC and FWI based on current evidence. We focused on patients with elevated risk, that is, with burns ≥20% total body surface area (TBSA) and in the Burn ICU (BICU). Interventions included: utilizing alternating silver sulfadiazine and mafenide acetate creams upon admission; reducing the use of mafenide acetate solution; utilizing silver nitrate solution post-operatively; and applying topical nystatin cream or powder for suspected FWC or FWI. We educated all staff members and updated order sets and training materials. We collected data on all burn patients who had a wound biopsy out of concern for possible infection. Biopsy results were categorized as FWC or FWI. Retrospective data were collected for MAR 2020 - MAR 2021 (PRE). Post-implementation, prospective data collection began MAR 2022 (POST) and will continue for one year. Adherence to the CPG was assessed by chart review. Mann-Whitney and Fischer Exact tests were performed.

Results
The PRE (n=15) and POST (n=9) groups were similar in age (43±13 vs. 48±18 years) but differed in TBSA (49±19 vs 28±25%, p&lt; .05). PRE group biopsies showed FWC in 0 patients and FWI in 11 of 15 patients (73%); 8 of these (53%), all with FWI, died. In the POST group, FWC was found in 1 patient (11%) and FWI was found in 2 of 9 patients (22%); one death occurred in the patient with FWC. Adherence to the CPG for admission topical wound care was 7% in the PRE group vs 89% in the POST group (p=0.0001); adherence to the CPG for day-of-biopsy topical wound care was 27% in the PRE group vs 89% in the POST group (p&lt; 0.01).

Conclusions
Adherence to a CPG for the prevention and treatment of FWC and FWI was associated with a lower (but not statistically significant) prevalence of these complications. Limitations include a difference in the TBSA between the 2 groups and potential concurrent changes in practice. Ongoing data collection includes the evaluation of other potential contributing factors.

Applicability of Research to Practice
Fungi are common in the environment, and when combined with immunosuppression and extensive open wounds, may cause wound infection in burn patients. More research is needed to further evaluate effective treatments for the prevention and treatment of FWC and FWI in these patients.
555 Pain Management During Bromelain-Based Enzymatic Debridement in a U.S. Adult Burn Center
Authors: Buta Martin , Annand Domenic , Findeisen Sarah , Hickey Sean , Sheridan Robert , Friedstat Jonathan , Schulz John , Bojovic Branko , Goverman Jeremy 
Published: May 2023

Abstract

Introduction
Outside the United States, bromelain-based enzymatic debridement (BBED) has become an effective tool for removal of burn eschar. BBED can be performed at bedside and allows for complete eschar removal with maximal dermal preservation and markedly reduced blood loss. It may also decrease the need for autografting or the amount of autograft required. A primary concern with BBED is that it is a painful procedure requiring appropriate analgesia. Experience with BBED in the U.S. has been gained through a multicenter phase 3 clinical trial (DETECT) and an expanded access treatment protocol (NEXT). In this retrospective study, we describe our experience using BBED, with particular focus on pain management.

Methods
A retrospective review was conducted on 29 adult burn patients enrolled in the DETECT or NEXT trials who underwent BBED of acute deep partial- and full-thickness thermal burn wounds at a major burn center between November 2016 and July 2022. Patient demographics and procedural characteristics, including pain management strategies and Numerical Pain Rating Scale (NPRS) scores before, during, and after debridement, were analyzed and described.

Results
Twenty-nine patients with an average age of 41.2 years (SD=17.8, range 18-72) and an average TBSA of 6.3% (SD=5.6, range 1-24.5) underwent a total of 29 BBED. For pain control during debridement, 6 patients required conscious sedation (CS), 7 a regional block (RB), 5 a local block (LB), and 9 only IV and oral (IVPO) medications. Two patients were intubated and sedated prior to the procedure. No patient required additional BBED treatment and all patients achieved &gt;95% eschar removal. The average NPRS pain score 24 hours before treatment, during treatment, and 24 hours after treatment was 4.0, 4.6, & 4.4, respectively (P=0.65). Sixteen patients (55%) healed without the need for autografting. The average number of days from debridement to wound closure for all patients was 34.9 days (SD=11.9) and for patients who underwent autografting was 40.1 days (SD=12.3).

Conclusions
With appropriate analgesia, it is possible to perform BBED of acute deep partial- and full-thickness thermal burns without significant changes in patient-reported pain scores. Prior to debridement, it is critical to establish procedure logistics and reasonable patient expectations.

Applicability of Research to Practice
The authors review their experience controlling pain associated with BBED.
559 Verticalization Therapy for ICU-Level Burn Patient: A Case Study
Authors: Tepe Melinda , Gerlich Nicole , O’Donnell Allison , Drake Mack , Feldman Michael 
Published: May 2023

Abstract

Introduction
The entire interdisciplinary team can be faced with many challenges when treating a bariatric, critically ill patient with significant burn injuries. Some studies suggest that the care of these patients increases staff workload and leads to the need for increased assistance for proper turning, positioning, and completion of wound care. When caring for these types of patients, patient and staff safety should be considered, as well as what will ensure the best patient outcomes. Our rehab team initiated the use of verticalization therapy with a patient on the burn unit with 28% TBSA full-thickness burns to back, chest, BUEs and a BMI of 45.8 in order to promote improved healing, cognitive status, and pulmonary function. While verticalization therapy is described for use in patients with pulmonary issues or invasive cardiac support devices, this was the first time this therapy was used in our busy ABA-verified burn center.

Methods
Once deemed appropriate for participation with PT/OT, a collaborative protocol with nursing, therapy, and burn provider team was developed. The patient was transitioned into a specialized bed allowing for verticalization up to 90 degrees. The patient was incrementally verticalized by 10 degrees at a time while monitoring vitals, assessing patient safety and pain response. Ultimately, the patient reached 40 degrees vertical and maintained this position for up to 2 hours. This intervention was utilized by both rehab specialists and nursing staff and was taught to nursing staff to be performed daily until patient was able to actively participate and tolerate edge of bed or out of bed activity.

Results
Use of the verticalization positioning was used to promote weight bearing activity, improve pulmonary function, improve cognitive status through upright positioning, and for pressure relief of graft areas specifically for offloading pressure to back wounds and grafts. The bed was used for 1 month. During this time, the patient successfully liberated from mechanical ventilation and shock state and mobilized with therapy assistance. The patient demonstrated improved strength, active participation with therapies, and decreased agitation as the month progressed. Autograft split-thickness skin grafts with autologous cell suspension epithelial autografts to the patient’s posterior torso healed well and were fully closed by the time of discharge to inpatient rehabilitation.

Conclusions
Use of verticalization beds can be implemented in the care of patients with burn injuries safely and successfully. Further research regarding skin healing related to use of the bed and verticalization therapy in burn injured patients should be conducted.

Applicability of Research to Practice
This intervention can be used for patients of all sizes and can be implemented as soon as hospital day one, if the patient is medically appropriate