bluuebunny/crossref_metadata_2025_split huggingface dataset:
103 Differences in Estradiol Levels Following Burn Injury
Authors: Willis Micah L , Soliman Daniel S , Ngeve Sally-Irene , Mahung Cressida , Wallet Shannon , Maile Robert 
Published: March 2022

Abstract

Introduction
The American Burn Association estimates over one million people with burn injuries in the US need medical care, with around 4,500 cases ending in mortality each year. Mortality is due to bacterial infection as a consequence of severe cytokine dysregulation and impaired wound healing. Previous research has shown females have worse outcomes than males following burn injury, but the reasoning is unknown. Estradiol is involved in the regulation of local and systemic interleukin-6 (IL-6) levels, which has been demonstrated by others to positively correlates with poor outcomes following burn. We hypothesize that concentrations of Estrogen can create a pro-inflammatory effect in epithelial cells, which is controlled in a negative feedback loop.

Methods
We utilized plasma from 1) human burn patients and 2) our murine model of burn injury, in which C57BL/6 mice are exposed to a 20% total body surface area burn injury and 3) an in vitro cell model using human Oral Epithelial Cells (OECs) and human Airway Epithelial Cells (AECs).

Results
We measured human estradiol levels 1-3 days after burn injury and murine estradiol levels 3 and 7 days after injury by ELISA. In humans there were differences in levels at these timepoints (p&lt; 0.05). In mice we observed a difference in the change in murine estradiol levels between males and females 7 days after injury (p &lt; 0.01). We simulated a wound by removing the cell insert and treating cells with concentrations of estradiol (0.1 nM, 1.0 nM & 250 nM). Images were taken at 0, 6 & 24 H and analyzed using Fiji to observe wound closure. Supernatant was removed from cells at 24 H and analyzed for IL-6 levels (a key pro-inflammatory cytokine linked to poor wound healing after burn) via ELISA. mRNA was isolated from cells and analyzed for IL-6, TNFα & VEGF (important regulators of wound healing) via PCR. We observed an increase in percent wound closure in the AECs, and no difference in OECs. We observed an increase in IL-6 production following stimulation with Estradiol and LPS at different rates for each cell type and corresponding reduction in TNFα and VEGF expression. We also described different Estradiol Receptors in the two cell types.

Conclusions
Taken together, these data suggest burn injury upregulates estradiol in both humans and mice following burn injury whereby this is more robust in females at later stages of burn injury and thus contributing to female-associated poor clinical outcomes.
105 Nursing Theory and Burn Competency Training Practices to Address Gaps in Post-covid Trained Graduate Nurses
Authors: Dowling Lynn , Wilson Joan , Echols Jane D , Burke Susan , Hills Jocelyn 
Published: March 2022

Abstract

Introduction
Recruitment efforts just after the recent COVID crises brought in several new graduate nurses. They had limited clinical exposure during COVID-19 resulting in difficulty transitioning into practice providing safe patient care. As a result, these nurses lacked the fundamental knowledge needed to care for acutely ill burn and wound patients resulting in the new graduate registered nurses (NGRNs) feeling overwhelmed at the bedside. These findings coincide with assessments noted in Kavanagh and Sharpnack’s (2021), article identifying only 9% of NGRNs were practice ready, with 7% failing to recognize urgency or a change in a patient’s condition.

Methods
In order to achieve the designated American Burn Association (ABA) competencies, our center designed a program based on Patricia Benner’s Novice to Expert nursing theory. Additionally, we divided the competencies into achievable goals and domains using the Donna Wright's nursing competency model.
StaRN program: didactics/simulation/skills/unit orientation one on one with a preceptor
Competency based staged orientation program for new staff
Burn Specific Education includes:
1) Burn and complex wound care didactic
2) Burn specific High-fidelity simulation scenario utilizing critical care equipment promoting critical thinking and critical reasoning skills
3) Task trainers
4) On-going preceptor education
5) Nurse Extern program

Results
NGRNS arriving at our unit in early 2020 were found to be incapable of performing clinical tasks in the burn ICU (BICU) setting at the level of competency recommended by the ABA. We immediately placed this cohort into the revised training program incorporating Benners Novice to Expert Theory and Wright’s Competency Model. Of the 25, 17 were able to be placed in the BICU (68%), and 8 were able to transfer to a lower level of care (progressive care/med-surg). All 25 were given extended orientation (12 weeks instead of the normal 8, as recommended by our facility). We will follow this group to determine retention rates.

Conclusions
Current levels of competencies by the ABA creates gaps in care for graduate nurses entering the workforce with deficits. Applying Benner's Novice to Expert Theory and Wright’s Competency Model to modify approaches to training helps identify gaps in care, addresses areas that are weak for the nurse, and help guide the graduate nurse through stages of expertise to arrive more confidently at the level of competency expected by the ABA.
108 Development and Implementation of a Burn Nurse Educator
Authors: Snyder Emily , Rosenthal Jennifer 
Published: March 2022

Abstract

Introduction
Prior to the introduction of the Burn Nurse Educator (BNE), at a growing and newly established burn center, the education of the Burn Trauma ICU staff was completed by the Burn Director and Burn Supervisor. In this burn center, large amounts of education became difficult to create and distribute by the current Burn Director and Burn Supervisor due to the demand of their respective job roles. The role of the BNE was to create initial and ongoing education for the Burn Trauma ICU Staff, Ortho-Trauma staff, ED staff, local EMS agencies, and the community.

Methods
The Burn Nurse Educator reviewed previous education that was provided to the staff, compared it to the Burn Nurse Competencies established by the American Burn Association, and was able to formulate a new education plan. The Burn Nurse Educator created several burn-based courses. These classes included: Floating into Burn Care, Burn Boot Camp, and Burns in the Pediatric Population. There was also the introduction of mock codes focused on the pediatric burn population. In addition to the formulation of these educational opportunities, the Burn Nurse Educator worked directly with the Quality Improvement Committee to find gaps in care. These gaps were then turned into project improvement plans and additional education was provided to the bedside staff. The Burn Nurse Educator formed relationships with local EMS agencies and was able to provide burn lectures and continuing education.

Results
Each class offered had a pre and post test administered, all with improved scores. A sample size of 30 nurses who enrolled in Burns in the Pediatric Population had a score increase from 46% to 94%. A sample size of 14 nurses had a score increase of 55% to 80% after enrolling in Floating into Burn Care. A sample size of 30 nurses who enrolled in Burn Boot Camp had a score increase of 71% to 95%. More importantly, the staff expressed a higher level of confidence when caring for a burn patient after these classes. The outreach with local EMS agencies also increased our EMS admits to the hospital, improved knowledge for caring for burn victims, and created a relationship with our local cities EMS.

Conclusions
It is anticipated that as the program continues to expand, the role of the Burn Nurse Educator will continue to grow and encompass new responsibilities. To ensure each nurse remains competent in their skill set, additional knowledge testing will be completed one year after a nurse has completed a class.
109 The Impact of Distance to Treatment Center on Long-term Outcomes of Burn Patients
Authors: Galicia Kevin E , Kubasiak John , Mehta Anupama , Riviello Robert , Nitzschke Stephanie , McMullen Kara , Gibran Nicole S , Stewart Barclay T , Wolf Steven E , Ryan Colleen M , Schneider Jeffrey C 
Published: March 2022

Abstract

Introduction
Geospatial access to American Burn Association (ABA)-verified burn centers or self-designated burn care facilities varies across the country. It is often necessary to transport patients hundreds of miles to provide definitive burn care and rehabilitation services. This study evaluates the impact of distance to treatment center on long-term outcomes of burn patients.

Methods
Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System (BMS) National Database, collected from 2015 to 2019, were analyzed to investigate the impact of distance to BMS center on long-term, patient-reported outcomes. Distance was calculated as driving distance between home zip code centroid and BMS center. Demographic and clinical data were compared between groups by distance from BMS center (&lt; 20, 20-49.9, &gt;50 miles). The following patient-reported outcome measures, collected 12 months after injury, were examined: Veterans Rand 12 Physical Component Summary Score (VR-12 PCS), Veterans Rand 12 Mental Component Summary Score (VR-12 MCS), Satisfaction with Life (SWL), employment status, and days to return to work. Mixed regression model analyses were used to examine the associations between distance to BMS center and each outcome measure, controlling for demographic and clinical variables.

Results
Of the 726 participants included in this study, 191 (26.3%) and 204 (28.1%) were &lt; 20 and between 20-49.9 miles from a BMS center, respectively; 331 (46.6%) were &gt;50 miles from a BMS center. Greater distance to BMS center was associated with white race/ethnicity (p&lt; 0.001) and employment at time of injury (p=0.001). Greater distance to BMS center was also associated with flame injury (p&lt; 0.001) and larger burn size (p&lt; 0.001). There were no significant differences in length of stay or number of operations between groups. Regression analyses did not identify significant associations between distance to BMS center and VR-12 PCS, VR-12 MCS, SWL, employment at 12 months, or days to return to work.

Conclusions
After burn injury, patient-reported outcome measures of physical and psychosocial function, as well as employment, do not differ based on distance to BMS center.
118 Burn Injury Vandalizes Cancer Survival with Increased Risk of Complications
Authors: Keys Phillip H , Gotewal Sunny , Wermine Kendall , Efejuku Tsola A , Chokshi Shivan N , Huang Lyndon G , Corona Kassandra K , Villarreal Elvia L , Chaij Jasmine M , De La Tejera Giovanna , Bagby Shelby P , Haseem Maria , Joglar Alejandro A , Golovko George , Wolf Steven E , El Ayadi Amina , Song Juquan 
Published: March 2022

Abstract

Introduction
Burn injuries place patients in a compromised state, especially those with pre-existing comorbidities. The presence of cancer complicates care and worsens outcomes for patients suffering from illnesses unrelated to burns, such as sepsis. Therefore, we posit the incidence of burn injury on patients with preexisting cancer diagnoses results in an increased risk of complications.

Methods
Burned patients were identified using the TriNetX database, a global federated health research network. Fifty-one thousand patients with a diagnosis of cancer prior to experiencing a burn injury were identified. Control groups included 1) patients who had a previous cancer diagnosis and no incidence of burn, and 2) patients who experienced a burn with no history of cancer. Outcomes analyzed included sepsis, nutritional deficiency, eating disorder, immunodeficiency, and depression within 5 years. Cancer diagnoses were categorized into 5 of the 13 most common cancer reported in the US. Data was analyzed using a chi-square analysis with p&lt; 0.05 considered significant, and presented odds ratio are with 95% confidence intervals.

Results
The majority of cancer survivors with burns were White (70%) and female (62%). Compared to cancer patients without burn injury, patients experiencing a burn after a diagnosis of cancer were more likely to develop sepsis (1.718, 1.612-1.83), nutritional deficiency (1.963, 1.593-2.418), immunodeficiency (1.265, 1.098-1.459), eating disorders (2.569, 2.077-3.177), and depression (1.538,1.468-1.611). When compared to burn patients with no history of cancer, burned patients with cancer diagnosis had increased odds of developing sepsis (3.806, 3.502-4.137), nutritional deficiency (3.529, 2.725-4.571), immunodeficiency (6.657, 5.126,8.645), eating disorder (2.184, 1.787-2.67), and depression (2.147, 2.041-2.259). Further, burned patients with a history of lung cancer experienced a uniquely high risk of sepsis. Additionally, burn patients with histories of either lung or breast cancers were also at increased risk ratios of experiencing depression (p&lt; 0.05).

Conclusions
Burned patients with a history of a cancer demonstrated considerable increases in complications when compared to those with only a burn injury. Categorization of the broad “neoplasm” label uncovers patterns or trends for specific cancer types to inform the current healthcare system more accurately.
122 PTSD Symptom Clusters as Predictors of Pain Interference in Burn Survivors
Authors: Wiechman Shelley A , Bhalla Arjun , Bamer Alyssa M , Carrougher Gretchen J , Stewart Barclay T , Gibran Nicole S , Schneider Jeffrey C , Temes Christina , Stoddard Frederick J J , Roaten Kimberly 
Published: March 2022

Abstract

Introduction
Individuals who experience burns are at higher risk of developing post-traumatic stress disorder (PTSD) and chronic pain. There exists a synergistic relationship between PTSD and chronic pain in burn survivors. Theories exist about how aspects of each condition may perpetuate one another, or share underlying mechanisms. Both of these conditions are of relevance to pain-related disability. We sought to examine the role of individual PTSD symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two PTSD symptom clusters, pain intensity, and other covariates (burn size, hospital length of stay, age and gender).

Methods
Data were analyzed from the Burn Model System National Database. Inclusion criteria required participants to have a moderate to severe burn injury that required surgery for wound closure. Patient-reported outcome data: PTSD Checklist - Civilian, PROMIS-Pain Interference Short Form 4a, and a 0-10 average Pain Intensity item were analyzed at 6-months after injury. Hierarchical linear regression models were fit to examine the impact of PTSD symptom clusters on pain interference over and above that of pain intensity, and standardized betas were calculated (B).

Results
A total of 439 adult participants had complete responses on the measures of interest (e.g. PTSD symptoms, PROMIS-Pain Interference, and Pain Intensity) and were included in the analysis. Mean age, percent total body surface area burned, and hospital length of stay were 47 years, 18%, and 27 days, respectively. 69% were male and 82% were Caucasian. Results of a linear regression found that hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) PTSD symptom clusters were each significant predictors of pain-related disability, even when accounting for pain intensity (B = .64, p &lt; .001). The covariates age, gender, days until discharge, and TBSA were all nonsignificant. The model accounted for 61% of the variance associated with pain-related disability.

Conclusions
Results highlight the importance of the emotional numbing and hyperarousal PTSD symptom clusters in explaining pain interference. Future evaluations parsing out the longitudinal relationships (i.e., beyond 6-months postburn) between PTSD symptom clusters, pain intensity, and pain interference, as well as evaluating other underlying mechanisms, are warranted.
126 Are Burn-injured Youth Anxiety Disorders Being Missed Because Parents Are Unaware of the Problem?
Authors: Brubaker Rimmer Ruth B , Bay R C C , Kalil Emile T , Chacon Daniel W , Foster Kevin N 
Published: March 2022

Abstract

Introduction
Anxiety disorders among pediatric burn survivors have been shown to be common in both the acute care and outpatient settings. However, there is a paucity of research regarding parental awareness of psychological issues affecting burn-injured Dallas & adolescents. This study examined the relationship between burn-injured youths’ self-reported anxiety levels, as compared to their parent’s perceptions.

Methods
Parents of burn injured Dallas were invited to complete the Parent Version of the 41-item survey, Screen for Child Anxiety Related Disorders (SCARED) which consists of five anxiety sub-scales as well as a Total Anxiety Score. Their Dallas also voluntarily complete the Child Version. A higher score indicates greater anxiety.

Results
Forty-five parent-child dyads, with girls (51%) and boys (49%), completed surveys Ethnicity was reported as Caucasian (36%) Hispanic (42%) African Am (18%). Mothers (78%) fathers (18%) grandmothers (2%) & guardian (2%) participated. Mean parent age was 39. Child mean age was 13. Burn scars were visible in 64% of Dallas. Matched-pairs t-tests were used to compare parent and child scores. Parents reported lower SCARED Total Anxiety scores (mean=10.52) than youth (21.06), p&lt; 0.001. Parents also reported significantly lower scores on the Panic Disorder/ Somatic Symptoms (p&lt; 0.001), Generalized Anxiety Disorder (p=.004), Separation Anxiety (p&lt; 0.001), and School Avoidance subscale (p&lt; 0.001). For the Separation Anxiety scale, 23 youth’s self-report exceeded the threshold for suspected disorder, while parent report classified only 3 with separation anxiety. Spearman correlations between parent and youth scale scores yielded no significant results (all less than rs =.20, p &gt;0.25), indicating virtually no association between the two.

Conclusions
Results reveal a lack of parental awareness of their child’s anxiety disorder symptomology. This lack of recognition is of concern because Dallas are dependent on their parents/caregivers to identify psychopathologies and to help them seek services for mental health challenges.
128 Mental Health Outcomes in Burn Patients: A Single-site Experience
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Williams Felicia 
Published: March 2022

Abstract

Introduction
Burn injuries are a leading cause of morbidity and mortality among patients worldwide. Many survivors continue to suffer from psychiatric sequalae long after their physical injuries have healed. This may even be more pronounced in groups who have a history of mental health disorders prior to admission. Common pre-injury mental health problems may include substance abuse disorders, as well as affective, psychotic, and personality disorders. The aim of this study was to explore the outcomes of patients with previously diagnosed mental health disorders who were admitted to our Burn Center.

Methods
This was a single-site, retrospective review using our institutional Burn Center registry. All adult patients (18 years or older) admitted to our Burn Center between January 1, 2014 and June 30, 2021 who had a previous history of mental health disorders were included in this study. All adult patients who did not have any previous history of mental health disorders were also included for comparative purposes. Variables of interest included demographics, burn mechanism, length of stay (LOS), cost of hospitalization, and mortality. A p-value of &lt; 0.05 was considered statistically significant for all analyses.

Results
There were 7,976 patients included in this study, with 32% of these patients having a previous diagnosis of mental health disorders. The mean age was 43.5 years, and the mean total body surface area (TBSA) involvement was 5.9%. Both the groups with a history of mental health disorders and those without were predominantly male (63.8% versus 68.0%). Most patients were flame-injured in both groups (44.5% versus 40.9%). The mean LOS for those with mental health disorder history was 14.5 days compared to 8.3 days for those without (p &lt; 0.00001). The overall cost of hospitalization was $133,967 for those with mental health disorder history and $65,993 for those without (p &lt; 0.00001). The overall hospital mortality for those with mental health disorder history was 2.3% and 3.4% for those without (p = 0.007).

Conclusions
Although there was no increase in mortality among patients with pre-existing mental health disorders, we did find that there was an increase in the hospital length of stay, as well as the overall cost of hospitalization. These findings do indicate that individuals with pre-existing mental health disorders do not necessarily have worse outcomes in terms of mortality; however, they may need access to care for longer periods of time, which may contribute to increased medical costs.
503 Social Media as a Platform for Burn Survivor Outreach at a Safety Net Hospital
Authors: Colbath Rachel A , Ross Erin E , Ebner Peggy J , Yu Jeremy , Gillenwater Justin , Yenikomshian Haig A 
Published: March 2022

Abstract

Introduction
Outpatient follow-up is a critical component of burn recovery. Sociodemographic variables that prevent patients from pursuing follow-up can lead vulnerable groups to have a lower quality of life after burn injury. Social media provides a platform for improvement of patient outreach and support. The purpose of this study is to investigate accessibility and interest in social media interventions among socioeconomically disadvantaged and minority burn patients.

Methods
Patients receiving treatment at a burn clinic in a large public hospital were asked to complete a survey about social media usage, difficulty attending follow-up appointments, and interest in engaging with the hospital through social media. Patient demographics and clinical data were obtained via chart review. The relationship between clinical or demographic factors, and interest in social media engagement, was assessed via exact logistic regression.

Results
Data were collected from 65 eligible patients. Social media use among participants (76.9%) was similar to the proportion in the U.S. general population (72%). 61.5% of participants used Facebook, 40% used Instagram, and 4.6% used Twitter. 81% of participants had consistent internet access. 58.3% of respondents expected to encounter challenges when planning follow-up appointments. Challenges included difficulty with transportation (26.2%), trouble taking time off work (9.8%), and forgetting to schedule (9.8%). Participants were asked if they were interested in receiving post-discharge education, care team outreach, and follow-up reminders via social media. 36.5% of patients were very or moderately interested, 27% were slightly interested, and 36.5% were unsure or not at all interested.
20% of patients both expected follow-up challenges and were moderately or very interested in social media engagement. While controlling for social media use, the odds of having moderate or greater interest in the post-discharge engagement program were estimated to be 2.6 times higher for patients older than 39 (OR 3.64; 95% CI 1.03-14.24; P=.044). There was a pattern of lower interest in social media engagement with higher %TBSA, while controlling for age or social media use, though P values were higher than .05.

Conclusions
Over half of the burn patients surveyed expected to face challenges when planning follow-up appointments, a third of whom were moderately or very interested in social media engagement. Social media may be an alternative form of outreach with older patients in particular. Observed overlap between follow-up difficulty and outreach program interest may suggest such a program could ameliorate follow-up challenges.