bluuebunny/crossref_metadata_2025_split huggingface dataset:
76 A Retrospective Review of Factors Influencing Return to Work/school in Burn Patients
Authors: Foster Kevin N , Islas Claudia , Kabir Samin , Richey Karen 
Published: March 2022

Abstract

Introduction
Treatment and time to healing for burn injuries is largely dependent on the depth of the burn, location, and size. Treatment varies and can include any or several forms of dressings, surgery to remove eschar, allografting, autografting, depending on the depth of the burn. Hospitalization time ranges from days to months. Once discharged, patients continue to follow-up with burn specialists to ensure burns are healing properly. The time it takes a burn patient to return to work or school differ and can be dependent on many factors including personal choice. The objective of this study was to assess the time it took patients to return to work or school following burn injuries and help identify potential factors influencing their return time.

Methods
A retrospective chart review of patients aged &gt; 5 years, with TBSA &gt; 10%, requiring hospitalization for &gt; 7 days in a two-year span (2018-2019) was performed. Patients who did not report employment during admission and those who expired during hospitalization were excluded. IRB approval was obtained to contact patients via telephone who did not report a return to work or school date during their outpatient follow-up.

Results
There were a total of 1579 burn admissions from 2018-2019, 93 of those patients met final protocol criteria. Seventy-four of those patients returned to work/school (RTW), and nineteen did not return to work/school (N-RTW) as of chart review date. The average total body surface area (% TBSA) for RTW was 18.30 vs. 33.08 for NRTW (p=0.0002). The average length of stay (LOS) for RTW was 23.55 vs. N-RTW 51.15 (p=0.0102). Exact return to work/school dates were obtained from 67 patients. The average length of days to return to work/school (n=67) was 102.19 post discharge, the minimum was 2 days, and the maximum was 785 days. There were 9 patients in the N-RTW group who filed for disability.

Conclusions
Results suggest the average days per %TBSA it takes for burn patients to return to work or school is 5 days. Additionally, larger %TBSA burned and longer hospital LOS also adversely affected return to work. Additional studies are needed to identify additional factors influencing return to work and to identify methods to hopefully improve the ability to return to work.
99 Feasibility of Deep Learning-based Automatic Myofiber Size Measurement for Burn-induced Muscle Wasting and Its Reversal
Authors: Morinaga Hiroyuki , Sugawara Yoh , Chen Jingyuan , Martyn Jeevendra , Yasuhara Shingo 
Published: March 2022

Abstract

Introduction
Patients with major burn injury (BI) often develop muscle wasting (MW) and mitochondrial dysfunctions (MD), which affect their prognosis. We have recently shown that auto/mitophagy response is defective in BI model and can be mitigate by trehalose treatment. Though auto/mitophagy is widely accepted as the quality control (QC) system of cellular components including mitochondria, the relationship among MD, auto/mitophagy response defect, and MW was unclear. Furthermore, to evaluate MW precisely by morphometric analyses was difficult, due to the ehavy workload of counting the size of muscle cross sectional area manually and analyzing the data. Thus, we have set up a streamline of whole section image capturing, analyzing with cutting edge deep learning-based method, processing it via image J-based program. Using this system, we have tested the efficacy of trehalose on mitigating MW in BI-treated mice.

Methods
First, the effect of auto/mitophagy modulator on normalizing defective auto/mitiophagy maturation was confirmed by in vivo microscopy of tfLC3-expressing mice with BI (30% BSA) or sham-burn (SB) control. A mitophagy inducer, CCCP was injected to induce mitophagy, and the auto/mitophagosome maturation was monitored with or without trehalose treatment. In a separate experiment, tibialis muscles were harvested at post-burn day (PBD)-7, with or without trehalose treatment (2g/kg/day, i.p.), cryosectioned, and stained by anti-laminin antibody. The entire tissue cross-sectional microscopic images were captured, fed into a cellpose, and processed in ImageJ and Prizm for automatic calculation of the cross sectional area (CSA).

Results
In vivo microscopic monitoring of auto/mitophagosome maturation revealed BI-induced maturation defect when treated by CCCP, which was rescued by trehalose treatment. Next, with MW analysis experiment, cross-sectional morphometric analysis of tibialis anterior myofibers showed a typical bi-phasic pattern of CSA distribution (large size population and small size population) in the control group. BI treatment showed a significant CSA decrease in both populations, which was effectively treated by trehalose. The average CSA was as follows (1843.0, 1245.3, 1683.9 for SB control, BI, BI+trehalose, respectively, in micron^2), and in accordance with manual counting measurement.

Conclusions
Normalizing defective auto/mitophagy response was shown an effective therapeutic approach to mitigate BI-induced MW. Deep learning-based size counting method is a feasible technique for a systematic MW analysis. Note that in our data, trehalose does not function in increasing the basal level of autophagy, but it mitigates the defective response of auto/mitophagy to the auto/mitophagic stimulation, by normalizing the maturation process.
104 Parkin-independent Pathway of Mitophagy as a Potential Target Mitochondrial Dysfunctions in Burns
Authors: Chen Jingyuan , Sugawara Yoh , Morinaga Hiroyuki , Martyn Jeevendra , Yasuhara Shingo 
Published: March 2022

Abstract

Introduction
In many critical illnesses including burn injury (BI), muscle wasting (MW) with mitochondrial dysfunction (MD) leads to poor prognosis. Disturbed mitochondria can normally be turned over by autophagic degradation of mitochondria (mitophagy). We have previously observed that BI causes disturbed mitophagy response in skeletal muscles both in vivo and in the cultured myocytes, a potential mechanism for BI-induced MD. These previous findings have lead to the expectation that augmenting mitophagy will rescue mitochondrial functions and can help treating the BI-induced MW and MD. There have been, however, limited research tools to specifically intervene (or augment) mitophagy. In the current study, we have established mitophagy-compromised cell strains by CRISPR/Cas9-mediated knocking out of BNIP3L, a pivotal molecule mediating parkin-independent mitophagy induction. Deferiprone (DFP), a recently established mitophagy inducer, had previously been known to exert cellular and organ protective functions, but the mechanisms of its beneficial effects were not investigated in detail. Nor has its efficacy been tested on BI-induced MD.

Methods
First, whether DFP stimulated mitophagy induction causes translocation of mitophagy markers into mitochondrial fraction, was tested by Western Blotting on the WT C2C12 cells against Parkin/PINK1- and BNIP3L- pathway molecules. Next we established BNIP3L knockout C2C12 myoblast cell like by CRISPR/Cas9-mediated gene deletion. Using both WT and BNIP3L knockout (KO) cell lines incubated in the BI or SB serum (from 30% rat burn at 3PBD) with or without DFP treatment, we tested whether DFP can rescue BI-induced upregulation of mitochondria-derived superoxide (SO) using MitoSOX staining.

Results
In WT C2C12 cells, mitophagy stimulation by DFP caused robust increase of the protein amount of BNIP3L in the mitochondrial fraction, but Parkin/PINK1 did not. KO completely abolished both basal and stimulated increase of BNIP3L. BI serum caused significant elevation of mitochondrial SO in WT myocytes ( &gt;20 fold of SB), which was ameliorated by DFP-stimulated mitophagy augmentation (95% reduction). In KO C2C12 cells, however, DFP-induced SO reduction in BI serum was completely abolished, suggesting that DFP-mediated mitochondrial protection against BI was through augmenting mitophagy via BNIP3L pathway.

Conclusions
By using BNIP3L KO C2C12 myocytes, mitochondrial protective role of BNIP3L-mediated mitophagy against BI-induced stress was demonstrated for the first time. Previously reported cellular and organ protective functions of DFP is likely through activation of this pathway. Augmentation of mitophagy will be a promising therapeutic approach in protecting BI-induced MW and MD.
111 Optimizing an Outpatient Mhealth Intervention for Dallas with Burns: A Mixed Methods Study
Authors: Lesher Aaron , Gavrilova Yulia 
Published: March 2022

Abstract

Introduction
Pediatric burn injury remains one of the most common traumatic injuries in childhood. Fortunately, up to 90% of pediatric burns may be treated safely in the outpatient setting after appropriate burn triage. Patients face significant geographic disparities in access to expert burn care due to the regionalization of burn care. To aid patients and their families during acute burn recovery, a smartphone app was developed to improve patient outcomes, increase access to care, and streamline communication. The purpose of this study is to evaluate patient-derived feedback to optimize this burn app prior to subsequent efficacy testing.

Methods
The burn app was evaluated using a mixed-method approach consisting of qualitative semi-structured interviews and quantitative usability data gathered from caregivers of pediatric burn patients who utilized the app during the treatment phase of their child’s burn injury. Usability data were collected using a psychometrically validated mHealth App Usability Questionnaire (MAUQ). To analyze the interview transcriptions, we followed the Braun and Clark (2006) framework of thematic analysis. The research questions focused on caregiver perceptions of smartphone-enhanced pediatric burn care and potential app improvements, including acceptability, usability, technical preferences, and emotional perceptions.

Results
14 caregivers (93% women; M age = 36) completed the study. Overall MAUQ scores (M = 6.46; SD = .62) indicated high app usability. Ease of Use & Satisfaction (M = 6.66; SD = .42), System Information Arrangement (M = 5.93; SD = 1.07), and Usefulness (M = 6.69; SD = .61) subscales indicated an average degree of agreement above “somewhat agree” with usability statements. Furthermore, 13/14 (93%) caregivers reported a positive overall experience and agreed that the app was an acceptable method to monitor burn care. 12/14 (86%) caregivers reported that the app captured important clinical information. 53% preferred app-based burn care, 31% preferred both face-to-face and app-based care, and 15% preferred in-person only. Only 1 person preferred synchronous video-based care to asynchronous text-messaging. All study participants suggested improvements, with the most common being: (1) keeping user logged in, (2) time-stamping photos and messages, (3) consolidating text-messages and pictures, (4) adding push notifications and appointment reminders, and (5) tracking pain level.

Conclusions
Mobile health technology may be leveraged to improve outpatient burn care. The results from this study (1) demonstrate caregiver experiences using a novel mHealth platform for outpatient pediatric burn care which showed high acceptability and usability and (2) provide systematic data for app optimization.
116 Clinical Impact of Transitioning from a Burn Provider-based to Hospitalist-based Sedation Service
Authors: Khandelwal Anjay , Solomon Jeffrey D , Beaucock Beverly , Lou Richard B 
Published: March 2022

Abstract

Introduction
Burn patients often experience a tremendous amount of pain and anxiety during dressing changes and other procedures, frequently requiring a moderate sedation (MS) or deep sedation (DS) for successful completion. We previously reported our primarily Nurse Practitioner-based model for procedural sedation but recently transitioned to a primarily hospitalist-based sedation service. We evaluated the clinical and financial impact of this transition.

Methods
Retrospective chart review of patients undergoing MS or DS from June 2019 to June 2020 (burn provider-based [BPB]) and August 2020 to August 2021 (hospitalist-based [HB]). Data included demographics, number and types of sedation, provider type, American Society of Anesthesiology Physical Status Classification (ASA score), complications and relative value units (RVU)/anesthesia units generated. Our hospitalist completed a combined Internal Medicine-Pediatrics residency and is credentialed by the institution for procedural sedation.

Results
During the BPB sedation timeframe, 263 patients were admitted to the burn center, of which 55 patients (21%) underwent 203 sedations (average: 3.6 sedations/patient). Twenty-one (10%) were DS. The most common medications used for DS were a combination of Midazolam, Ketamine, Fentanyl, Glycopyrrolate and Ondansetron (81%); and for MS, a combination of Fentanyl and Midazolam (77.5%). Ten percent of patients had an ASA of 3 or greater.
During the HB sedation timeframe, 203 patients were admitted, of which 73 patients (36%) underwent 353 sedations for an average of 4.8 sedations/patient (74% increase). Ninety-one (26%) were DS (333% increase). Medication combinations were similar as above for DS (90%) and MS (93%). Nineteen percent of patients had an ASA of 3 or greater.
Our hospitalist performed 16% of the sedations in the BPB timeframe and 72% in the HB timeframe. In the BPB group there were 4 desaturation events (0.02%) among all sedations, compared to 8 desaturation and 1 hemodynamic change events (0.025%) in the HB group. Total work relative value units (wRVUs) and anesthesia units of service (for the DS) generated were 599.6 and 133 respectively in the BPB group compared to 1104.2 (84% increase) and 784 (489% increase) respectively in the HB group. During the BPB timeframe 40 patients were taken to the OR for dressing changes for a total of 69.3 hours, compared to zero in the HB timeframe.

Conclusions
Transitioning from a BPB to HB sedation service resulted in increased sedation numbers and percentage of patients undergoing a sedation, especially DS, as well as increased RVU generation. Sedations were performed in patients with higher ASA scores without a significant increase in adverse events. There was operating room cost and time savings. HB sedation services can be an efficacious and safe model in a burn center.
121 Acute Stress Disorder and Post-traumatic Stress Disorder in the Outpatient Burn Population
Authors: Dyamenahalli Kiran U , Carmichael Heather , Wiktor Arek J 
Published: March 2022

Abstract

Introduction
Early screening and intervention for acute stress disorder (ASD), diagnosed within 30 days of the inciting trauma, and post-traumatic stress disorder (PTSD), diagnosed after 30 days, are quality metrics in burn care. However, a considerable knowledge gap remains surrounding these psychological conditions in the outpatient burn setting. In this study, we assessed the effectiveness of ASD and PTSD screening at an academic burn center and identified risk factors for their development.

Methods
A retrospective cohort study of all patients treated at our ABA-verified burn center’s outpatient clinic, between July 2016 and August 2019, was undertaken. Adult patients with flame, flash, contact, or scald burns who were initially evaluated in the outpatient setting were included. ASD and PTSD were assessed using validated screening tools (ASDS and PCL-5, respectively). ASD/PTSD screening rate, screening tool appropriateness, and subsequent interventions were tracked, along with age, gender, % total body surface area (TBSA) burned, burn mechanism, operative intervention, psychiatric history, substance abuse history, and co-morbidities. Chi-square and Mann-Whitney U tests were used for univariate analysis of categorical and continuous variables, respectively.

Results
The analysis included 2494 clinic encounters and 1147 unique patients. Patients were screened for ASD or PTSD at 94.8% of encounters. Median age was 36 years (range of 18 to 94 years), 57.6% of patients were male (n=661), and median TBSA burned was 1% (range of 0.1 to 12%). Among all screens, the appropriate screening tool was applied 88.5% of the time. For all encounters, positive screening rates for ASD and PTSD were 13.2% (n=286) and 14.6% (n=48), respectively. Risk factors for positive ASD screens included a history of substance abuse (OR 1.9, p=0.03) and history of psychiatric illness (OR 2.6, p=0.002). Similarly, risk factors for positive PTSD screens included a prior positive ASD screen (OR 9.5, p=0.001), a history of substance abuse (OR 2.1, p=0.04), and a history of psychiatric illness (OR 3.3, p=0.002). Age, gender, burn mechanism, TBSA burned, and need for operative intervention did not predict positive screens. The intervention rate for positive PTSD screens by referral, counseling, or medication, was only 7.9%.

Conclusions
Demographics and burn severity do not appear to predict development of ASD or PTSD in the outpatient burn population. In contrast, a history of substance abuse or psychiatric illness warrant further attention. Despite consistent use of validated screening tools, these conditions remain under-treated in the outpatient setting, indicating a need for resource-expansion.
540 Burn-Specific Triage Guidelines in State-Based Crisis Standards of Care
Authors: Chrisco Lori , Williams Felicia , King Booker , Nizamani Rabia 
Published: March 2022

Abstract

Introduction
In times of crisis, medical institutions must utilize contingency plans to ensure the highest quality of patient care. When these plans are overwhelmed, crisis standards of care may be adopted, resulting in modifications in resource allocation. The current coronavirus pandemic has created tremendous strains on hospitals throughout the world, with periodic shortages in equipment, PPE, ICU beds, and personnel. These pressures have been great enough at times to result in several states implementing crisis standards of care to allow hospitals to triage patients and "do the most good possible for the largest number of people with limited resources". However, these guidelines may not account for the unique needs of burn patients, whose care is often resource intensive. We examined state-based crisis standards of care guidelines in the United States to ascertain the degree to which triage of burn patients was addressed.

Methods
Internet search engines were used to locate state-specific actionable “crisis standards of care” or “scarce resource allocation” policies available before October 1, 2021. Once identified, these guidelines were further examined to determine whether explicit information was provided to direct the triage of burn patients.

Results
Of the 50 states and the District of Columbia, only 35 states (70%) were confirmed to have official crisis standards of care policies that could be implemented by healthcare institutions during the current pandemic. Additionally, guidelines from non-government entities were identified for 4 states (Florida Bioethics Network, Ohio Hospital Association, Missouri Hospital Association, and West Virginia Hospital Association). Of the 39 plans available, only 13 (26%) provided specific information regarding triage of burn patients during implementation of crisis standards of care.

Conclusions
Crisis standards of care are heterogenous throughout the United States and have varying levels of specificity. The majority of states and the District of Columbia do not provide clear, actionable guidance on the triage of burn patients.
542 Mobile Burn Response Teams: A Scoping Review
Authors: Fuchko Danielle H , King-Shier Kathryn , Gabriel Vincent 
Published: March 2022

Abstract

Introduction
Advancements in the treatment of burns have reduced morbidity. However, the resources needed to deliver up-to-date care may be overwhelmed by mass casualty disasters. In 2021, the World Health Organization (WHO) recommended that countries prepare teams of deployable burn experts to assist with responding to a mass casualty disaster including burn patients. The aim of this scoping review was to identify existing literature regarding burn management mobile response team organization, describe the reported effectiveness of these teams, identify challenges in adopting the WHO recommendations and consider how the recommendations may be evolved.

Methods
We conducted a scoping review of all literature types published up to February 2021. Searches of MEDLINE, EMBASE, Scopus, and CINAHL databases were conducted to identify reports informing or reporting the use of mobile burn care specialty teams that respond to events resulting in multiple burn-injured victims, including pediatric victims and military response to civilian events.

Results
Of 5,737 identified reports, 24 publications were reviewed. Three distinct types of mobile burn response teams were identified: 1) teams organized by burn care networks; 2) government-organized medical disaster teams with burn-specific experts, and 3) the US Army Burn Flight Team. Teams have responded to events such as terrorist attacks by providing specialized burn supplies and personnel. Mobile burn response teams have demonstrated expert triage and stabilization advantages but are limited by the number of deployable specialists. A challenge in deploying a mobile team is the removal of experts from a burn centre.

Conclusions
Although the WHO recommends increasing the number of mobile burn response teams available around the world, few countries have implemented this recommendation. A hybrid model where responders on scene communicate with burn centre experts to manage triage may address these challenges.
547 Clinical Outcomes for Burned Patients with Covid-19
Authors: Walters Elliot , Shah Nikhil , Wolf Steven E 
Published: March 2022

Abstract

Introduction
The COVID-19 epidemic has affected all aspects of medical care including a reduction in elective procedures, however, the incidence of burns and treatment for this condition has continued undaunted. Some of these patients were also diagnosed with COVID-19 infection, but it is unclear what effect, if any the SARS-CoV 2 virus has on patients recovering from a burn injury. In this study we examined the outcomes of burned patients with a concomitant diagnosis of SARS-CoV 2 virus.

Methods
We examined a de-identified database of patient electronic medical records across 55 health care associations containing over 75 million patients. ICD 10 codes were used to identify those with thermal or chemical burns from January 1, 2020 to July 31, 2021 and those also diagnosed with Sars-CoV 2 virus infection within 1 month of injury. We found 49,501 patients suffered burns during the study time period; of these 474 patients (0.96%) also experienced a concomitant COVID-19 infection. We compared outcomes based on ICD 10 and CPT codes.

Results
We found no significant increase in mortality between groups during the study period. However, we did find a significant increase in infections, pneumonia, respiratory failure and sepsis in those with Sars-CoV infection (p&lt; 0.05). However, there was no significant increase in ventilator management days (p &gt;0.05) In terms of wound healing, patients with COVID-19 also experienced significantly more excision and grafting procedures and had a higher incidence of hypertrophic scarring (p&lt; 0.05).

Conclusions
COVID-19 infection is well known to worsen respiratory outcomes, but in burned patients was also associated with an increase in other infections and poorer wound outcomes. These outcomes may emanate from a change in inflammatory status for patients with the SAR-CoV 2 virus infection. This is the first broad-based study to examine outcomes of burn victims with concomitant SARS-CoV 2 infection. Further investigation is indicated as more long-term data becomes available.