bluuebunny/crossref_metadata_2025_split huggingface dataset:
772 Impact of Clinical Course on Psychosocial Outcomes in Adult Burn Survivors
Authors: Ross Erin E , Colbath Rachel A , Yu Jeremy , Munabi Naikhoba , Gillenwater Justin , Yenikomshian Haig A 
Published: March 2022

Abstract

Introduction
There has been conflicting data on the relationship between burn severity and psychological outcome. The present study aims to characterize the baseline psychosocial disposition of adults attending outpatient burn clinic at a large county hospital, as well as the impact of clinical course on self-reported psychosocial well-being.

Methods
Adult patients attending outpatient burn clinic completed survey questions from National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Managing Emotions (ME) and Managing Social Interactions (MSI). Sociodemographic variables collected from surveys and retrospective chart review included age, ethnicity, zip code, employment, and marital status. Clinical variables included total body surface area burned (TBSA), initial hospital length of stay (LOS), surgical history, and number of days since injury. US census data based on patient’s home zip code was used to estimate percent of community living below US poverty level. Scores on ME and MSI were compared to the population mean by one-sample T-test. TBSA, hospital LOS, surgery, and days since burn were separately evaluated for associations with ME and MSI scores by Tobit regression while adjusting for sociodemographic variables.

Results
71 patients completed surveys. Compared to the general US population mean score of 50.0, had lower scores in MSI (mean=48.0, p=.041) but not significantly different ME scores (mean=50.9, p=.394). While controlling for age, ethnicity, marital status, employment status, and neighborhood poverty, increased LOS was associated with lower scores on both ME and MSI scores (Table 1); the associations of TBSA, surgical

Conclusions
Burn patients may experience difficulty in getting support after burn injury. This challenge may be increased in patients with more extensive debilitation after injury, as increased duration of hospitalization worsened self-efficacy for managing emotions and social interactions. Additionally, prolonged hospitalization may remove patients from their normal support systems.
773 Insurance Coverage Does Not Increase Risk of Depression and Anxiety in Burn Patients
Authors: Pezzopane Laura , Gray Anthea , Cordova Alfredo C , Bergus Katherine , Bernal Nicole O 
Published: March 2022

Abstract

Introduction
A burn injury can have long-term mental and physical effects on individual patients. When burn injuries occur at work, there is an additional unfamiliar stress of income loss and dependence on a third-party payer. Patients with claims through the Bureau of Worker’s Compensation (BWC) report frustration and overall dissatisfaction in working with the BWC to achieve claim coverage. Of workers who are off of work more than 5 days due to a work-related injury, 10% are diagnosed with depression in the 12 months following the injury (Carnide, 2016).
In our clinic, screening for depression and anxiety is done through the Patient Health Questionnaire (PHQ-4), a valid four-item assessment tool that utilizes a Likert style measurement to assess symptoms of depression and anxiety (Kroenke et al., 2009). This is a health questionnaire that determines a patient’s risk for depression and anxiety as mild, moderate, or severe.

Objective
To determine if there is a correlation between insurance type and PHQ-4 scores in burn patients. We hypothesized that risk of depression and anxiety could differ based on payer, which can affect a patient’s access to care, referral approval, and financial burden of treatment. Additional focus was placed on BWC patients due to their reported frustrations and dissatisfaction in working with BWC and the established correlation between depression and missed work.

Methods
A quality improvement project was initiated based on increased rates of referrals for psychological evaluation and treatment in BWC patients. A retrospective review was conducted of outpatient burn clinic visits where a PHQ-4 questionnaire was completed in the past 3 fiscal years: 7/1/2019-6/30/2021.

Results
Total of 1932 visits with PHQ-4 collection were reviewed within the above specified time frame. The rates of moderate and high-risk scores for anxiety and depression were highest with BWC and Medicaid patients. Patients with private insurance showed a lower risk of moderate and severe depression. However, there was no significant difference when comparing BWC verses all other insurance. Table 1

Conclusions
Overall there was no significant difference in risk of anxiety and depression with BWC versus other insurance coverage based on PHQ-4 scores. Limitations of the study include no distinction of extent of burn injury/burn depth, burn care/treatments, length of hospital stay if any; no distinction was made amongst BWC patients and their length of time off of work. A portion of the timeframe reviewed was during the COVID-19 pandemic.
776 Quality Improvement in Prehospital Burn Care
Authors: Phillips Frank , Sturges Mariah 
Published: March 2022

Abstract

Introduction
Burn center implemented a new quality improvement program with emergency medical services (EMS) that examined patient care prior to arrival. Inconsistencies were noted with key interventions that would improve patient’s overall health. These included oxygen administration, fluid resuscitation, pain management, and the application of sterile dressings. There was also improvement in the transfer of care from EMS to receiving hospital.

Methods
Patient care reports were examined to see the quality of care that was being given in the prehospital setting. Based on these results, education in the form of a lecture and prior cases are presented routinely to different emergency medical services. To improve transfer of care at bed side from EMS, “burn page” was created. This is a page sent directly to charge nurse of burn unit, emergency department, attending physicians of burn unit, outreach coordinator, and prehospital care coordinator. This allows for improved preparation to receive burn patient from EMS. After the patient is received from EMS, a patient follow up is provided by the prehospital care coordinator to EMS within 24 hours. The patient care report from EMS is reviewed along with the care currently being provided by the burn unit. A case review is scheduled with EMS to examine the care provided and see where improvement can be made with both EMS care and the transition of care at the bed side. This case review also allows the EMS crew to see how the patient is doing a few weeks later.

Results
The burn center has noticed drastic improvement of care in the prehospital setting. This includes hitting critical bench marks as described in the introduction. This improvement is seen at the transition of care at bedside and in patient care reports done by EMS. These EMS providers also express the improvement of how patients are transferred to the burn center and a sense of trust that the patient will have excellent burn care. They also express that creating the patient follow ups and case reviews helps close the loop in patient care resulting in better burn care being provided in the prehospital setting.

Conclusions
With noticing what critical bench marks that were not being met regarding burn care in the prehospital setting, corrective actions can be created that will establish a closed loop that drastically improves care. From the point of injury to the end of stay in the burn unit, patient care has been drastically improved.
781 Multimodal Virtual Reality Encouragement
Authors: Thomas Mini , Blacker Hayley 
Published: March 2022

Abstract

Introduction
Burn units’ nurses develop creative methods to mitigate unpleasant experiences. Peer reviewed research has affirmed that non-pharmacological stimuli can distract patients from noxious procedures. Therefore, novel virtual reality was introduced as a nurse-driven modality to improve patient care. Multiple approaches encouraged staff utilization of this exciting, yet unfamiliar, technology.

Methods
A needs assessment concluded that patients experience moderate pain and some anxiety during wound care - indicating an opportunity to explore virtual reality. The virtual reality headset was introduced to nurses via in-services to encourage hands-on experience. The following month, an interactive “VR Superstars” poster was developed as a visual cue to motivate nurses to attempt the new product. Whenever a nurse used the device with a patient, a star sticker was applied next to his/her name. Next, a resource binder was created: This binder included the device protocol, patient inclusion criteria, educational handouts to assist staff with introduction to patients, and surveys. Biweekly emails encouraged virtual reality use and acknowledged staff members who proactively utilized it. The multidisciplinary team also discussed virtual reality at daily rounds.

Results
To assess virtual reality’s effectiveness, patients completed surveys after each use. At the end of the first month, staff implemented virtual reality only three times - as identified by the number of surveys. Upon completion of the multi-modal staff encouragement, virtual reality use doubled. By the third month, nurses implemented the technology on six occasions within the month.

Conclusions
The multi-modal approach ultimately familiarized nurses. These techniques contributed to increasing staff experience, thereby improving staff confidence to utilize a new product. As exposure increased, nurses reported more excitement to introduce the product to patients. Due to the implementation of multiple motivators, nurses are more readily implementing an intervention to benefit a patient’s experience.
787 Two Year Follow Up of Microblading in Patients with a Facial Burn Injury
Authors: Brown Melissa , Turgeon Lori , Bojovic Branko 
Published: March 2022

Abstract

Introduction
Recovery from a facial burn injury can be challenging. Excessive reconstructive interventions and the emotional devastation can be taxing. Microblading, semi-permanent eyebrow tattooing, is a potential non-invasive alternative treatment. Little research exists on microblading’s longevity and durability over burn scar or its impact on self-esteem. A single case study showed positive impact on patient perceived body image and maintenance of shape and color. Two years post microblading new data supports its efficacy as a potential treatment for patients with a facial burn.

Methods
Single case study two years post microblading of a 22-year-old female who sustained a 30% total body surface area burn injury to bilateral upper extremities, hands and face at age one. Based on referral from her plastic surgeon, she underwent first microblading treatment March 2019 with a standard touch up session May 2019. Patient has not undergone any additional sessions since. Photos obtained two years post treatment were compared to before/after photos immediately following microblading to assess longevity and durability on scar tissue. Self-reported patient outcomes obtained two years after microblading assessed impact on self-esteem and body image.

Results
Photos were taken pre/post microblading, at nine months, and 2.5 years post. Comparison of photos over time showed some expected fading but maintenance of overall shape. Patient self-reports using an eyebrow pencil to darken when she desires brows that are more vibrant and trims hair as needed to maintain shape. Patient reports positive impact to her self-esteem post-microblading. “I most definitely did notice some changes in my self-esteem.” She notes feeling happier and more confident, especially in social situations with peers. Comparison of responses immediately post-microblading with 2.5 years later show focus on improved self-esteem versus satisfaction with appearance of the eyebrow.

Conclusions
Comparison of follow up photos obtained 2.5 years after initial microblading shows maintenance of eyebrow shape with some fading of color. Further research is needed to determine if color fading is as expected or more pronounced in patients with scarred skin. Also important is the impact of characteristic dryness of scars on fading rate. To maintain adequate color, additional treatments would be recommended. Better understanding of factors affecting fading would help determine frequency and timing of maintenance sessions. Patient report indicates increasingly improved self-esteem over time as evidenced by focus on confidence versus appearance. Despite some fading, data supports microblading as an effective non-surgical treatment in establishing eyebrow appearance and function over burn scar.
789 Role of Speech Therapy (SLP) in the rehabilitation of a complicated case of glossoparesis (GP)
Authors: Shaw Janet , Wilson Joan 
Published: March 2022

Abstract

Introduction
Glossoparesis is defined as a neurodegenerative process resulting in progressive dysphagia and dysarthria. The deinervation of the tongue and related structures results in flaccid muscle function unilaterally and bilaterally, this process is difficult to treat and rehabilitate and prognosis is considered poor. We encountered this in a patient that had a complicated case of necrotizing fasciitis (NF) that arose from an abscessed tooth.
The purpose of this case report is to summarize the overall approach to a rehabilitation plan which resulted in successful return to speech and partial swallow.

Methods
The patient was diagnosed with an abscessed tooth which resulted in Necrotizing fasciitis of the face, neck and chest. Multiple surgical interventions resulted in removal of necrotic tissue and reconstructive interventions were implemented. Initial prognosis of return of function was noted as “poor” per ENT services. Ear, Nose and Throat (ENT) specialist noted that prognosis for recovery of function is unknown but was low.
Speech Therapy was also consulted and an individualized plan of care to address the deficits assessed was developed. Initial prognosis of return of functional speech / swallow was guarded. It was felt to be highly appropriate to provide the patient with therapeutic options.
Speech Therapy sessions included use of Neuromuscular Electrical Stimulation, Thermal Stimulation, Tactile Stimulation, Therapeutic Massage to affected regions, Deep Pharyngeal Neuromuscular Stimulation, finger occlusion trials for speech production attempts to ready patient for use of Passy Muir Valve, Oral Motor Exercises, Laryngeal Elevation Tasks, Vocal Stretching / Relaxation tasks and oral trials of ice chips as musculature function improved.

Results
Through the use of these multiple modalities of skilled speech therapy intervention, the patient had return of functional verbal communication prior to discharge to a skilled rehabilitation program.

Conclusions
Upon initial evaluation, the true potential for return of function was questioned. It is paramount that patient be given an opportunity to succeed - to be included in the plan of care - to be provided with opportunities to return to their prior level of function or as close as possible. There is little to no research regarding return of function for patients affected by glossoparesis.
791 Occupational Therapy in Operating Room An Emerging and Distinct Role in Collaborative Burn Care Practice
Authors: Espelita Allen R 
Published: March 2022

Abstract

Introduction
Numerous health professions face challenges and opportunities resulting in increasing contexts for service delivery. One element of this changing landscape for occupational therapy is the ongoing development and delivery of services in new or underdeveloped practice settings, often identified as emerging practice (Holmes & Scaffa, 2009). Often, occupational therapy practitioners work on interprofessional teams. Articulating occupational therapy's distinct value is necessary to communicate with clarity to those outside of the profession. According to the American Occupational Therapy Association (AOTA) Vision 2025, As an inclusive profession, occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living. One of the pillars identified in the AOTA 2025 vision is Collaboration: Occupational therapy excels in working with clients and systems to produce effective outcomes (AOTA, 2017).

Methods
Through the initiative of one of the surgeons, she collaboratively integrated Occupational Therapy in the OR during the debridement and skin grafting process. While the patient is on sedation, the surgeon allowed OT to facilitate a range of motion, allowing optimal range of motion (ROM). The focus of the management in the acute phase of burn rehabilitation is the preservation of function through the prevention of deformities. Using a case study, the therapist's clinical and professional reasoning concerning a client's occupational performance (AOTA, 2020 p.20).

Results
Occupational therapy specialists use theoretical principles and models, knowledge about the outcomes of disorders on participation, and existing evidence on the efficacy of interventions to guide their reasoning. Understanding this distinct role as an occupational therapist should start from the beginning of burn care management among patients with burns inside the operating room. Having said all this, our Rehabilitation Department Burn Therapy Team was allowed to learn the introductory course in scrubbing, gowning, and gloving for healthcare professionals.

Conclusions
The idea of health care teams working together is not new. However, applying a culture of transformation, where concepts such as patient safety, mutual respect, shared decision making, and patient centered care are the norm, remains a novel and often fleeting idea in most burn care facilities (Sexton & Baessler, 2016).
795 Autologous skin cell suspension application for toxic epidermal necrolysis: a case report
Authors: Pang Alan , Pham Theophilus , Felan Sarah , Raghuram Akshay , Terry Michelle , Bharadia Deepak , Griswold John A 
Published: March 2022

Abstract

Introduction
Toxic epidermal necrolysis (TEN) is a drug-mediated disease which occurs at the same level of a partial thickness thermal injury. It has been treated with frequent dressing changes and supportive care as there are no definitive therapies. The pathophysiology involves necrosis of keratinocytes at the dermal-epidermal junction leading to sloughing of the epidermis and sub-epidermal bullae. Patients have massive fluid and electrolyte dysregulation due to chronic wounds that are susceptible to infection. This case report describes the application of autologous skin cell suspension (ASCS) to a patient with TEN. His hospital course included arrest of the disease process, timely closure of the wound, and minimal wound care. To our knowledge, this is the first case of TEN treated with ASCS.

Methods
The patient was mechanically debrided with a water scalpel hydrosurgery system to remove all devitalized tissue. A donor graft for ASCS was then obtained at standard depth from unaffected skin at the ankle and was processed in the standard fashion and applied to the wound. Clear plastic dressing with a non-adherent, antibiotic impregnated cloth dressing followed by dry non-shear dressing were then applied to the torso. Extremities were dressed in clear plastic dressing, antibiotic impregnated cloth dressing, zinc paste impregnated cloth, dry gauze roll, and elastic compression bandage. This was performed over the patient’s anterior surface and subsequently on the posterior one week later. Dressings were taken down on post-operative day (POD) 6 and replaced as appropriate.

Results
The patient demonstrated 60% closure of wounds on his anterior torso at POD 6. By POD 8, the patient's anterior torso and face were completely closed. His second application of ASCS to his posterior closed in a similar timeline. The patient was discharged on POD 16 from his initial intervention with 2% total body surface area open. At POD 30, his wounds were healed with the return of a large portion of pigmentation.

Conclusions
TEN is a rare, high-mortality disease without efficacious therapy. Given that the wounds are at a similar level to a partial thickness burn, ASCS could be a new intervention which could mitigate open wounds, frequent dressing changes, prolonged hospital stays, and mortality.
800 Immediate/Ultra-Early v. Early Burn Excision: A Systematic Review of Surgical Outcomes
Authors: Lagziel Tomer , Cemaj Sophie L , Mafla Laura M , Karius Alexander K , Hultman Charles S 
Published: March 2022

Abstract

Introduction
This is a systematic review which seeks to establish if immediate/ultra-early excision (immediate: &lt; 24 hours, ultra-early: 24 - 72 hours) and grafting is better or equivalent to early excision and grafting (early: 72 hours - 6 days) in adults with major burns. The concept of early excision and grafting, as opposed to late excision (late: &gt;7 days), was introduced by Cope et al. and later popularized by Janzekovic in the 1970s when she introduced the concept of tangential excision. Delaying excision 24 to 48 hours has previously been thought to allow resuscitation and correction of physiologic derangements to optimize outcomes. However, timing for excision and grafting is subject to debate. The outcomes of interest include mortality, length of stay, complication rates, wound healing time, infection rates, physiologic demand, blood loss, and resting energy expenditure.

Methods
In this systematic review, we searched PubMed, Embase, CINAHL, Cochrane, Web of Science, and Scopus for studies that compared outcomes and complications between burn patients with ultra-early and early excisions. From this search, we screened 4235 articles. Through our selection criteria, five articles focusing on timing of burn excision were selected for systematic review.

Results
Five studies observing a total of 382 burn patients, published between 1995 and 2016, were included. All five studies are cohort studies, three were prospective studies while two were retrospective chart reviews. Two studies showed decreased length of stay with immediate/ultra-early excision (Still, Keshavarzi) and decreased time to healing with immediate/ultra-early excision (Guo, Lu). One study demonstrated decreased infection and mortality in ultra-early excision (Keshavarzi). One study demonstrated decreased resting energy expenditure in the ultra-early excision group (Gao). One study showed a decrease in blood transfusion in the immediate/ultra-early excision group (Guo). Both the Guo and Gao studies suggest that concerns over excision during the burn shock period may be unfounded provided that the patient is adequately resuscitated.

Conclusions
Studies investigating the immediate/ultra-early excision of burns tend to show improved outcomes for adults with major burns. It is difficult to attain conclusive data due to the lack in overlap of reported outcomes in modern studies. More studies are needed which compare outcomes in adults with major burns between immediate/ultra-early excision and early excision.