bluuebunny/crossref_metadata_2025_split huggingface dataset:
767 Medical Decision Making in the Burn Unit: A Qualitative Study
Authors: Gerrek Monica L , Lambrix Marcie A , Goff Anna D , Yowler Charles J 
Published: March 2022

Abstract

Introduction
In 1973, Dax Cowart was severely burned as a result of a car explosion. He spent the next 46 years advocating for patients’ rights to decline treatment as he felt his repeated wishes to do so and be allowed to die were ignored by his burn providers. Due in large part to his advocacy, many strongly believe that burn providers are problematically paternalistic and force unwanted treatment upon capacitated, autonomous patients (e.g., Hurst et al 2014). Unfortunately, there are only a few attempts to provide the perspectives of other severely burned patients (e.g., Brewster et al 2006 and Gerrek 2018). The purpose of this qualitative study was in part to gain further understanding of the views of severely burned patients regarding medical decision making during the acute phase of their injury.

Methods
Building on Brewster et al. and Gerrek, our team created a semi-structured interview questionnaire. We followed standard IRB research study protocols and then identified adult individuals with 2nd and 3rd degree thermal injury minimum 30% TBSA burns for recruitment. Though 20 patients met the criteria, we completed 5 (26%) interviews (3 females, 2 males).

Results
All interviewees discussed ways in which they struggled to make informed autonomous decisions for weeks or even months post-injury and felt dependent on the burn team to lead them through treatment decisions.
“[I]t's all new to me … obviously I've never been burnt like this before. I will assume it's similar for most of the people … when you wake up and find out how badly you were burned, and maybe you try to move and you figure out how bad you're hurting, you don't really make the decisions for yourself. I kinda put myself in their hands … I figured that's my best shot, to listen to them and let them do what they need to do. Really, I didn't want to make any decisions. I just listened to them and put my trust in them that they were doing the best they could for me”. (P2)
None of the interviewees, not even those who underwent amputation, felt the team acted in an inappropriately paternalistic manner. In fact, as a whole, they believed the team only did procedures that were absolutely necessary for their survival and wellbeing.
“I believe that they made all the right decisions surgery wise and everything.” (P5)

Conclusions
This study supports the limited but important work of the perspectives of severely burned patients’ regarding, among other things, how medical decisions were made during the acute phases of their injury. It shows that patients trusted their providers to make and encourage life-saving, wellbeing enhancing decisions during the early stages of treatment when patients are not sure they are capacitated and autonomous. Furthermore, the positive feelings patients had about those decisions did not change over time.
777 Improving Parent Communication With Family Rounds In The Pediatric Critical Care Unit (PICU)
Authors: Arredondo Olivia , Day Mary , Martens Sally A , Romanowski Kathleen S , Sen Soman , Palmieri Tina L , Greenhalgh David G 
Published: March 2022

Abstract

Introduction
Effective communication between pediatric burn patients, their family members and the health care team is crucial to developing a "working alliance" and improving their overall experience in the Pediatric Intensive Care Unit (PICU). The aim of the project is to standardize and improve patient and parent communication through the implementation of weekly inter-disciplinary family rounds.

Methods
Our nursing team developed the innovate PICU survey which is a 9 question Likert scale survey that evaluates patient and family satisfaction. All pediatric patients being discharged or transferred from the PICU received the PICU survey. After reviewing baseline data, communication between patient/parents and the health care team was identified as a potential targeted area for improving satisfaction scores. Aimed at improving communication, we established weekly inter-disciplinary family rounds. Each family was designated a specific day of the week for inter-disciplinary family rounds and staff provided families with a pre-printed standardized flyer explaining the process and were encouraged to write down questions for discussion. Survey scores from burn patients who received inter-disciplinary family rounds were compared to baseline scores, as well as to the scores of other pediatric patients of services that do not utilize family rounds.

Results
Prior to implementing family rounds, our PICU survey average score was 4.9/5 out of 6 surveys. After implementing inter-disciplinary family rounds, our average score for pediatric burn patients was 4.9/5 out of 10 surveys. The average scores of pediatric patients of services that did not utilize family rounds 4.7/5 out of 19 surveys.

Conclusions
Scheduled inter-disciplinary family rounds can improve communication and over patient care satisfaction in pediatric patients with complex critical care issues related to burn injuries. Scheduled family rounds may also be beneficial for other non-burn pediatric ICU patients.
783 Use of Multidisciplinary Collaboration to Establish a Standardized Endotracheal Tube Wiring Guideline
Authors: Shostrand Lisa M , Hartman Brett C , Zieger Madeline , Ealy Aimee , Meadors Diana M 
Published: March 2022

Abstract

Introduction
Pediatric patients with facial burns and advanced airway needs precipitate acute situations requiring multidisciplinary team member collaboration. Significant facial burns, particularly involving considerable edema or smoke inhalation, may warrant dental or circum-mandibular endotracheal tube (ETT) wiring for stabilization. Guidelines were created, trialed, and revised based on patient outcomes and clinician feedback at a pediatric verified burn center.

Methods
The guideline was created by the burn team in 2019. This standard work was utilized with pediatric burn cases presenting to the burn center. Guideline variances, such as prolonged time from door to ETT wiring, prompted a gap analysis need to improve the process. Through two case review sessions held in 2020, a multidisciplinary team consisting of the burn providers, emergency department providers, nursing, and respiratory therapists revealed process knowledge deficits, unclear role expectations, and supply issues. Literature was reviewed and a myAmeriburn listserv inquiry of current practice was made to seek additional guidance.

Results
Based on feedback from the multidisciplinary group and data gathered from the literature and collegial burn community, action plans and guideline modifications were developed in 2021. The respiratory therapy department developed education for their staff highlighting use of twill tape and taping. The use of ETT suturing was removed from the guidelines.

Conclusions
Multidisciplinary contribution and engagement was necessary to produce, execute, and evaluate the pediatric endotracheal tube wiring guidelines. Through dialogue, patient trial, and constructive feedback, guidelines were amended to produce a smoother team process and better patient experience. The standard work is currently being evaluated in its modified version.
784 A Burn Resting Hand Orthosis Fit Checklist
Authors: Warthman Renee , Martinez Andria , Murray Derek , Richey Karen , Foster Kevin N 
Published: March 2022

Abstract

Introduction
Resting hand orthoses (RHO) are often used to manage hand burns but can be difficult for inexperienced clinicians to fabricate, assess, and utilize without causing complications to the patient. Previously we had shared data on how we reduced RHO related complications by utilizing burn and hand certified staff to fabricate RHOs.

Methods
Advanced clinicians certified in either hand, burn, or both were queried to describe the methodology they utilized to fabricate an effective RHO. From this query, a list of conditions was created. These conditions were presented to the entire group of certified clinicians and re-examined. Conditions were recorded if consensus was reached on their inclusion for a guide to fabricate a successful RHO.

Results
A 14-condition checklist, with 8 essential items, was developed. It is intended that this checklist can be utilized by less experienced clinicians to guide safe and effective RHO management.

Conclusions
The checklist is a straightforward way to assess commonly identified issues with RHO and offers a potential resource to manage effective fabrication for novice or inexperienced clinicians.
785 Assessing The Kinematics Of Virtual Reality Gaming As Physical Therapy In Burn Patients
Authors: Qiu Cecil S , Vocke Scott , Rodriguez Joshua , Roemmich Ryan , Andre Gregory , Dean Brooke , Caffrey Julie 
Published: March 2022

Abstract

Introduction
Virtual reality (VR) gaming offers an immersive experience that can enrich physical therapy for the burn patient by introducing variability, enjoyment, and reward during functional motions of the upper extremities. In this study, we aim to support a proof-of-concept for VR gaming in upper extremity burn rehabilitation by characterizing shoulder and elbow kinematics during VR gaming in a healthy volunteer.

Methods
A healthy volunteer without burn injuries played two games, a virtual rhythmic baton and virtual boxing game, on a commercially available VR gaming platform. Kinematics during play were assessed using two external cameras placed orthogonally, to the player’s front and left, so that 3-dimensional motion of the player’s left arm could be captured. Video of each gaming session was processed using an open-source perceptual computing software that dynamically tracks the user’s upper extremity during play. Kinematics at the left shoulder and elbow were characterized with respect to range of motion (ROM) and time spent in composite positions.

Results
During the rhythmic baton game, the player achieved 157 degrees of elbow flexion ROM and 90 degrees shoulder elevation ROM. During the boxing game, the player achieved 156 degrees of elbow flexion ROM and 123 degrees shoulder elevation ROM. The baton game was associated with more time spent in the “rest” position (elbow extended with shoulder adducted, 60% of the game) while boxing was associated with more time in the “Guard” position (elbow flexed with shoulder elevated, 79% of the game) (Figure 1). Both games demonstrated simultaneous movement at both the shoulder and elbow during play.

Conclusions
The two VR games investigated in this kinematic assessment challenged players to achieve a wide range of motion at the upper extremity with functional, multi-joint movements. These findings support a potential role for commercial VR gaming in burn rehabilitation and future research in burn patients is required to demonstrate its therapeutic value.
792 Exoskeleton Robot Using 3-Dimensional Modeling in Burn Patient
Authors: Seo Cheong Hoon , Joo So Young 
Published: March 2022

Abstract

Introduction
Hands are the part of the body that are most commonly involved in burns, and the main complications are finger joint contractures and nerve injuries. Hypertrophic scarring cannot be avoided despite early management of acute hand burn injuries, and some patients may need application of an exoskeleton robot to restore hand function. To do this, it is essential to individualize the customization of the robot for each patient. Three-dimensional (3D) technology, which is widely used in the field of implants, anatomical models, and tissue fabrication, makes this goal achievable.

Methods
Therefore, this report is a study on the usefulness of an exoskeleton robot using 3D technology for patients who lost bilateral hand function due to burn injury. Five burn patients with upper limb dysfunction after a flame and chemical burn injury, with resultant impairment of manual physical abilities.

Results
After wearing an exoskeleton robot made using 3D printing technology, the patients could handle objects effectively and satisfactorily.

Conclusions
This innovative approach provided considerable advantages in terms of customization of size and reduction in manufacturing time and costs, thereby showing great potential for use in patients with hand dysfunction after burn injury.
802 A retrospective study: rapid removal of biofilm and necrosis with a hygroscopic chemical debriding compound
Authors: Hermans Michel H 
Published: March 2022

Abstract

Introduction
Removing necrosis and biofilm is an essential step in the treatment of all lesions. A new debriding compound (TDA) uses a hygroscopic mechanism to reach this goal: when in contact with biofilm and necrosis this causes desiccation, with subsequent dissolution of these compounds.

Methods
In a retrospective proof-of-principle study the results of a one-time application of TDA in 54 serious foot and leg lesions, mainly diabetic and venous ulcers, were analyzed.

Results
Outcomes were positive: at study end: 50 out of 54 lesions (92.5%) showed complete granulation and in 40 out of 54 lesions (74.0%) complete reepithelialization was reached.
TDA efficacy is represented by three cases. In the first one, an 83-year-old diabetic female with sever peripheral arterial disease and status post-toes-amputation suffered from a gangrenous lesion of the left foot. A second case involved a 77-year-old female who had a non-healing, post-trauma lesion over the Achilles tendon, and the last case entails an 81-year-old male with a non-healing lesion on the left lower leg. All patients showed very rapid debridement and subsequent healing and reepithelialization

Conclusions
Typically, diabetic, and venous ulcers require repeated debridement and treatment of the biofilm is notoriously difficult. It also takes a long time before the woundbed is healthy enough to start to granulate and, subsequently, epithelialize. The results, obtained in this study, indicate that a one-time application of TDA is highly effective for “jumpstarting” wound healing.
804 Catastrophic Burn Management: A case series using autologous skin cell suspension
Authors: Deeter Lyndsay 
Published: March 2022

Abstract

Introduction
Catastrophic thermal injury treatment is complex due to the lack of autologous donor site, which is imperative for permanent wound closure. Historically, our burn unit has relied on application of cultured epithelial autografts for wound closure in this patient population. Lab grown skin requires a significant time investment. Therefore, in our most recent subset of large burn injuries, we have transitioned to the use of autologous skin cell suspension over widely meshed autograft utilization almost exclusively.

Methods
A case series of four thermally injured patients with injuries greater than 75% TBSA was reviewed. Patient length of stay, operative interventions, skin coverage, mortality and cost were examined.

Results
Burn size ranged from 75-85% TBSA in four patients. Early excision was implemented for all four patients in the case study. One of the four patients was treated with a combination of lab grown skin and autologous skin cell suspension. The three other patients were treated exclusively with autologous skin cell suspension for wound coverage. All patients underwent widely meshed autograft with the autologous cell suspension for wound coverage. All four patients survived to discharge and their initial follow up. Cost of operative interventions were less expensive for autologous skin cell suspension than for cultured epithelial autografts. Length of stay varied from 66-179 days. Discharge location varied from acute rehabilitation, to a homeless shelter, to another burn facility with inpatient psychiatric services.

Conclusions
Autologous skin cell suspension is a safe and efficient treatment modality to obtain permanent wound closure in catastrophic thermal injuries.
808 Combination of Adipose Micro Fragments and Liquid Scaffold Improve Wound Healing Outcomes
Authors: Sheikh-Oleslami Sara , Hassanpour Ida , Amiri Nafise , Jalili Reza B , Kilani Ruhangiz Taghi , Ghahary Aziz 
Published: March 2022

Abstract

Introduction
In full-thickness wounds, high levels of inflammation, lack of matrix deposition and paucity of progenitor cells delays normal healing processes. One major problem with commercially available solid (sheet) scaffolds is their inability to conform to wounds of varying shapes and sizes. To overcome this, we previously generated a liquid, injectable skin substitute which can fill wounds of any shape and depth from bottom up and has all the necessary ingredients for skin cells to be nourished, proliferate, and migrate in. In combination with adipose micro fragments as a viable source of progenitor cells, a composite, in situ forming skin substitute was tested for treatment of silicon ring splinted wounds in rats.

Methods
The in vitro survival and migratory capacity of adipocytes derived from rat micro-fragmented fat when cultured in our 3D nutritional scaffold was examined with a Live/Dead assay. The efficacy of our combined liquid scaffold alone (MF) or with adipose micro fragments (MFA) in treating full thickness splinted wounds in rats was compared to a standard dressing protocol (NT). The healing process was monitored for 10 days. Following wound measurements, histological and immunofluorescent analyses were performed and compared.

Results
Adipose-derived cells migrated within the 3D nutritional liquid scaffold after 7 and 14 days. The number of red (dead) cells was negligent, indicating cell viability. In vivo, both MFA and MF showed both accelerated and ameliorated wound healing, including complete epithelialization and less immune cell infiltration, compared to the NT control. No significant differences were observed between the MF and MFA groups for any outcome.

Conclusions
Our findings show that a 3D nutritional liquid skin scaffold is a rich environment for adipocyte viability and migration and that addition of adipose micro fragments to this scaffold can be used as a rich source of cells.
813 Histologic Changes of Skin Biopsies After Autologous Skin Cell Suspension
Authors: Lennard Shana , Carter Jeffrey E , Kopari Nicole M , Cook Michael , Paige John , Hodgdon Ian , Phelan Herb A , Hickerson William L 
Published: March 2022

Abstract

Introduction
Over 10,000 cases of autologous skin cell suspension have been performed around the world for the treatment of burn and soft tissue injuries. A key component of the procedure is the harvest of skin biopsies which are exposed to enzymatic degradation. In some regions, epidermal graft harvest has been attempted manually without enzymatic degradation. Our study goal was to examine the histologic changes of the skin biopsies in manual versus enzymatic degradation.

Methods
Our study was an IRB-approved, prospective controlled analysis of residual skin harvested from 10 patients undergoing hernia repair. Two specimens from each patient were procured intraoperatively with each measuring 2x3cm. Each specimen produced two 4mm punch biopsies from three regions (control, mechanical, and enzymatic) for a total of 12 specimens per patient. Enzymatic specimens were prepared using the Avita Medical ReCell® system per manufacture instructions for use. Mechanical specimens were prepared using an abrasive pad until epidermis was macroscopically removed. Histologic analysis was performed with hematoxylin and eosin stain and whole slide scanning. Two or more investigators reviewed each biopsy concurrently with consensus agreement on the remaining epidermis and evidence of degraded reticular dermis. Descriptive statistics were used to assess the variances in the three groups.

Results
The mean residual epidermis was 9% in the enzymatic group, 35% in the mechanical, and 98% in the control. Epidermal harvest was higher in the enzymatic group relative to the mechanical group (two tailed t-test = 0.0008). Reticular dermis was degraded in 10% of the mechanical specimens and none of the enzymatic specimens.

Conclusions
Epidermal harvest was more consistent in the enzymatic group with less trauma to the dermis. Our study suggest that mechanical harvest requires larger donor sites given the decreased epidermal harvest. Further research is needed to determine impact of cell isolation technique on autograft cell suspension viability and distribution of cell types harvested.
Missing Masters: Causes, Consequences and Corrections for States’ Disengagement from the Investment Treaty System
Authors: Mehranvar Ladan , Johnson Lise 
Published: March 2022

Abstract
Proponents of the international investment law system have treated the concept of depoliticization as a key justification of the investor–state arbitration mechanism. However, this rationale has been increasingly questioned. The system is itself a reflection of the asymmetrical power relations that exist among various actors. We examine data on states’ exercise of their interpretive powers through unilateral interpretations, as a potential means of shifting power away from capital, and identify the factors that may make such engagement more or less likely. What emerges is the asymmetrical patterns of engagement and influence in shaping the law, tilting the balance not just away from states generally, but from Global South states in particular. We propose various reforms that seek to recognize and address the enduring role of politics in the system, produce more just outcomes, and be more inclusive of all state parties in the development of international investment law.
Numerical study of hydrodynamic herringbone-grooved journal bearings combined with thrust bearings considering thermal effects
Authors: Wang Chin-Cheng , Lin Jyun-Ting 
Published: March 2022

Abstract
Hydrodynamic herringbone-grooved journal bearings (HGJBs) are analyzed by solving Navier–Stokes and energy equations. It is well known that the load capacity of hydrodynamic bearings may be affected by high temperatures and low oil viscosity. Therefore, the main objective of this study is to understand the pressure distribution of hydrodynamic HGJBs under different oil viscosity and eccentricity ratios. In this paper, 3 different configurations are studied, namely, a HGJB, a combined HGJB and thrust bearing, and a combined HGJB and grooved thrust bearing. The bearing characteristics, such as load capacity and attitude angle that vary with different eccentricity ratios, are also discussed. The results show that the load capacity of the bearing decreases with increasing temperature. The pressure difference also increases as the eccentricity ratio increases. The high-pressure region is concentrated at the tip of the groove for the HGJB. In addition, the combined HGJB and grooved thrust bearing can be used to stabilize the journal because of the low attitude angle. These findings may help and facilitate the design of hydrodynamic bearings suitable for working in warm and hot environments in the future.
Pancreatic rest disguised as inflammatory bowel disease in young adult
Authors: Curfman Karleigh , Linders Megan , Poola Ashwini , O’Bryant Larry , Rashidi Laila 
Published: March 2022

Abstract
Pancreatic rest, otherwise known as aberrant, ectopic or heterotopic pancreas, occurs when the pancreatic tissue does not have an anatomical or vascular connection to the normal body of the pancreas. This rare congenital anomaly was first described in 1727 by Hunt and Bonesteel, and it is now known to be found predominantly within the stomach or proximal small bowel. Most of the time, pancreatic rest is asymptomatic and is found incidentally. When symptomatic, the most common presentations tend to be: abdominal pain, nausea, gastrointestinal bleeding, obstruction and symptoms of pancreatitis. We report a case of a 21-year-old female with symptomatic pancreatic rest noted in two locations: antrum of the stomach and the proximal jejunum just distal to the ligament of Treitz.