bluuebunny/crossref_metadata_2025_split huggingface dataset:
505 The Successful Development of a Digital Peer Supporter Training Program - How It is Done
Authors: Cramolini Sandra J , Irven Jessica , Peterson Pam 
Published: March 2022

Abstract

Introduction
The global pandemic of 2020 and 2021 has had an unforgettable impact on our lives and community well-being. Burn survivors are a particularly vulnerable population for social isolation and loneliness and, therefore, an amplified need for social connection. This abstract outlines the strategic structure, curriculum, and training required to move an in-person course to an innovative digital model.

Methods
A group of burn subject matter experts (SMEs), including burn survivors, peer supporters, and course instructors, virtually met to brainstorm program redesign, considering the needs of the burn survivors. Research of topics guided manual and course revisions. Experts recommended a website and digital resource review to streamline organizational data collection and participants’ experiences. A scheduled pilot course and evaluation would provide feedback for changes. SMEs created a short turnaround timeline.

Results
After research, the revised digital manual was condensed from 200 to 50 pages, allowing for hyperlinks, abbreviated resources, and replicated content removal. Five major content areas previously taught in-person were converted to recorded PowerPoint learning modules (April – June 2020). The asynchronous modules totaled 4 hours of self-paced learning assigned to the candidates before a set virtual course. A survey monkey assessment after each module evaluates the learner's base knowledge. SMEs developed a 4-hour virtual class incorporating the modules, manual, and group exercises. A designed pre-course worksheet prepares the candidates for group exercises. Based on their burn injury type or situation (parent to parent, survivors with amputations, death of loved one), candidates practice virtual peer support visits. After the first pilot course, a comprehensive evaluation tool assessed participant satisfaction and confidence, curriculum, instructor expertise, and comfort level navigating the virtual model (August 2020). A website landing page centralized course resources and content location, streamlining participant experience and organizational data collection (March 2021). A 2-hour instructor course (n=10) provided an update on the new structure. The instructors also observe a virtual peer supporter course, participate as an instructor in-training, then co-teach with another instructor before independent course instruction (June 2021).

Conclusions
The digital model has trained burn survivors (n=41) in 6 courses over eight months during a pandemic. Burn survivors have trained together from around the globe to one of the calendared courses improving efficiencies. There are monetary and resource cost savings for burn centers and the organization. The digital manual is easily updated, saving in resource allocation. Peer supporters navigate additional online resources for ongoing self-growth through the embedded website landing page.
509 Why do elderly burn patients die? Analysis of early versus delayed ICU deaths, from 2014-2021
Authors: Werthman Emily H , Ballou Jessica , Lagziel Tomer , Yoon Joshua S , Akhavan Arya A , Shamoun Feras , Caffrey Julie , Hultman Charles S 
Published: March 2022

Abstract

Introduction
Despite continued improvements in critical care, nutrition, and surgical technique, elderly patients with burn injury remain a vulnerable population, with increased mortality. The purpose of this study was to compare early versus late deaths in elderly burn patients admitted to the intensive care unit, to identify potential interventions that might improve survival.

Methods
We conducted a retrospective review of elderly patients (age &gt;=60 years), who were admitted to an urban burn center ICU, with thermal and/or inhalation injury, over an 8-year period. Data were extracted from a prospectively maintained registry and verified through our electronic medical record. Patients who died less than 1 week after admission were compared with those who died after the first week. Univariate analysis was performed by 2-tailed Student’s T test and chi-square, with statistical significance assigned to p values &lt; 0.05.

Results
From 2014-2021, we admitted 1322 patients to the burn ICU for thermal and/or inhalation injury. Mortality was 9.4% for patients &gt;= 60 years of age, compared to 2.0% for patients &lt; 60 (p&lt; 0.001). The elderly patients who succumbed to their injury had a mean age of 75.3 years, TBSA 27.7%, modified Baux score of 111.3, and survival of 13.8 days. We observed a bimodal distribution of deaths, peaking on the first day after injury, and in the third week after admission, the most common cause of which, for both groups, was multisystem organ failure. Compared to the delayed deaths (n=21), patients who died within the first week (n=16) had an increased incidence of inhalation injury, a higher modified Baux score but similar age and TBSA, and lower baseline comorbidities and complications (TABLE).

Conclusions
Presence of inhalation injury and high modified Baux score, not necessarily age or %TBSA, was associated with early mortality in the elderly, after burn injury. Older patients who survive their initial resuscitation often succumb to complications related to baseline comorbidities. Improved management of these comorbidities, via the active involvement of geriatric medicine and palliative care, represents an opportunity to increase survival.
516 Phosphorus Requirements in Patients with Severe Thermal Injuries Requiring High-Volume Hemofiltration
Authors: Hill David M , Kail Daniel , Arif Faisal , Sultan-Ali Ibrahim , Velamuri Sai R 
Published: March 2022

Abstract

Introduction
Patients with thermal injuries have increased metabolic demands, requiring increased phosphate supplementation. Evidence is scant depicting incidence of hypophosphatemia and repletion requirements in patients with thermal injuries treated with high-volume hemofiltration (HVHF) and a high-flux membrane. The objective of this study was to determine the incidence of hypophosphatemia and characterize repletion requirements in this population.

Methods
This study was a case-control, retrospective chart review. Patients were included if sustained at least 20% total body surface area (TBSA) thermal injuries and required continuous HVHF (prescribed doses ≥ 35 mL/kg/hr). A randomly selected cohort (matched to age, TBSA, and inhalation injury) without acute kidney injury (AKI) was used to compare phosphorus requirements over an initial 14 day period. An a priori sample size was calculated (n = 26) to detect a minimum difference of 0.3 mmol/kg/day. Repeated measures ANOVA was used to compare requirements and concentrations. Demographics, diet, and variables affecting phosphorus concentrations were compared utilizing Fisher's exact, Student's t-test, or Mann-Whitney test depending on type and distribution.

Results
One thousand sixty-six patients were screened. Most were excluded from the HVHF group for TBSA &lt; 20% (58%) or not a burn injury (29%). Sixteen patients were included in each group. The average age was 60.2 ± 15.1 vs 53.3 ± 16.4 (p = 0.22) with median TBSA (p = 0.73) of 30% (23.4, 56.3) vs 29% (26.4, 33.9). All patients in the study group were started on HVHF for AKI, utilizing a 1.6m2 polyethersulfone membrane (mean delivered prefilter dose of 54.7 ± 1.5 ml/kg/hr), and had statistically higher potassium and phosphorous laboratory values at baseline. Parenteral phosphorus replacements were 2 fold higher in the HVHF group (p = 0.02), but not statistically different after accounting for estimated enteral intake. Despite providing 0.75 mmol/kg/day of phosphorous supplementation (vs 0.66 mmol/kg/day in control, p = 0.45), the HVHF group experienced more days with hypophosphatemia (49.6 ± 12.4 % vs 29.3 ± 16.3 %, p = 0.012). By 72h, every HVHF patient experienced at least one episode of hypophosphatemia. Patients on longer durations of therapy had increasing risk of hypophosphatemia. There was a significant difference in days requiring mechanical ventilation (p &lt; 0.001)

Conclusions
This study demonstrates thermally injured patients receiving HVHF for AKI are at increased risk for hypophosphatemia and require higher phosphate supplementation to maintain lower average serum concentrations, as compared to the controls with similar burns but without acute kidney injury.
543 Challenges in Burn Nurse and Therapy Staffing During and After a Category 4 Hurricane
Authors: Peterson Abbey , Compton Desiree , Nakamura Dana Y , Landry Jeremy , Keating Aimee , Kopari Nicole M , Carter Jeffrey E , Phelan Herb A 
Published: March 2022

Abstract

Introduction
Burn nurse/therapy staffing has been stretched for months by the pandemic. Along the Gulf Coast, Hurricane Ida recently taxed these resources further as regional burn centers saw a weeks-long surge in serious burn injuries in the setting of prolonged power and water outages. We reviewed the execution of a plan for the provision of burn nurse/therapist staffing at an ABA-verified adult burn center that experienced a direct hit by a Category 4 storm.

Methods
Hospital leadership planned to activate Code Gray on 8/29/21 at which time the hospital would be placed on lockdown with no one allowed in or out until Code Gray was lifted.
Our burn leadership subsequently designed a plan to have ten burn nurses and one Occupational Therapist (TEAM A) in house from the inception of Code Gray at 7am on 8/29 thru 7am on 9/1. If Code Gray conditions persisted, nine dedicated burn nurses (TEAM B) were to relieve TEAM A. TEAM B was planned to remain in-house until 7am on 9/4. If Code Gray conditions continued, the plan was to be reassessed at that time. The same burn therapist was planned to remain in-house throughout. Physician coverage was to be provided by the in-house trauma team during Code Gray. No housing or bedding was provided for in-house personnel, and the hospital generator system ostensibly had a 30-day fuel supply.

Results
TEAM A day/night staffing was 6/4 with the off crew sleeping in conference rooms and clinic spaces. An unexpected event occurred when a mission-critical tower for the city’s grid toppled into a river resulting in delays for restoration of the grid, and city-wide boil-water and burn-ban policies. As generators came into widespread use, our pre-storm census of 9 increased to a mean of 12.7 + 1.4. Due to this increase, on the morning of 9/1 six TEAM A nurses elected to stay and be absorbed into Team B with day/night staffing of 6/6.
The rapid influx in number and complexity of burn patients made it clear a burn surgeon presence was needed during Code Gray. One burn attending was able to make it to the hospital at 7am on 8/30 and worked until being relieved at 7am on 9/5. An informal triage strategy was enacted in which only burns of &gt;10% TBSA would be considered for admission. OR availability went down to 2 + 1 at the inception of Code Gray and 3 + 1 on 9/6. Eleven cases were done during this time with a mean TBSA of 20.2 + 10.7%.
Hospital generators were found to consume fuel at a rate almost twice predicted. Due to prioritization, the hospital went back on city power on 9/2. Code Gray was lifted at 7am on 9/4 and normal operations resumed at 7am on 9/11.

Conclusions
The successful provision of care required a willingness for nurses and one therapist to remain in the hospital for six consecutive days and for hospital administration to approve the overtime.
545 “After The Fire: Legacy of A College Dormitory Fire Twenty Years Later"
Authors: Conlon Kathe M , Marano Michael A , Lee Robin A 
Published: March 2022

Abstract

Introduction
In January 2000 fire erupted at a local college. Panicked students, many who failed to attend school-sponsored fire drills or simply ignored alarms, found themselves scrambling to escape. Seven students were admitted to a burn center (BC) for critical burns, with 54 initially staged in the Medical Center Emergency Department. While this dormitory fire took place more than twenty years ago, its legacy is still being felt today.

Methods
History shows that, with any tragedy, there are lessons to be learned to lessen the impact on property destruction, injury or death. Looking at the legacy of this fire, four key areas of improvement emerged: disaster preparedness, media relations, legislation and fire prevention.

Results
Changes to disaster preparedness include an expanded, more comprehensive response plan, revised triage and transfer protocols, BC staffing protocols, creation of a regional group of BCs, which eventually morphed into a Disaster Consortium, and a medical command center for regional disaster response. A series of articles resulted in a Pulitzer Prize-finalist book, documenting the journey of two of the survivors, with award-winning photographs displayed at a national museum. Redesigned fire safety programs emphasizing escape plans and the dangers of false alarms now targets high school and college students, an often overlooked group, and clinical education programs have expanded to include nursing’s role in disasters, reinforced with a functional exercise. Two survivors are motivational speakers, continuing to share their personal story on campuses across the United States. New legislation mandated sprinkler installation in dormitories nationwide, and a non-profit foundation was formed to improve burn care. The anniversary of this fire is commemorated annually on campus to serve as a powerful reminder for new generations of students.

Conclusions
Despite this dormitory fire being ranked as the deadliest in state history, all these years later the legacy of this landmark event remains one of triumph and resilience, as its impact is still evident today. These lessons serve as the foundation for improved disaster response, locally, regionally and nationally.
559 Nursing Management of Multiple Concurrent Pediatric Patients with Cultured Epidermal Autografts
Authors: Grauer Christine M , Yelvington Miranda L 
Published: March 2022

Abstract

Introduction
For patients with large areas of full-thickness burns and limited autologous donor sites, cultured epidermal autografts (CEAs) can provide life-saving coverage. Nursing care of a patient with CEAs can be challenging due to the fragility of these grafts and compounded by the critical status of the patient. Care of a single patient with CEAs can prove challenging, but in cases in which multiple patients receive CEAs concurrently, these challenges are amplified.

Methods
Three pediatric patients with large burn injuries were admitted on a single day to a large academic hospital with a Burn Center (Table 1).

Nursing care of these children with concurrent CEA placement required an all-hands-on-deck approach and collaboration between the Burn Center (BC) and the Pediatric Intensive Care Unit (PICU) with regards to staffing, care, and positioning. Consistent primary RNs from both the BC and PICU staffed patients and volunteered to work additional shifts during a period of high census. To meet patient needs, the multi-disciplinary care team developed a schedule for CEA exposure, wound care, and therapy interventions.

Results
To meet the needs of these patients under the current staffing pattern, a team schedule was developed (Table 2).
Table 2. Care Schedule
0300-0400 Night shift staff removed anterior and extremity dressings with patients in supine.
0800-0900 Therapy staff arrived early during the day shift to perform therapy interventions with anterior CEAs exposed. Multi-disciplinary teams applied anterior and extremity dressings, positioned patients prone, and removed dressings from posterior CEA sites.
1700-1800 After approximately six to eight hours of CEA exposure, teams reapplied dressings and positioned patients supine.

Conclusions
Staff followed this schedule for these patients until their CEAs were determined to be integrated. Planning and collaboration among all members of the treatment team are integral to the successful care of pediatric patients with CEAs. A schedule for wound care, turning, and CEA exposure can improve staff communication, ease hand-offs, and ensure optimal quality of care for multiple patients with these large burn injuries.
562 Influence of the COVID-19 Pandemic on Emergency Room Visits for Burn Injury
Authors: Gotewal Sunny , Chokshi Shivan N , Song Juquan , El Ayadi Amina , Golovko George , Wolf Steven E 
Published: March 2022

Abstract

Introduction
The COVID-19 pandemic was a devastating occurrence that left millions in critical condition in emergency rooms (ER) across the country. While hospitalizations due to COVID-19 increased exponentially in the last year, several reports have indicated declines in ER use due to common non-COVID related problems. There is currently a dearth of literature examining the effect of the COVID-19 pandemic on emergency room use for acute burn injuries. Thus, we performed a retrospective database analysis using the TriNetX database to quantify the effects of COVID-19 on United States ER visits for acute burn injuries. We hypothesize that ER visits due to burn injury decreased, especially in patients with severe burn injuries- defined as burned total burn surface area (TBSA) &gt;20%.

Methods
Patients who visited the ER from 2010-2020 due to burn injury were identified using ICD-10 codes. We then stratified these patients by age (&lt; 18 and ≥18), severe ( &gt;20% TBSA) vs. non-severe (&lt; 20% TBSA) burn injury, and by change over time in 1-year intervals from 2010 to 2020. Extracted data was analyzed using chi-square with p&lt; .05 considered significant.

Results
We identified a total of 24,620,393 ER visits from 2010-2020. Of these, 142,007 (0.58%) were due to burn injury. A large majority of burn-related ER visits were for non-severe burns (n=134,120, 94.4%). ER visits for acute burn injury decreased by 21.6% during 2020 when compared to years prior. Stratification by age group revealed that pediatric patients (&lt; 18) had more significant decreases in ER Visits than adult patients (≥18). Pediatric patients visited the ER 71.6% less than adults during 2020. When stratified by burn severity, patients with severe burns ( &gt;20% TBSA) and patients with non-severe burns (&lt; 20% TBSA) had similar decreases in ER usage during 2020 when compared to years prior (21.7% and 24.6%, respectively). Further age analysis revealed that both pediatric patients with severe burns and pediatric patients with non-severe burns visited the ER less than their adult counterparts (71.4% and 60.9%, respectively). All of the above differences were statistically significant (p&lt; .05).

Conclusions
During the COVID-19 pandemic in 2020, there was a sharp decrease in ER usage by patients with severe and non-severe burn injuries. This decrease was particularly salient in pediatric populations across all TBSA data points measured.
564 The Impact of COVID-19 on the Provision of Pediatric Burn Care
Authors: Chakera Hawwa , Zuccaro Jennifer , Kelly Charis , Fish Joel 
Published: March 2022

Abstract

Introduction
The WHO declared the outbreak of COVID-19 a pandemic in the spring of 2020 which led to widespread restrictions on daily life activities as people were instructed to isolate at home. Given that 75 – 85% of pediatric burns occur in the home, it is likely that these measures had an impact on pediatric burn care. Thus, the aim of this study was to investigate the impact of the COVID-19 pandemic on the provision of pediatric burn care at an American Burn Association-verified pediatric burn center.

Methods
Data was retrospectively extracted from all new burn patients aged 0-18 years during a pre-pandemic period (April 2019 – August 2019) and a pandemic period (April 2020 – August 2020). Continuous data was examined using 2 tailed t-tests (p &lt; 0.05), while non-continuous data was examined using Pearson chi-squared tests (p &lt; 0.05). These analyses were used to analyze burn demographics and examine changes in the delivery of acute and follow-up burn care before and during the pandemic.

Results
During the pre-pandemic period, 213 new burns were identified, compared to 172 new burns during the pandemic period. No clinically significant changes were observed in patient age at presentation (p = 0.54), total body surface area of burn (p = 0.85), and time to presentation following the injury (p = 0.24). Interestingly, a significant increase in friction burns (p = 0.023) was observed, which mainly consisted of treadmill burns. During the pandemic, burn operating room utilization remained high and represented approximately 25% of the hospital's total surgical capacity. In addition, there were no significant changes to inpatient and outpatient encounters (p = 0.56 and p = 1.00) between the two periods thereby highlighting the need for these essential services during the pandemic.

Conclusions
Burn-related service needs remained consistent across the pre-pandemic and pandemic cohorts as demonstrated by the number of new burns as well as the continued provision of burn care. Overall, no clinically significant changes to patient demographics, aside from the increase in friction burns, were observed. Furthermore, the ability to provide all aspects of pediatric burn care at this tertiary pediatric hospital remained consistent across the pre-pandemic and pandemic cohorts. Although this study presents data from the first five months on the pandemic, further analysis of the entire year will be carried out in order to identify additional trends.