bluuebunny/crossref_metadata_2025_split huggingface dataset:
761 Burn first aid in Australian pre-hospital environments
Authors: Griffin Bronwyn R , Kimble Roy M , Holbert Maleea 
Published: March 2022

Abstract

Introduction
Best-practice burns first aid is well defined as 20 minutes of cool running water (CRW) within three hours of injury and an expectation of burn care in Australia. This study aims to identify barriers to applying this intervention and assess burn first aid knowledge amongst Australian paramedics.

Methods
Using multiple methods we assessed; 1) burn first aid adequacy in a cross-sectional study of health care professionals, utilizing a prospectively collected registry of patients managed at an Australian tertiary children’s hospital. Logistic regression models were used to evaluate the relationship between first aid adequacy between health services (eg. Paramedics and emergency departments). Then 2) paramedics completed a questionnaire containing demographic and clinical expertise and environment as well as recording immediate first aid management across five multiple choice burn case scenarios

Results
Overall, 31.3% of children received adequate CRW from caregivers. Factors associated with caregiver inadequacy of CRW were very young age and early adolescence (p&lt; 0.001) rural location ( P = 0.045), low socioeconomic status ( P = 0.030) amongst others. Paramedics and general practitioners provided adequate cooling to 184/735 (25.0%) and 52/215 (24.2%) of their patients, respectively. Local general hospitals provided adequate CRW to 1019/1809 (56.3%) patients. Paramedic questionnaire responses (n=326) identified 56% of paramedics answered all burn case scenarios correctly. Respondents who treated a burn within six months scored higher on burn first aid scenarios compared to paramedics who had not recently treated a burn (p=0.004).

Conclusions
: deficiencies remain in the cooling of paediatric burns patients at all levels of initial management. First aid delivery was significantly worse in children aged 0-2, adolescents aged 15-16, those living rurally, and the socioeconomically disadvantaged.
770 Increasing SOAR Participation in a Burn Center through a Social Work Team Approach
Authors: Dines Margaret M , Spotts Margaret , Madsen Laura , Wiktor Arek J 
Published: March 2022

Abstract

Introduction
Peer support has long been used in Burn Centers through organized support groups and programs like Phoenix Society for Burn Survivor’s SOAR (Survivors Offering Assistance in Recovery) individual peer support, often led by Social Workers (SW). The addition of an ambulatory SW in partnership with an inpatient SW allowed our Burn Center to continue participation in the group and individual peer support offerings despite the simultaneous COVID-19 pandemic. We sought to examine participation in support services using our dual SW model.

Methods
Prior to 2020, our ABA verified Burn Center only had an inpatient SW who was able to engage our admitted patient population to support services. With the addition of an ambulatory SW, we have been able to target support group participation in the larger ambulatory population. Our dual SW model allows for continued recruitment to our support services; meeting the patient’s needs at each stage of recovery. This tag team approach, coupled with increased use of technology driven by the pandemic, has shown to increase the average number of participants. We reviewed our support group participation and attendance over the past 2 years.

Results
In calendar year 2020 with one SW facilitator, only 14 virtual support groups were held with an attendance average of 4-5 participants and 22 individual peer support visits. In only the first 9 months of calendar year 2021 with the addition of a second SOAR trained SW, 18 support groups were completed virtually with new inpatient, in-person participation. The participation rate of now bi-monthly support groups has increased to 9 participants per support group average. At this continued rate, we expect to serve 216 attendees per year through support group. In this same 9-month span 51 SOAR individual peer support visits (12 in-person and 39 virtual), were conducted. Which is an increase from the 22 total peer support visits facilitated in 2020.

Conclusions
An additional SOAR trained SW to our Burn Center has increased participation and availability of support groups and individual peer support visits. Peer support promotes socialization and can provide healing for the burn patients and their families in a meaningful and profound way. Burn centers must continue to prioritize the role of the clinical SW to ensure programs such as SOAR support group and individual peer support can be facilitated to ensure an environment that fosters psychological and emotional healing.
774 Digital Interventions for Social Participation in Adults with Long-term Physical Conditions: A Systematic Review
Authors: Deng Huan , Shepler Lauren J , Abouzeid Callie , Hamner Jason W , Mercier Hannah W , Andrew Taylor J , Kazis Lewis E , Slavin Mary D , Ryan Colleen M , Schneider Jeffrey C 
Published: March 2022

Abstract

Introduction
Burn survivors experience significant social participation challenges in their recovery. However, enrolment and compliance with face-to-face interventions for such issues are often limited by time, location, and financial resources. Digital technologies are increasingly utilized in healthcare and provide a flexible, accessible, and low-cost treatment option. Given the sparse literature on this topic in the burn field, this review evaluated digital interventions for social participation in adults with long-term physical conditions to inform future use in the burn population.

Methods
MEDLINE, EMBASE, CINAHL and PsycINFO databases were searched using keywords and Medical Subject Headings (MeSH) terms related to ‘digital intervention’ and ‘social participation’ for studies published in English between January 2010 and May 2021. Studies that adopted digital technology interventions to improve social participation in adults with long-term physical conditions were included. Study quality was evaluated using Oxford Levels of Evidence. Data on study methodology, digital intervention and findings related to social participation were summarized.

Results
The search yielded a total of 4646 articles, of which 158 were full-text screened and 14 met inclusion and exclusion criteria. There were five randomized controlled trials, two non-randomized clinical trials and seven one-group pretest-posttest clinical trials. Twenty-five different measurement tools were utilized to assess social participation and two of them were used twice. Three types of digital interventions were implemented to improve social participation: group support, individual skill training or counselling, and education and support. The group support intervention developed a social network among affected people through videoconference, app, or virtual reality platform (3 of 4 studies with positive results). Individual skill training or counselling utilized phone calls or videoconference to help participants with activity participation and interpersonal relationships (2 of 6 studies with positive results). The education and support intervention used messages and website information to increase participants’ knowledge and provide support (3 of 3 studies with positive results).

Conclusions
This review presents evidence of different digital interventions’ effect on improving social participation in adults with long-term physical conditions. However, the existing literature is limited by the heterogeneity of outcome measures and varied methodology quality that preclude larger generalizations.
793 "Minimally Invasive" Skin Grafting with Enzymatic Debridement and Autologous Skin Cell Suspension
Authors: Kahn Steven A , Gaweda Gabriel G , Halicki Elizabeth , Hirsch Jason , Hink Ashley , Hickerson William L , Holmes James H , Carter Jeffrey E 
Published: March 2022

Abstract

Introduction
Minimally invasive surgery has become standard of care across numerous subspecialties. However, burn surgery has lagged behind; as the mainstay of treatment still involves excision with a knife and a split thickness skin graft (STSG) with a painful donor site. Enzymatic debridement with bromelain and autologous skin cell spray (ASCS) have independently been STSG use and decrease the donor site size. Due to constraints with the time course of these products only being available via studies before one was FDA approved, these technologies have not been utilized together in the United States until recently. Little literature exists regarding their use in combination. The current study characterizes a series of patients who received “minimally invasive” skin grafts with enzymatic debridement and ASCS as proof of concept.

Methods
This was a retrospective study of a single academic burn center’s experience using bromelain and ASCS together. Data collection included demographics, injury characteristics, length of stay, complications, and measurements of donor sites, STSGs, and ASCS treatment. Donor site size:total area treated with ASCS and/or STSG was calculated. Length of stay (LOS) was qualitatively compared to expected using a factor of 1.1days:%TBSA, and O/E LOS ratio was calculated. Data was reported in medians with interquartile ranges. Patients with 1-30%TBSA qualified for the bromelain study and were treated according to protocol. Those deemed to have enough residual dermis were treated with ASCS, while 3rd degree areas received meshed split thickness skin patch grafts with ASCS overspray.

Results
Eleven patients were included in the study. Four patients received ASCS alone, while 7 patients received a meshed STSG on portions of their burn. Median burn size was 13% TBSA (IQR:5,20), while DPT+FT size was 9% TBSA (IQR:5,16). Patients had a median of 1067 sq cm (IQR:772,2183) of burn operatively treated with ASCS, and 351 sq cm (IQR:0,457) treated with meshed autograft. Donor site size (ASCS and STSG) was 225 sq cm (IQR:72,315), and ratio of donor site are to total treatment area was 0.0125 (IQR:0.01,0.32), suggesting an expansion of 80:1. Median LOS was 11 days (IQR:7,21), 0.84 days per %TBSA (IQR:0.5,1.16). Expected LOS was 14.3 days, with an O/E ratio of 0.77. Two patients developed infection; one required reoperation with STSG on half of his burned areas (5% TBSA).

Conclusions
Enzymatic debridement and ASCS can be used to treat burn injury with a “minimally invasive” approach. Donor sites were much smaller than expected had they been treated with a conventional meshed STSG on deep 2nd degree and 3rd degree areas. The data also suggests that length of stay was lower than expected. Further study is needed to determine which subsets of patients and burn wounds are optimal for this combination of technologies.
796 Predictive Factors/Outcomes for Lower Extremity Amputations in Burn-Injured Adult Patients: 10 Year Review
Authors: Smith Susan L , Curry Dominick M , Rainey Andrew , Smith Howard G , Seoane Jacqueline 
Published: March 2022

Abstract

Introduction
Lower extremity amputations (LEAs) in the burn population may occur urgently due to critical loss of tissue and perfusion or may proceed more slowly if viability remains uncertain. The existing literature describes amputations following electrical injuries; however, little is published discussing burn-injured patients who underwent delayed lower extremity amputations due to other burn mechanisms. Co-morbid illness and infections, patient/family resistance and provider delay in hopes of salvage may prolong time to amputation. Examining outcomes for burn patients’ suffering LEAs will delineate relationships among demographics, burn size, surgical timing, morbidity, mortality and length of stay (LOS) supporting the importance of early amputation.

Methods
Single verified burn center conducted an IRB exempted retrospective medical records review of adult burn – injured patients, 18 years of age and older, admitted as inpatients from January 1, 2010 to December 31, 2020. Patients were identified using International Classification of Disease 9 & 10 and Current Procedural Terminology codes. Patients with non-burn related amputations or toe / partial foot amputations resulting from diabetes were excluded. The association between multiple variables and both day of first amputation and burn size was measured through linear regression, one sample t-test, and one-way analysis of variance (ANOVA).

Results
The study population was 12 with 11 males, mean age 44, and one mortality. The majority (83%) suffered flame burns and 58% with mechanism of motor vehicle collision. Hospital day of first amputation ranged from 1-30, with a mean 11. Seven patients required vasopressors ranging from 30 minutes to 500 hours. For every 24 total pressor hours, day of first amputation increased by 1 day. Three patients (25%) had positive blood cultures and two (16%) had positive sputum cultures. Five patients (42%) had positive tissue cultures from the affected extremity. The diagnosis and treatment of infections were detailed and analyzed. Patients with positive tissue cultures were found to have waited an average 10.17 days longer for amputation than those without. Hospital LOS ranged from 31-126 days with mean of 54 days.

Conclusions
Day of first amputation was the most impactful parameter, with longer time to first amputation associated with positive tissue cultures, mortality, vasopressor therapy and hospital length of stay. Limitations include retrospective nature, small sample size and reliance on electronic medical record and registry data. This study provided data to support earlier amputation for non-viable extremities, though additional research is clearly needed to better describe these relationships.
803 Biodegradable Temporizing Matrix as a Dermal Template in the Reconstruction of Pediatric Full-Thickness Foot Injuries
Authors: Renkert Miriam , Svoboda Daniel , Wessel Lucas M 
Published: March 2022

Abstract

Introduction
Extensive thermal or traumatic full-thickness injuries to the foot, though rare in children, can lead to severe complications. They are often associated with significant skin loss and underlying tendon or bone exposure. Timely wound closure is essential to minimize the risk of deep infection and to avoid subsequent loss of function.
Tried and tested animal- or human-derived biological dermal templates have always come with a risk of infection and subsequent scar contraction. A biodegradable temporizing matrix (BTM) consisting of a polyurethane scaffold is a synthetic alternative to cover deep defects and promote the development of neodermis.
We report on our first experience with this dermal matrix in the reconstruction of complex foot injuries in children.

Methods
From August 2020 to June 2021, we treated four patients with severe full-thickness injuries of the foot and need for necrectomy with BTM, as the prevalence of exposed bone or tendon prohibited primary wound closure via skin grafting. All cases were caused by contact burns or mechanical trauma. In three of these cases, we utilized a temporary negative pressure wound therapy. Wound closure was achieved by application of full-thickness (3/4) or split-thickness (1/4) skin grafts after delamination of the fully integrated BTM.

Results
Wound monitoring through regular outer dressing changes showed that BTM remained in place and was fully integrated after 3-6 weeks. We saw excellent dermal regeneration in all patients. Swab cultures at first patient contact detected pre-existing wound contamination with Pseudomonas aeruginosa in two children and MRSA in one case. Wound healing before and after skin grafting was unimpaired, though, under topical antimicrobial treatment with polyhexanide. There were no signs of systemic infection.
The take rate of skin grafts was excellent with no graft failure, resulting in pliable, smooth scars. Long-term outcome showed minimal to no scar shrinkage without any functional impairment.

Conclusions
BTM is a good alternative to established dermal templates for complex foot injuries in children. In our experience, even in cases of bacterial wound contamination the synthetic material integrates well and promotes unimpaired tissue regeneration. Contraction and hypertrophic scarring is minimal with very good quality of the developing neodermis.
809 An Allogenic Fat-First Approach to Burn Reconstruction Mitigates Adhesion and Soft Tissue Deficit
Authors: Loder Shawn J , Lee Phoebe , Cannon Matthew , Leftwich Patricia , Kokai Lauren , Marra Kacey , Rubin J 
Published: March 2022

Abstract

Introduction
Adipose and adipose-derived stem cell therapies have met success as adjunctive treatment during burn reconstruction with well described benefit in the delayed-treatment of soft-tissue deficits. While the use of allogeneic skin is well-described, adipose tissues have typically remained autologous. Allogenic fat is not commonly used in burn care, however, in large, complex burns where autologous tissue is limited adipose may not be readily available for harvest or use. Understanding the efficacy of allogeneic tissues in this setting is critical to expand our reconstructive options. Here we describe a protocol utilizing allogeneic fat as well as examine the efficacy of this approach on burn-wound contractures, adhesions, and soft-tissue deficits.

Methods
Female, Yorkshire swine received 16, 4x4 cm full-thickness burns. After 48 hours, eschar was removed to fascia. Wounds were stratified to receive either A) No Reconstruction, B) Skin-Only, C) Fat-Only, D) Immediate-Skin, Delayed-Fat, or E) Immediate-Fat, Delayed-Skin. All fat utilized was allogeneic sourced from vendor-matched swine. At 8-weeks post-engraftment animals were sacrificed and all wounds were collected for photography, ultrasound, histology and serum studies.

Results
Use of allogeneic fat significantly improved terminal soft-tissue thickness under both immediate and delayed administration (p&lt; 0.05). Immediate use of allogeneic fat significantly improved tissue mobility vs. untreated and skin graft controls (p&lt; 0.05). Contracture was most significantly affected by timing of skin graft placement, however, could be further mitigated under standard delayed-fat approached with allogeneic tissue.

Conclusions
Here we demonstrate use of allogeneic fat in both traditional-delayed and a fat-first approach with significant mitigation of adhesion when applied as an initial basal layer. Both immediate and delayed allogeneic fat were sufficient to improve on soft tissue deficits.
810 Synthetic Platelet-Mimetics with Gentamicin: Outcomes in Deep Partial-Thickness Burns
Authors: Valdera Franklin , Nuutila Kristo , Cooper Laura E , Varon David E , Cooley Jennifer , Chapa Javier , Chan Rodney K , Carlsson Anders H 
Published: March 2022

Abstract

Introduction
Infection and prolonged inflammation in deep partial-thickness burns can lead to inadequate healing. In addition to their role in hemostasis, activated platelets also contain granules with anti-inflammatory properties which may impact wound healing. However, portability and storage of platelets remain a challenge. Synthetic platelet-mimetics (SPM) avoid these difficulties, but like natural platelets, SPM have vesicles that can transport bioactive agents, such as antibiotics. We sought to evaluate wound healing outcomes in deep partial-thickness burns treated topically with SPM.

Methods
A total of 30 circular, deep partial-thickness burns were created on the dorsum of 2 porcine models. Each wound measured 5cm in diameter and was standardized using a thermocoupled burn device. Sets of six wounds were randomized into five groups: SPM, gentamicin alone, SPM with gentamicin, a vehicle control (saline), or dry gauze (the standard of care, SOC). Additionally, two separate 5cm diameter circular areas were demarcated to serve as normal skin controls. Wounds were assessed at post-burn days 3, 7, 14, 21, 28, 60 and 90 with a variety of non-invasive imaging and punch biopsies. Treatments were re-applied at each assessment. The primary outcome was the amount of wound re-epithelialization, measured histologically, at post-burn day 28. Secondary outcomes consisted of the percentage of wound contraction, amount of superficial blood flow, and mean bacterial load.

Results
The amount of wound re-epithelialization in wounds treated with SPM was 96% whereas those treated with the SOC measured only slightly less at 92% (p = 0.56). The percentage of wound contraction was 39% in the SPM with gentamicin group, while in the SOC group contraction was higher at 45% (p = 0.20). Moreover, superficial blood flow in the SPM group was measured to be 168% of normal skin controls, while wounds in the SPM with gentamicin group were slightly lower at 160%, and in wounds treated with the SOC blood flow was 110% of normal skin controls (p = 0.27). The mean bacterial load in each group was measured at post-burn day 3 and notably consisted of bacterial load being the lowest in wounds treated with gentamicin alone at 17/100, meanwhile in wounds treated with the SOC or those in the SPM with gentamicin group, mean bacterial loads were significantly higher at 43/100 and 47/100, respectively (p = 0.02).

Conclusions
SPM applied to deep partial-thickness burns did not significantly improve measured outcomes over the SOC. Although numerical improvements were shown in all measured outcomes, no significant differences were noted. The theoretical and observed potential for SPM to improve wound healing deserves additional evaluation in larger preclinical studies.
814 Devices measuring transepidermal water loss of the skin: a systematic review of measurement properties
Authors: Klotz Tanja , Ibrahim Abdullah , Maddern Guy , Caplash Yugesh , Wagstaff Marcus 
Published: March 2022

Abstract

Introduction
TEWL is a physiological property of skin which increases when the epidermis is damaged. It is, therefore, a commonly utilised measure of skin barrier integrity. Devices measuring TEWL are available as open, semi-open or closed chamber. Studies of reliability examine the consistency of measurement, and/or responsive whereas measurement error scores in absolute terms the amount of error due to sources of variation.

Methods
The search strategy aimed to locate published and unpublished studies. Databases searched included PubMed, Embase, CINAHL and Web of Science, utilising identified keywords and limited to studies in English. Grey literature sources were searched to identify any unpublished documents. Study selection using the inclusion criteria was then assessed by two reviewers for methodological quality utilising the COSMIN risk of bias tool to assess the reliability and measurement error of outcome measurement instruments.
Studies examining the reliability and/or measurement error of TEWL measurement devices were included. Studies that only report on measurement of TEWL outcomes without examination of reliability and/or measurement error were excluded.

Results
A total of 22 devices were examined in the 38 included studies. The quality of study design was on average rated as ‘Adequate’ however reliability and measurement error statistical methods were on average rated as ‘Doubtful’.

Conclusions
TEWL measurement devices were found to demonstrate good reliability and often correlated with other devices. However, measurement error was highly variable but improves under in-vitro conditions.