bluuebunny/crossref_metadata_2025_split huggingface dataset:
618 Firefighter Resiliency Project: Survey Findings and Implications for a Program Model
Authors: Dillard Dana R , King Erin A , O'Dare Kellie , Rotunda Rob 
Published: March 2022

Abstract

Introduction
Firefighters are trained to respond to an array of acute emergencies that culminate in repeated exposure to trauma subsequently impacting their mental health. Yet, they often fail to seek services that could mitigate those adverse effects due to stigma, as well as a dearth of systematized resources and first responder proficient trained mental health professionals. This study explored work-related traumatic event exposure, PTSD symptomatology, levels of depression, anxiety, and suicide risk, and barriers to care for firefighters in a designated catchment area of a southeastern state. Results were used to inform local departments interested in culture change and intervention, as well as providing the basis for successfully obtaining federal grant monies.

Methods
Using Qualtrics, a web-based survey platform, researchers administered a cross-sectional survey to firefighters between Fall 2020 and Spring 2021. The survey included the PCL-5, PHQ-9, GAD-7, SBQ-R, and BACE. Descriptive statistics, correlations, and independent t-tests were run to determine the level of trauma exposure and clinically significant mental health symptomatology, associations between different types of trauma and mental health symptoms, and barriers to accessing care. The sample (N=511) primarily identified as Caucasian (n=421) and male (n=477). Mean age and time in fire service were 39.1 and 14.5 years, respectively.

Results
In this sample, 18.7% met the criteria for a provisional diagnosis of PTSD based on the PCL-5; 24.4% met the criteria for moderate to severe depression based on the PHQ-9; 14.5% met the criteria for moderate to severe anxiety based on the GAD-7; and 13.7% reported a significant risk of suicidal behavior as measured by the SBQR. Firefighters also indicated the following as the most common barriers to accessing care: 1) being unsure of where to get care (47.3%); 2) thinking the problem would get better itself (41.8%), 3) feeling embarrassed or ashamed (39%), 4) concern that they might be seen as weak for having a mental health problem (36.2%), and 5) thinking they did not have a problem (34.3%).

Conclusions
Due to the high levels of work-related trauma exposure, firefighters in this study were at an increased risk of developing mental health symptomatology including PTSD, depression, anxiety, and risk of suicidal behavior when compared to the general population. Additionally, perceived and actual barriers to care provided implications for the grant program application.
619 Pain Management in Burn and Wound Patients: Effects of Acupuncture in Pain Score and Medication
Authors: Lasso Erika Tay , Herekar Anjali , Riggle Clara , Li Sheng , Hwang Hui , Horie Mariko , Phelps Kenneth S , Burton Kimberly , Alaniz Leonardo , Hovis Gabrielle , Hecht Kim , Nunez Molly E , Joe Victor C , Chin Theresa L 
Published: March 2022

Abstract

Introduction
Pain management in burn patients is a complex ongoing problem. Opioid and non-opioid medications have historically been used as the primary pain management modality in burn care. Considering the ongoing opioid epidemic, a multidisciplinary holistic approach is needed for pain management. Acupuncture has been recognized to help in different settings such as chronic back pain, neurological problems, depression, and anxiety.
We hypothesize that burn and wound patients receiving acupuncture will have a decrease in opioids and non-opioid medications on acupuncture day (ACd) compared to non-acupuncture day (n-ACd) and a reduction of pain scores before and after acupuncture.

Methods
A prospective observational study in all patients admitted to the burn service was made. We exclude patients that were unable to provide consent or age 6 years and younger.
A numeric pain score (1-10) was collected from the patients before and after each acupuncture session; if patients were sleeping after acupuncture pain score was collected when they woke up. A prospective collection of daily opioids and non-opioids medications was made. Opioids were converted to daily morphine equivalents (MME).

Results
From February to August 2021, 53 patients on the burn service were treated with acupuncture for a total of 185 sessions. The median age was 49 years (IQR:32.5-63.0). Median TBSA for burn patients was 3.3% (IQR:1.5-8.1). The number of sessions per patient ranged from 1-12 with a median of 3 (IQR1.7-4). Before acupuncture, the median pain score was 5 (IQR:2.6-6.4), and after treatment was it was 1.5 (IQR:0.2-2.8).
Of 185 sessions, 49 (26%) of those sessions, patients fell asleep afterward. Median morphine use on ACd was 26.6 MME (15.8-62.1) vs. n-ACd 27.35 MME (15.5-65.3). For non-opioid medication, the median of acetaminophen on ACd 1007.5mg (313.39 -1950) vs. n-ACd 1381.25mg (642.5-2535).
After adjusting for TBSA and chronic opioid use, patients were given a daily mean of 391 MME CI: (1201.12-419.12 p=0.334) less in ACd vs. n-ACd. In addition, acetaminophen had a daily mean of 395.12mg CI: (130.05, 660.19 p=0.005) less in ACd vs. n-ACd.
Overall, acupuncture was associated with a significant lower pain score with a mean of 2.799 points less.

Conclusions
Acupuncture seems to abrogate pain in burn and wound patients, as demonstrated by doses of pain medication. While there was no significant difference in opioid medications, there was a significant difference in acetaminophen, indicating that additional education of a tiered approach to pain medications is essential to reduce unnecessary opioid use.
624 Implementation of a Collaborative Drug Therapy Management Protocol in an Adult Burn Clinic
Authors: Boyd Allison N , Walroth Todd A , Hartman Brett C 
Published: March 2022

Abstract

Introduction
Collaborative Drug Therapy Management (CDTM) protocols allow qualified clinical pharmacists working within a defined context to independently assume responsibility for a variety of direct patient care activities. The goal of this model is to improve access to care, often in a more affordable and timely manner. Pharmacists in our burn center have historically assisted with discharge planning and transitions of care for patients being sent home or to a facility. Despite these efforts, pharmacists were not formally involved in managing Burn Clinic patients. The objective of implementing a CDTM Protocol in Burn Clinic was to streamline management of burn-related pharmacologic issues.

Methods
The CDTM protocol allows the pharmacist to assess patients’ therapeutic needs related to thermal injury, inhalation injury, or dermatologic disorder. Disease states managed include: pain, agitation, delirium, insomnia, venous thromboembolism, skin and soft tissue infections, and complications of hypermetabolic burn response.

Results
In Burn Clinic, via in-person or telephone visits, pharmacists can independently evaluate and modify pharmacologic treatment regimens in accordance with state legislation, including initiation, renewal, and adjustment of drugs and vitamins. The pharmacist can also review, order, interpret, and conduct pertinent laboratory studies and wound culture results. In addition, the pharmacist completes medication reconciliation, performs patient education, and consults other healthcare providers, as needed. All visits, patient care, education, and treatment decisions are documented in the electronic record. “Incident-to” billing is completed at Level 99211, as this is a hospital-based clinic.

Conclusions
Historically, pharmacists were peripherally involved with Burn Clinic patients when issues arose, serving in an “as-needed” capacity. With more proactive involvement, pharmacists are uniquely positioned to help with de-prescribing, drug interactions, insurance issues, access to medications, adherence, and dose optimization. Implementing a CDTM protocol allows pharmacists to become more formally involved in post-discharge follow-up and to help manage ambulatory burn patients.
701 Outcomes of Patients with Burns Associated with Home Oxygen Therapy: A Systematic-Review and Meta-Analysis
Authors: Yoon Joshua S , Mafla Laura M , Ha Michael , Kim Justin , Keller Patrick R , Lagziel Tomer , Nam Arthur J , Galiatsatos Panagis , Hultman Charles S 
Published: March 2022

Abstract

Introduction
Home oxygen therapy (HOT) is frequently prescribed for patients with pulmonary dysfunction, which predisposes these patients to a unique health hazard at home. Given the combustibility of oxygen and method of delivery, HOT can result in burns that will affect primarily the facial area and may potentially be associated with inhalational injury. Additionally, a significant portion of patients on HOT are active smokers, which further heightens the risk of these HOT related burns. The outcomes of burn patients with burns associated with HOT is not yet completely understood. We conducted a systematic review and meta-analysis to characterize the outcomes of burn patients with burns associated with HOT.

Methods
We searched MEDLINE (Pubmed) for studies that reported on outcomes of burns associated with HOT. From this search, we screened 80 articles via online platform. Through our selection criteria, 17 articles focusing on patients with HOT-related burns were selected for systematic review and meta-analysis. Data was analyzed using a data analysis program.

Results
Seventeen studies observing a total of 1460 burn patients, published between 1990 and 2020, were included. Of these, one is a prospective study, twelve are retrospective chart reviews, and four were case reports/series. The mean age of the patients was 64.3 ± 4.5 years with a male to female predisposition of 1.5:1 and an average TBSA of 4.2 ± 4.1%. Of these burn patients, 93.4% were on HOT for COPD and 85.2% of injuries occurred while at home. Smoking caused 84.3% of all HOT-related burns and accrued a mean hospital charge of $73,628. With respects to clinical outcomes, the overall mortality rate was 11.3%, 33.6% required intubation, the average duration of intubation was 8.5 days, 31.3% had inhalational injury, 7.8% underwent tracheostomy, and 60.8% of patients were discharged home.

Conclusions
The majority of HOT-related burns are secondary to smoking and these injuries can result in significant morbidity and mortality and associated healthcare costs. A significant portion of these injuries can be prevented with smoking cessation and/or more judicious HOT allocation, however further studies and efforts will be needed to address this issue.
706 High Versus Low Dose Vitamin C in Burn Care
Authors: Jong Seungwon , Malkoc Aldin , Fine Kerry , Dao Tam , Wong David T 
Published: March 2022

Abstract

Introduction
While vitamin C is a regular part of burn management, there is no consensus on the most effective dose for a reduction in mortality, fluid resuscitation requirement, and other various clinical benefits. In this study, we aim to evaluate the potential protective effects of a higher dose of intravenous vitamin C in burn patients with greater than 40% total body surface area (TBSA) as compared to the effects on low dose oral vitamin C with lower TBSA burns.

Methods
A total of 54 subjects were retrospectively reviewed with burns greater than 20% TBSA from January 2018 to 2021. In our burn unit, patients with smaller burns were given 2,500 mg PO vitamin C and larger TBSA burns were given 15,000 mg IV vitamin C within 72 hours. During this period, we found 40 patients in the low dose group and 14 patients in the higher dose group. Demographics, length of stay, length on a ventilator, fluid requirements, number of procedures, days to the first infection, and mortality were compared using the Chi-square test.

Results
We found that there was a significant difference in the degree of burn on admission and reassessment between the dosing groups (30% vs. 48%, p = 0.006; 32% vs. 57%, p &lt; 0.001). Overall fluid requirements for the first three days (9 liters vs. 25 liters, p &lt; 0.001), length of stay (13 days vs. 38 days, p = 0.011), length on a ventilator (2 days vs. 13 days, p &lt; 0.001), and total procedures required (1 vs. 5, p = 0.014) were also significantly higher in the group given the IV dose. No significant difference in other outcomes such as days until first infection and mortality rate were found, (p=0.451 and 0.326, respectively).

Conclusions
Parameters that were statistically significant were consistent with the higher burn TBSA. Despite the group with larger surface area burns to require much higher fluid requirements (25 liters vs. 9 liters in 72 hours), high dose IV vitamin C may have been protective since the outcomes of days until first infection and mortality rate had no significant difference compared to the group with the smaller TBSA burn which should have predictably better outcomes. This clinical study supports other studies that high dose vitamin C may improve outcomes from a reduction in capillary leak to mortality but an adequately powered randomized prospective approach is needed to better define the benefits as well as dosing.
709 Reconfiguration: Extracorporeal blood purification of a burn patient on ECMO
Authors: Basel Anthony P , Thomas Jason , Williams Alicia M , Stoffel Steven , Walter Robert , Mason Phillip , Britton Garrett W , Cancio Leopoldo C 
Published: March 2022

Abstract

Introduction
Patients who require extracorporeal membrane oxygenation (ECMO) have a very high mortality if they develop septic shock. Extracorporeal blood purification has been studied as an adjunct to antimicrobials but has yielded mixed or even disappointing results. The Seraph-100 Microbind Affinity Blood Filter (ExThera Medical Corporation, Martinez, CA) is currently undergoing clinical trials. The filter consists of polyethylene beads, coated in heparin sulfate, that irreversibly binds bacteria, fungi, viruses, and toxins. Seraph-100 therapy is traditionally delivered through conventional hemodialysis or continuous renal replacement therapy (CRRT), with the filter being placed in-line with these circuits. We present a case of a burn patient on veno-venous (VV) ECMO in septic shock, who was treated with a Seraph filter by connecting it directly to the ECMO circuit.

Methods
We present a case.

Results
A 34-year-old male presented with 56% thermal burns and grade 1 inhalation injury from a fuel tank explosion. He underwent a large-volume resuscitation for burn shock with lactated Ringer’s and albumin, receiving 18,152 mL (163 mL/kg) in the first 24 hours. He was placed on CRRT for acute kidney injury and underwent escharotomies of the hands and legs. On day 4, he developed bacteremia, septic shock and progressed to acute respiratory distress syndrome requiring VV ECMO. Extracorporeal blood purification was started via the Seraph-100 filter. Due to limitations of blood flow rates on CRRT, the Seraph-100 filter was added directly into the ECMO circuit. Inflow tubing was connected to an existing port on the oxygenator (Fig 1) and returned to the venous drainage by cutting a new port into the drainage tubing (Fig 2). The filter itself did not require any special configuration or orientation (Fig 3). This configuration allowed for pressures generated by the ECMO circuit to drive blood flow through the Seraph-100 filter (Fig 4). After 6 hours of treatment, vasopressor requirements drastically decreased.

Conclusions
Complications related to the Seraph-100 filter are rare but may include catheter thrombosis. This is typically due to the type of catheter used and/or the blood-flow rate through the filter rather than the filter itself. This issue was avoided with the ECMO configuration. Similarly, clinicians can avoid transient hypotension, blood loss from a clotted circuit, catheter-site bleeding, and other complications frequently associated with a renal replacement circuit.
720 Intensive Insulin Therapy in the Burn Intensive Care Unit: A Systematic Review of Literature
Authors: Peters Jasmine N , Collier Zachary J , Gillenwater Justin , Yenikomshian Haig A 
Published: March 2022

Abstract

Introduction
The significant burden of burn-related morbidity and mortality is partly due to the complex pathophysiological derangements that occur in the acute post-burn period. Critical care literature has pushed for tighter glycemic control, but these studies often use heterogenous groups of medical and surgical patients. Furthermore, some of these studies present conflicting evidence of whether there is true mortality benefit. Providers must balance the risks associated with hyperglycemia such as infection, inflammation, and pour wound healing against the risks associated with severe hypoglycemia, most notably coma and death. This study aims to review the literature on outcomes in tight glucose control regimens (glucose &lt; 150mg/dL) in the burn ICU population to help guide further research and practice guidelines.

Methods
A systematic review of literature utilizing PubMed was conducted for any article published at any time. Searches used the AND function to identify articles with a burn term (burn injury OR burn care OR burn ICU OR burn OR thermal injury OR burned) and a glucose control related term (glucose control OR glycemic control OR glucose management OR insulin OR metformin OR glipizide). Inclusion criteria were English studies that describe intensive care unit (ICU) glucose management in adult burn patients. Exclusion criteria were involvement of children, animals, and settings outside of the ICU. Case reports, editorials, and position pieces were also excluded.

Results
The search identified 2,154 articles. Full text review of 61 articles identified 8 that met inclusion criteria. Two randomized control trials, 3 retrospective case-control studies, 2 retrospective cohort studies, and 1 systematic literature review. Only 1 study showed mortality benefit of tighter glucose control (&lt; 150 mg/dL) compared to controls (&lt; 200 mg/dL), while 3 studies showed no difference in mortality between cases and controls. Three studies demonstrated a reduction in infectious complications including sepsis, pneumonia, urinary tract infection, and bacteremia. Nearly all studies (6/8) showed increased rates of hypoglycemia with tight control, but very few instances of adverse sequela following hypoglycemia were noted.

Conclusions
Like the broader critical care population, tighter glucose control may be beneficial to burn patients but with some variability. Balancing the complications of hypoglycemia with hyperglycemia continues to be a challenge with no clear guidelines. Further research in a burn specific population would help create a safe and effective treatment algorithm which could be adapted widely.
726 Evaluating Outcomes and Pharmacoeconomics Associated with Collagenase Use in Burn Patients
Authors: Boyd Allison N , Walroth Todd A , Eberle Madilyn , Grooms Cortni , Hull Victoria , Hartman Brett C 
Published: March 2022

Abstract

Introduction
Collagenase is routinely used for partial thickness burns at our health-system. A 30 gram tube costs over $300, which creates financial challenges for uninsured patients and impacts revenue capture. The objective of this medication utilization evaluation was to characterize the use of collagenase and evaluate compliance to our institution’s criteria for use.

Methods
All admitted patients who received collagenase for burn injury from 3/14/21 to 6/14/21 were included. Patients were excluded if they were not admitted to the burn unit or left against medical advice. A cost analysis was also conducted.

Results
A total of 26 patients were included with a mean (SD) age of 45 (17) years. Most burns were thermal (77%) with a median (IQR) of 7.5% (1.9,13.5) total body surface area (TBSA). Twenty-three patients presented with mixed partial thickness or partial thickness burns (89%). The three remaining patients had full thickness burns, which is not an indication for collagenase use at our institution. There was a median of 1 (0,1) collagenase treatment day per TBSA. Median length of hospital stay was 5 (2,22) days with a length of stay per TBSA of 1 (1,2). Approximately 58% of patients required a surgical procedure. Of these, 8 had documented graft loss or failure while 7 did not. In those who experienced graft loss, median TBSA was higher [31.4 (7.8,57.5) vs. 10 (2.5,15); p = 0.269] and they required more surgeries [7 (1,9) vs. 1 (1,3); p = 0.104]. A potential total revenue of $428,280 was found. Additional cost data are provided in Table 1.

Conclusions
There was a high level of compliance with criteria for use, with some opportunities for improvement. Over 40% of patients who received collagenase for partial thickness burns were treated non-operatively, supporting its likely benefit, despite the cost. The potential exists for significant revenue for the health-system.
736 Intravenous Immunoglobulin in Stevens-Johnson Syndrome & Toxic Epidermal Necrolysis: Experience from a Tertiary Care Center
Authors: Hassan Manal , Ho Bao Vincent , Bhavsar Dhaval , Korentager Richard 
Published: March 2022

Abstract

Introduction
Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are rare severe cutaneous adverse reactions associated with high morbidity and mortality, however, there lacks an established treatment protocol. Treatment with intravenous immunoglobulin (IVIg) has demonstrated mixed success rates in improving mortality. It has been suggested that early intervention with IVIg in SJS/TEN patients may lead to a reduction in observed mortality rate when compared to the predicted rate. We present 24 patients with SJS/TEN treated in our burn unit with IVIg.

Methods
We conducted a retrospective analysis of patients who were hospitalized with the diagnosis of SJS/TEN in a specialized burn center over the years 2011-2020. Data regarding clinical factors, causative agent(s), disease severity, treatment received, and outcome were collected on chart review. SCORTEN and ABCD-10 prognostic scores were calculated for each patient at the time of admission. All patients were started on IVIg at the recommendation of dermatology. A standardized mortality ratio was obtained to compare the actual number of deaths to the predicted number based on SCORTEN and ABCD-10 formulas.

Results
A total of 24 patients were identified with a mean age of 49.8 ± 18.1 years. Most of the patients, i.e., 18 out of 24 had TEN, and 6 patients had SJS/TEN overlap with an overall average initial BSA involvement of 42.7% ± 25.3. Among the suspected drugs, sulfonamide antibiotics (41.7%) was the major predicted culprit. All patients were started on IVIg, 3 of which were treated in combination with corticosteroids. Most of our patients (23/24) received IVIg within 2 days of admission, but on average 11 ± 27 days (range: 2-135) after symptom onset. Many patients (10/24) experienced complications during hospital admission, such as: acute respiratory distress syndrome (8/24), sepsis (6/24), and anemia (2/24). There was no statistically significant difference in the overall observed mortality of 4 patients (16.7%) and the predicted overall mortality of 6.4 patients (26.7%) by the SCORTEN formula [standardized mortality ratio = 0.63; 95% confidence intervals, 0.17-1.61; P = 0.48], and the predicted overall mortality of 3.6 patients (15%) by the ABCD-10 formula [standardized mortality ratio = 1.12; 95% confidence intervals, 0.30-2.86; P = 0.96].

Conclusions
The findings of the present study do not support the clinical benefits of IVIg for SJS/TEN overlap and TEN patients.