A5058195918- Burn Injury Management and Outcomes
- Wound Healing and Treatments
- Injury Epidemiology and Prevention
- Trauma and Emergency Care Studies
- Disaster Response and Management
- Cardiac Arrest and Resuscitation
- Pressure Ulcer Prevention and Management
- Healthcare Technology and Patient Monitoring
- Simulation-Based Education in Healthcare
- Electronic Health Records Systems
- Palliative Care and End-of-Life Issues
- Opioid Use Disorder Treatment
- Respiratory Support and Mechanisms
- Patient Safety and Medication Errors
- Diabetic Foot Ulcer Assessment and Management
- Traumatic Brain Injury and Neurovascular Disturbances
- Complex Systems and Decision Making
- Pharmaceutical Practices and Patient Outcomes
- Telemedicine and Telehealth Implementation
- Human-Automation Interaction and Safety
- Acute Kidney Injury Research
- Abdominal Surgery and Complications
- Diagnosis and Treatment of Venous Diseases
- Delphi Technique in Research
- Personal Information Management and User Behavior
United States Army Institute of Surgical Research
2015-2024
Brooke Army Medical Center
2014-2023
Vanderbilt University Medical Center
2023
The University of Texas Southwestern Medical Center
2012-2022
Southwestern Medical Center
2022
University of Washington
2022
Healthwise
2022
United States Army Medical Research and Development Command
2011-2021
United States Army Medical Command
2021
Applied Research Associates (United States)
2019
Objective: Several formulas have been developed to guide resuscitation in severely burned patients during the initial 48 hrs after injury. These approaches require manual titration of fluid that may result human error this process and lead suboptimal outcomes. The goal study was analyze efficacy a computerized open-loop decision support system for burn compared historical controls. Design: Fluid infusion rates urinary output from 39 with >20% total body surface area burns were recorded upon...
Journal Article Summary of the 2012 ABA Burn Quality Consensus Conference Get access Nicole S. Gibran, MD, FACS, FACS Search for other works by this author on: Oxford Academic Google Scholar Shelley Wiechman, PhD, ABPP, ABPP Walter Meyer, MD Linda Edelman, RN, PhD Jim Fauerbach, Gibbons, MS, MS Radha Holavanahalli, Carly Hunt, MA, MA Kelly Keller, RN Elizabeth Kirk, MSN, APN, APN ... Show more Jacqueline Laird, BSN, Giavonni Lewis, Sidonie Moses, BSN Jill Sproul, Gretta Wilkinson, Steve...
The rate of wound healing and its effect on mortality has not been well described. objective this article is to report trajectories in burn patients analyze their effects in-hospital mortality. authors used software (WoundFlow) depict wounds, surgical results, progression at multiple time points throughout admission. Data for all admitted the intensive care unit with ≥ 20% TBSA burned were collected retrospectively. open size (OWS), which includes both unhealed burns donor sites, was...
Accurate burn estimation affects the use of resuscitation formulas and treatment strategies, thus can affect patient outcomes. The objective this process-improvement project was to compare accuracy a computer-based mapping program, WoundFlow (WF), with widely used hand-mapped Lund–Browder (LB) diagram. Manikins various representations (from 1% more than 60% TBSA) were for comparison WF system LB diagrams. Burns depicted on manikins using red vinyl adhesive. Healthcare providers responsible...
BACKGROUND Optimal fluid resuscitation of burn patients with burns greater than 20% total body surface area is critical to prevent shock during the initial 24 hours 48 postburn. Currently, most formulas incorporate patient's weight when estimating 24-hour requirements. The objective this study was determine impact on requirements and outcomes after admission. METHODS We performed a retrospective review admitted our intensive care unit from December 2007 April 2013, resuscitated computerized...
Abstract The objective of this multicenter observational study was to evaluate resuscitation volumes and outcomes patients who underwent fluid utilizing the Burn Navigator (BN), a clinical decision support tool. Two analyses were performed: examination first 24 hours postburn regardless when began, account for presented in delayed fashion. Patients classified as having followed BN (FBN) if all hourly rates within ±20 ml recommendations that hour at least 83% time; otherwise, they not (NFBN)....
The fragile health of patients who are admitted to a burn intensive care unit (ICU) requires clinicians and clinical teams perform complex cognitive work that includes time-pressured diagnostic therapeutic decisions based on emergent interrelated patient information. Barriers clinician efforts delay increase cost, length stay, the potential for misadventures. Cooperative Communication System is real-time information technology system in its final year development designed support individual...
Abstract Introduction The electronic medical record (EMR) is presumed to support clinician decisions by documenting and retrieving patient information. Research shows that the EMR variably affects care clinical decision making. way information presented likely has a significant impact on this variability. Well-designed representations of salient can make task easier integrating in useful patterns clinicians use improved judgments decisions. Using Cognitive Systems Engineering methods, our...
Abstract Initial fluid infusion rates for resuscitation of burn injuries typically use formulas based on patient weight and total body surface area (TBSA) burned. However, the impact this rate overall volumes outcomes have not been extensively studied. The purpose study was to determine initial 24-hour using Burn Navigator (BN). BN database is composed 300 patients with ≥20% TBSA, >40 kg that were resuscitated utilizing BN. Four arms analyzed formula—2 ml/kg/TBSA, 3 4 ml/kg/TBSA or...
OBJECTIVES: To determine the impact of telementoring on caregiver performance during a high-fidelity medical simulation model (HFMSM) critically ill patient in resource-limited setting. DESIGN: A two-center, randomized, controlled study using HFMSM with community-acquired pneumonia complicated by acute respiratory distress syndrome. SETTING: notional clinic remote location staffed single clinician and nonmedical assistant. PARTICIPANTS: Clinicians limited experience managing patients....
Management of wartime burn casualties can be very challenging. Burns frequently occur in the setting other blunt and penetrating injuries. This clinical practice guideline provides a manual for injury assessment, resuscitation, wound care, specific scenarios including chemical electrical injuries deployed or austere setting. The also reviews considerations definitive care local national patients, pediatric who are unable to evacuated from theater. Medical providers encouraged contact US Army...
The Special Interest Groups of the American Burn Association provide a forum for interested members multidisciplinary burn team to congregate and discuss matters mutual interest. At 47th Annual Meeting in Chicago, IL, Fluid Resuscitation Group sponsored special symposium on resuscitation. purpose was review history, current status, future direction fluid resuscitation patients with shock. reader will note several themes running through following presentations. One is perennial question...
The goal of burn resuscitation is to provide the optimal amount fluid necessary maintain end-organ perfusion and prevent shock. objective this analysis was examine how Burn Navigator (BN), a clinical decision support tool in resuscitation, utilized across five major centers United States, using an observational trial 300 adult patients. Subject demographics, characteristics, volumes, urine output, resuscitation-related complications were examined. Two hundred eighty-five patients eligible...
The intrinsic relationship between fluid volume and open wound size (%) has not been previously examined. Therefore, we conducted this study to investigate whether can be predicted from plus other significant factors over time evaluate how machine learning may perform in predicting size. This retrospective involved patients with at least 20% TBSA burned. Various predictive models were developed compared using goodness-of-fit statistics (R2, error [mean absolute (MAE), root mean squared...
The depth of burn has been an important factor often overlooked when estimating the total resuscitation fluid needed for early care. goal this study was to determine degree which full-thickness (FT) involvement affected overall 24-hour volumes.We performed a retrospective review patients admitted our intensive care unit from December 2007 April 2013, with significant burns that required using computerized decision support system resuscitation. We defined FT as Index (FTI; percentage...
In 2006, burn clinical practice guidelines were developed to provide recommendations for optimal care of U.S. military and local national casualties. As part that effort, a paper-based Burn Flow Sheet (BFS) was included document the resuscitation combat casualties with ≥20% total body surface area burns. The purpose this study evaluate BFS in terms ongoing utilization, management, outcomes patients transported.A retrospective review performed hard-copy BFSs received from January 2007...
OBJECTIVES: Most high-fidelity medical simulation is of limited duration, used for education and training, rarely intended to study technology. U.S. caregivers working in prehospital, resource-limited settings may need manage patients extended periods (hours days). This “prolonged casualty care” occurs during military, wilderness, humanitarian, disaster, space medicine. We sought develop a standardized model that accurately reflects prolonged care order caregiver decision-making performance,...
Multidisciplinary rounds (MDRs) in the burn intensive care unit serve as an efficient means for clinicians to assess patient status and establish priorities. Both tasks require significant cognitive work, magnitude of which is relevant because increased work task completion has been associated with error rates. We sought quantify this workload during MDR using National Aeronautics Space Administration Task Load Index (NASA-TLX). Research staff at three academic regional referral centers...
The purpose of this study was to determine baseline user satisfaction for 2 computer decision support systems (DSSs) with demonstrated improvement in patient outcome used a burn intensive care unit. We conducted survey staff members 16-bed unit (n = 82) using written, anonymous questionnaire DSSs: commercial glycemic management system and software program guide initial fluid resuscitation. Staff are not yet convinced positive correlation between DSS technology outcomes. suggest may be...
Abstract We hypothesized that burn location plays an important role in wound healing, mortality, and other outcomes conducted the following study to test this multifold hypothesis. a retrospectively look at patients with burns ≥10% TBSA. Demographics, TBSA, partial/full thickness (PT/FT) various locations, fluids, inhalation injury, ICU duration, hospital duration were considered. Initial healing rates (%/d) also calculated as slope from time of first mapping open size third size....