2025 Southern Region Burn Call for Abstracts Abstract submission form for the 38th Annual Southern Region Burn Conference (Abstract deadline is June 6, 2023 at 11:59 pm CST) "*" indicates required fields Step 1 of 3 33% Presenting Author - Name*All correspondence will be sent to the attention of the presenting author at the email address listed. First Middle Last Presenting Author - Degree*Enter your degree (ie, MD, PA, NP, RN, PT, etc.). If no degree, enter n/a.Presenting Author - Position*Enter your academic or departmental title (ie, Unit Manager; Staff Nurse; Outreach Coordinator, etc.)Presenting Author - Department/Division*Enter your department/division (ie, Department of Surgery, etc.)Presenting Author - Burn/Institution Name, City and State*Enter the name of your Burn Center or Institution, and the City and State.Burn Center/Institution NameCityStatePresenting Author - Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Presenting Author - Phone*Presenting Author - Email* Presenter - Briefly describe your professional experience or areas of expertise*Include publications, job experience, etc.Presenter Education*Enter all education information through highest degree held. Click + to add more. College/UnivCity, StateDegree AchievedMajor Field of StudyYear Degree Received Add RemovePresenter - Do you have any financial relationship(s) with ineligible companies occurring within the past 24 months to disclose?*ACCME now requires all authors/presenters to list ALL ineligible company affiliations regardless if they pertain to your abstract or not. INELIGIBLE companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. If you have received a financial benefit, you must disclose the relationship. Yes No Presenter - Disclosure of Relevant Financial Relationships*Enter the Name of Ineligible Company An ineligible company is any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Enter the Nature of Financial Relationship Examples of financial relationships include employee, researcher, consultant, advisor, speaker, independent contractor (including contracted research), royalties or patent beneficiary, executive role, and ownership interest. Individual stocks and stock options should be disclosed; diversified mutual funds do not need to be disclosed. Research funding from ineligible companies should be disclosed by the principal or named investigator even if that individual’s institution receives the research grant and manages the funds. Has the Relationship Ended? If the financial relationship existed during the last 24 months, but has now ended, please check the box in this column. This will help the education staff determine if any mitigation steps need to be taken.Enter the Name of Ineligible CompanyEnter the Nature of<br>Financial RelationshipHas the Relationship Ended? Add RemoveOff-label Content*Will you include information about unlabeled use, or products/treatments that are not yet approved by the FDA? Yes No If Yes, Explain*Do You Have Co-Authors to Add?* Yes No Enter Co-Author Information*Do not duplicate presenting author's name. Click + to add authors.First NameLast Name/DegreeTitle/DepartmentInstitution/City, State Add RemoveCo-Authors - Disclosure of Financial Relationships*First, list name(s) of ALL Co-author(s) - and provide each person's relationship(s) for the last 24 months (enter N/A in all fields if that person has nothing to disclose). Second, Enter the Name of Ineligible Company An ineligible company is any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Third, Enter the Nature of Financial Relationship Examples of financial relationships include employee, researcher, consultant, advisor, speaker, independent contractor (including contracted research), royalties or patent beneficiary, executive role, and ownership interest. Individual stocks and stock options should be disclosed; diversified mutual funds do not need to be disclosed. Research funding from ineligible companies should be disclosed by the principal or named investigator even if that individual’s institution receives the research grant and manages the funds. Fourth, Has the Relationship Ended? If the financial relationship existed during the last 24 months, but has now ended, please check the box in this column. This will help the education staff determine if any mitigation steps need to be taken.Co-Author's NameName of Ineligible CompanyNature of the RelationshipHas the Relationship Ended? Add Remove Submission Type* Oral Presentation Poster Presentation Willing to Present as a Poster if NOT accepted as an oral presentation? Yes No Competition Category*Oral Abstract Best Paper Awards are presented in three categories: Resident/Fellow; Medical Student; and Allied Health Professional. Indicate the appropriate category for this submission.Click to SelectResident/FellowMedical StudentPhysician in PracticeAllied Health ProfessionalWhat Year?*PharmacotherapeuticsIs the content of this presentation related to pharmacology, meeting the ANCC Pharmacotherapeutics and/or State Board requirements for Nurse Practitioners and Clinical Nurse Specialists? Yes No Abstract Title*Enter the title of your abstract, using Title Case, not all caps. Example: Reading Tea Leaves: Markers for Infection in Patients with Burn Injuries Using a Sepsis Algorithm Structured Abstract*Organize your abstract to include: 1) Introduction/Background (Knowledge Gap); 2) Methods/Design; 3) Results/Findings; 4) Conclusions/Implications. Check CAREFULLY when copying/pasting that all paragraphs are included. Upload Charts/GraphsIf applicable, upload chart(s) and/or graph(s) in either Microsoft Word or Excel Format. Drop files here or Select files Max. file size: 256 MB. Learning Objectives*Indicate how the presentation's content will fulfill the knowledge gap(s), by providing one to three learning objectives incorporating verbs that communicate knowledge (example: describe, discuss, examine, identify, etc.), impart skill (example: demonstrate, measure, etc.) or convey attitudes (example: reflect, recognize, consider, realize, etc.). Avoid use of learn, understand, or know, as they are open to many interpretations. Complete this sentence: Upon completion of this lecture, learners should be better prepared to:Test Question*Provide two (2) multiple choice questions with the correct answer noted for use in providing CME and MOC credit to the attendees. Indicate correct answer with an asterisk (*), and provide a brief explanation for the correct answer. References and Resources*Provide 3 references and/or resources used for this abstract and for further study regarding the content in this presentation (a book, article, website URL, or other source for supplemental information). Permission to Record*SMA may audio or video capture your lecture during this activity. Please review the statements below and indicate authorization to record your lecture either for possible purchase as a CME activity on SMA’s website or for non-commercial educational purposes only. I authorize the Southern Medical Association (SMA) to create an audio and/or video recording of this presentation and to use, distribute, copy, and edit the recording, in whole or in part, in any form or media for educational purposes, including but not limited to, continuing medical education content available for purchase on the SMA website. I authorize the Southern Medical Association (SMA) to create an audio and/or video recording of this presentation and to use, distribute, copy, and edit the recording, in whole or in part, in any form or media for non-commercial, educational purposes on the SMA website. I do not authorize permission for SMA to record my lecture. Attestation*As a presenter for this certified CME activity, I understand and agree to the following: I will disclose to the SMA all relevant financial relationships. Additionally, I will disclose this information to learners verbally and with a slide at the beginning of my presentation(s). The content and/or presentation of the information with which I am involved will promote quality or improvements in healthcare and will not promote a specific proprietary business interest of a commercial interest. Content for this activity, including any presentation of therapeutic options, will be well-balanced, evidence-based and unbiased. I have not and will not accept any honoraria, additional payments or reimbursements from a commercial entity for this presentation. I understand that my presentation and/or content will be peer-reviewed prior to the activity, and I will provide educational content and resources in advance as requested. Conflict(s) of interest, if applicable, will be resolved prior to the activity. I understand that a CME monitor may attend the event to ensure that my presentation is educational, and not promotional. If I am providing recommendations involving clinical medicine, they will be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported or used in CME in support of justification of a patient care recommendation will conform to the generally accepted standards of experimental design, data collection and analysis. If I am discussing specific health care products or services, I will use generic names to the extent possible. If I need to use trade names, I will use trade names from several companies when available, and not just trade names from any single company. If I am discussing any product use that is off label, I will disclose that the use or indication in question is not currently approved by the FDA for labeling or advertising. If I have been trained or utilized by an ineligible company or its agent as a speaker (e.g., speaker’s bureau), the promotional aspects of that presentation will not be included in any way with this activity. If I am presenting research funded by an ineligible company, the information presented will be based on generally accepted scientific principles and methods, and will not promote the interest of the funding company. I have procured permission to use (in part or total) any copyrighted information in slides and/or printed material distributed. The content presented in my lecture meets the definition of CME, which is as follows: Continuing medical education consists of educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession. The content of CME is that body of knowledge and skills generally recognized and accepted by the profession as within the basic medical sciences, the discipline of clinical medicine, and the provision of health care to the public. The content should promote quality or improvements in healthcare and should NOT promote a specific proprietary business interest of a commercial interest. Electronic Signature*By signing electronically, I understand and agree that the information outlined in this document is correct and accurate, and that I agree to the attestation statements above.Today's Date MM slash DD slash YYYY
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