Fairview Lakes Medical Center

BACKGROUND: There is wide recognition that, with the rapid implementation of electronic health records (EHRs), large data sets are available for research. However, essential standardized nursing data are seldom integrated into EHRs and clinical data repositories. There are many diverse activities that exist to implement standardized nursing languages in EHRs; however, these activities are not coordinated, resulting in duplicate efforts rather than building a shared learning environment and resources. OBJECTIVE: The purpose of this paper is to describe the historical context of nursing terminologies, challenges to the use of nursing data for purposes other than documentation of care, and a national action plan for implementing and using sharable and comparable nursing data for quality reporting and translational research. METHODS: In 2013 and 2014, the University of Minnesota School of Nursing hosted a diverse group of nurses to participate in the Nursing Knowledge: Big Data and Science to Transform Health Care consensus conferences. This consensus conference was held to develop a national action plan and harmonize existing and new efforts of multiple individuals and organizations to expedite integration of standardized nursing data within EHRs and ensure their availability in clinical data repositories for secondary use. This harmonization will address the implementation of standardized nursing terminologies and subsequent access to and use of clinical nursing data. CONCLUSION: Foundational to integrating nursing data into clinical data repositories for big data and science, is the implementation of standardized nursing terminologies, common data models, and information structures within EHRs. The 2014 National Action Plan for Sharable and Comparable Nursing Data for Transforming Health and Healthcare builds on and leverages existing, but separate long standing efforts of many individuals and organizations. The plan is action focused, with accountability for coordinating and tracking progress designated.

The lack of compliance with universal precautions (UP) is well documented across a wide variety of healthcare professions and has been reported both before and after the enactment of the Occupational Safety and Health Administration's Bloodborne Pathogens Standard. Gershon, Karkashian, and Felknor (1994) found that several factors correlated significantly with healthcare workers' lack of compliance with UP, including a measure of organizational safety climate (e.g., the employees' perception of their organizational culture and practices regarding safety). We conducted a secondary analysis using data from a cross-sectional survey of a convenience sample of 1,746 healthcare workers at risk of occupational exposure to bloodborne pathogens to assess the validity and reliability of Gershon's measure of safety climate. Findings revealed no relationship between safety climate and employees' gender, age, education, tenure in position, profession, hours worked per day, perceived risk, attitude toward risk, and training. An association was demonstrated between safety climate and (1) healthcare worker compliance with UP and (2) the availability of personal protective equipment, providing support for the construct validity of this measure of safety climate. These findings could be used by occupational health professionals to assess employees' perceptions of the safety culture and practices in the workplace and to guide the institution's risk management efforts in association with U.P.

BACKGROUND: Blunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department. METHODS: Children presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts. RESULTS: The preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation. CONCLUSION: The series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.

Cross-country skiers can suffer acute injuries, such as sprains of the ulnar collateral ligament of the thumb, the medial collateral ligament of the knee, and the ankle. They are also subject to overuse injuries, including arthritic changes in the great toe, and are at risk for cold-related injuries. Most of these injuries can be treated conservatively, and some can be avoided with adequate preparation and training.

A systematic literature review identified fourteen studies published between 1980 and 2002 that addressed the reciprocal nature of sibling interaction when one sibling presents with a developmental disability. Variables of birth order, chronological age, age gap, sex composition, gender, and type and/or degree of disability were studied as possible contributing factors to difference in interactional patterns among siblings. This research found that the primary difference between siblings, frequency of role symmetry and social reciprocity, is influenced primarily by the presence of a sibling with a disability rather than any other variable studied. Suggested methods of increasing the frequency of sibling role symmetry and social reciprocity as a family-centered intervention are given.

BACKGROUND: There is a need to improve prognostic accuracy for patients with cutaneous melanoma. A 31-gene expression profile (31-GEP) test uses the molecular biology of primary tumors to identify individual patient metastatic risk. OBJECTIVE: Develop a nomogram incorporating 31-GEP with relevant clinical factors to improve prognostic accuracy. METHODS: In an IRB-approved study, 1124 patients from 9 Mohs micrographic surgery centers were prospectively enrolled, treated with Mohs micrographic surgery, and underwent 31-GEP testing. Data from 684 of those patients with at least 1-year follow-up or a metastatic event were included in nomogram development to predict metastatic risk. RESULTS: Logistic regression modeling of 31-GEP results and T stage provided the simplest nomogram with the lowest Bayesian information criteria score. Validation in an archival cohort (n = 901) demonstrated a significant linear correlation between observed and nomogram-predicted risk of metastasis. The resulting nomogram more accurately predicts the risk for cutaneous melanoma metastasis than T stage or 31-GEP alone. LIMITATIONS: The patient population is representative of Mohs micrographic surgery centers. Sentinel lymph node biopsy was not performed for most patients and could not be used in the nomogram. CONCLUSIONS: Integration of 31-GEP and T stage can gain clinically useful prognostic information from data obtained noninvasively.

Introduction: The relationship between obesity and the quality of life (QoL) or health-related quality of life (HRQoL) has been confounded by several factors, including multi-morbidity. The objective of this study is to review and explore the relationship between obesity and quality of life, controlling for the long-term conditions alongside various demoic, health, and lifestyle factors within the general population. Methodology: To achieve the objective, we have conducted a systematic review of 21 studies published between 2020 and 2024, focusing on the influence of obesity on individuals’ quality of life. This systematic review employed a robust methodology that follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. It included studies published between 2010 and 2024, drawn from various databases, including SCOPUS, PubMed, Embase, and Google Scholar. Results: The findings indicate that obesity is directly associated with reductions in the quality of life, including mental and physical health, activities of daily living, and psychological functioning. Obese persons have higher functional limitations levels than normal and overweight individuals, even as obesity has been linked to the development of various sleep disorders, including obesity hypoventilation syndrome (OHS) and obstructive sleep apnea (OSA). Conclusions: The systematic review has disclosed the existence of a clear inverse relationship between increased weight status and decrease in the quality of life. Obesity significantly influences the quality of life of persons with obesity as it adversely affects individual’s health and affects different aspects of the person’s quality of life, including physical and psychological functioning, mental health and well-being, and body image, among others.

Although widely practiced in China for 2,000 years, acupuncture was introduced in the United States 40 years ago, and it has only gained acceptance by the medical establishment here in recent years. Now, a growing body of evidence supports its efficacy for a number of conditions, and it is being routinely recommended for them. This article provides an overview of acupuncture and reviews some of the evidence showing its effectiveness for treating various conditions.

1267 HISTORY: A 24-year old male presented to the office with progressive wax/waning severe knee pain associated with effusions for 4 weeks. He denied any acute injury or increase of his usual activities of jogging and weight training. He had a past medical history significant for a torn medial meniscus in the same knee 2 years ago confirmed by MRI, which subsided without invasive intervention. He felt that his symptoms at present were reminiscent of those associated with his prior injury. He denied locking or buckling, but admitted to difficulty pivoting in certain directions, and also admitted to pain with full weight-bearing. He denied systemic symptoms. PHYSICAL EXAMINATION: Patient walked in with a noticeable limp, but was able to fully bear weight. Patient's knee was warm and swollen, with a significant joint effusion. The skin is slightly wam, without erythema. range of motion severely limited in both flexion and extension, with knee held at 45 degrees. There was no obvious deformity. The knee was globally tender without definitive joint line tenderness. There was no patellar apprehension or associated tenderness upon gentle manipulation. Lachman, McMurray's, anterior and posterior drawer tests were limited secondary to patient discomfort, with no positive findings. Likewise, there was no appreciable laxity with valgus and varus stress (also limited). Under sterile conditions the knee joint was aspirated, yielding 37 cc. of cloudy serous fluid, with partial resolution of the patient's symptoms. DIFFERENTIAL DIAGNOSIS: Reexacerbation of medial meniscus tear Other internal derangement Septic arthritis TEST AND RESULTS: Joint aspiration-cloudy serous synovial fluid. CBC- Largely WNL Comprehensive metabolic panel, including uric acid- WNL Synovial Fluid Cell Count: WBC 13900 cells/mm-3 RBC 2200 cells/mm-3 Polys 50% Lymph 14% No crystals Glucose 51 mg/dl Protein 4.2 g/dl Fluid culture- No aerobic or anaerobic growth Lyme Western Blot of Fluid: Positive for IgM and IgG FINAL WORKING DIAGNOSIS: Lyme disease TREATMENT AND OUTCOMES: Patient was placed on Doxycycline 100 mg BID for a thirty day course, along with Ibuprofen 800 mg TID, and sent to orthopaedics for further evaluation. Patient was initially with assisted weight bearing, progress as tolerated. The patient subsequently had complete resolution of his symptoms after his course of antibiotics. Complete follow-up pending.

When this article was written, Bobbi L. Hallberg was a nurse manager in the ICU and pediatrics and Anne Marie Renaker was a clinical nurse specialist at Fairview Lakes Health Services in Wyoming, Minn. Now Ms. Hallberg is the director of progressive and critical care at Skagit Valley Hospital in Mount Vernon, Wash., and Ms. Renaker is a pediatric clinical nurse specialist in the emergency department at the University of Minnesota Children's Hospital, Fairview.

Introduction: Children with chronic respiratory technology dependence (CRTD) are at increased risk for critical illness due to their underlying physiology, comorbid conditions, and device dependence. Home nursing allows these children to be cared for outside of the hospital, but this nursing care may be hard to access and have frequent gaps. Little is known about how these gaps may impact child and family functioning. Methods: Prospective, single-center, longitudinal study of critically ill children with CRTD. Families completed custom ecological momentary assessment (EMA) surveys up to 4x/day for the first week following hospital discharge and again for one week at 3, 6, and 9 months after discharge. EMA survey contents included real-time assessment of the child’s mood, energy, and respiratory support needs, as well as daily assessment for missed nursing shifts, parental stress, parental fatigue, and child sleep. Overall caregiver stress was measured using the PedsQL Family Impact Module (FIM) and Patient Health Questionnaire (PHQ-9). Linear mixed models were built to assess associations between missed nursing shifts and child and family outcomes. Results: Of 32 enrolled patients, 21 received home nursing following ICU discharge. 31 patients (21 with home nursing) had sufficient EMA data for analysis, primarily in the first week after discharge due to enrollment patterns. Families reported missed nursing shifts on 25.6% of queried days. Missed nursing shifts were associated with parental fatigue due to lack of sleep on the day following the missed shift (coeff 0.9559, p=0.029) and poor child sleep on the day of the missed shift (coeff 0.3966, p=0.002). Missed nursing shifts were not associated with parental worry about family events, parental worry about money, or parental physical discomfort as assessed by EMA. The percentage of queried days with missed nursing shifts was not associated with FIM or PHQ-9 at 3 months following hospital discharge (n=15). Conclusions: Missed home nursing shifts are associated with worse child sleep and increased parental fatigue following the missed shift in children with CRTD recovering from critical illness and their families. However, short- and long-term parental stress as measured by EMA questions, FIM, and PHQ-9 was not associated with missed nursing shifts.

Introduction: Children with chronic respiratory technology dependence (CRTD), including home oxygen or mechanical ventilation, are at risk for post-ICU morbidity. We hypothesized that children whose families reported more problematic early post-hospital recovery trajectories would have worse overall function at 3 month follow up. Methods: Families of children with CRTD whose child had >24 hours of ICU stay were recruited for prospective, long-term follow up via standard survey instruments and custom ecological momentary assessment (EMA) surveys. Families completed EMA surveys up to 4x/day for the first week following hospital discharge, providing real-time assessment of the child’s mood, energy, and respiratory support needs. Functional outcomes were measured using the Functional Status Scale (FSS), which has six subdomains to reflect areas of child functioning. Days in the hospital in the 3 months after discharge was assessed via manual chart review. Linear regressions were performed to assess the relationship between EMA data and early post-hospital recovery and change in 3 month FSS subdomain differences from baseline. Data are presented as median (IQR) unless otherwise stated. Results: 27 participants had adequate EMA data and FSS scores. Child age at enrollment was 4.4 years (1.5-10.1). 56% were female. Severity of illness, as measured by PRISM III, was 0 (0-3). Total FSS at baseline (reflecting pre-illness status) was 15 (10-16). Median change in total FSS at 3 months was 0 (0-0, range -1-1), true of all subdomains. Better reported child mood was associated with worsening child sensory subdomain score (coeff 0.2839, p=0.021) and improved FSS respiratory subdomain score (-0.41003, p=0.033). No queried EMA data was significantly associated with change in the FSS motor, feeding, or mental status subdomain scores. Children spent a median of 0 days in the hospital in the 3 months following discharge (0-3, range 0-9). Parental-reported respiratory support needs were not associated with days in the hospital in the 3 months following discharge. Conclusions: Family-reported assessments of a child’s clinical status in the first week after hospital discharge are associated with change in FSS subdomain scores 3 months after discharge, but not days in the hospital during the same time period.

Introduction: Congenital heart defects effect about 1% of births, or 40,000 babies annually. Of these, about 1 in 4 have a critical defect, often requiring prompt diagnosis and intervention within the first hours of life. However, many remote and low resource hospitals do not have access to echocardiography required for diagnosis. A new medical device, the RAPIDscan autonomous 30-second ultrasound device, is being developed by Bloom Standard (Minneapolis, MN). In this study we conducted initial feasibility testing of multiple iterations of the RAPIDscan device. The RAPIDscan ultrasound device is designed for early detection of critical congenital heart disease in newborns and infants at hospitals without congenital heart programs. Methods: We enrolled 22 patients admitted to the pediatric intensive care unit and cardiac intensive care unit at University of Minnesota Masonic Children’s Hospital from February 2024 to July 2025. Inclusion criteria were age < 12 months and a full echocardiogram within the past three months. Ultrasound images were obtained via RAPIDscan and compared to patient’s most recent full congenital ECHO. Two independent pediatric cardiologists reviewed the images and provided qualitative feedback using an anatomical checklist on image quality comparing the two images. Image quality and device feasibility data was collected with each scan and communicated to the engineering team, allowing them to iterate on the device multiple times during the study. Results: A total of 22 RAPIDscan ultrasounds were obtained from patients with known congenital heart disease. Approximately half were of sufficient quality for the reading cardiologists to rule out critical congenital heart disease. Image quality was affected by internal pacer wires and chest tubes and was consistently better in smaller patients. Image quality improved over multiple iterations of the device with the last several images taken comparing closely to the patients congenital ECHO images. Conclusions: Critical congenital heart defects are a serious and potentially life-threatening condition often requiring prompt diagnosis and intervention. The RAPIDscan medical device shows significant potential as a solution for hospitals without fast access to a congenital ECHO team and equipment.

1267 HISTORY: A 24-year old male presented to the office with progressive wax/waning severe knee pain associated with effusions for 4 weeks. He denied any acute injury or increase of his usual activities of jogging and weight training. He had a past medical history significant for a torn medial meniscus in the same knee 2 years ago confirmed by MRI, which subsided without invasive intervention. He felt that his symptoms at present were reminiscent of those associated with his prior injury. He denied locking or buckling, but admitted to difficulty pivoting in certain directions, and also admitted to pain with full weight-bearing. He denied systemic symptoms. PHYSICAL EXAMINATION: Patient walked in with a noticeable limp, but was able to fully bear weight. Patient's knee was warm and swollen, with a significant joint effusion. The skin is slightly wam, without erythema. range of motion severely limited in both flexion and extension, with knee held at 45 degrees. There was no obvious deformity. The knee was globally tender without definitive joint line tenderness. There was no patellar apprehension or associated tenderness upon gentle manipulation. Lachman, McMurray's, anterior and posterior drawer tests were limited secondary to patient discomfort, with no positive findings. Likewise, there was no appreciable laxity with valgus and varus stress (also limited). Under sterile conditions the knee joint was aspirated, yielding 37 cc. of cloudy serous fluid, with partial resolution of the patient's symptoms. DIFFERENTIAL DIAGNOSIS: Reexacerbation of medial meniscus tear Other internal derangement Septic arthritis TEST AND RESULTS: Joint aspiration-cloudy serous synovial fluid. CBC- Largely WNL Comprehensive metabolic panel, including uric acid- WNL Synovial Fluid Cell Count: WBC 13900 cells/mm-3 RBC 2200 cells/mm-3 Polys 50% Lymph 14% No crystals Glucose 51 mg/dl Protein 4.2 g/dl Fluid culture- No aerobic or anaerobic growth Lyme Western Blot of Fluid: Positive for IgM and IgG FINAL WORKING DIAGNOSIS: Lyme disease TREATMENT AND OUTCOMES: Patient was placed on Doxycycline 100 mg BID for a thirty day course, along with Ibuprofen 800 mg TID, and sent to orthopaedics for further evaluation. Patient was initially with assisted weight bearing, progress as tolerated. The patient subsequently had complete resolution of his symptoms after his course of antibiotics. Complete follow-up pending.

Introduction: Rates of extracorporeal life support (ECLS) for children with critical illness have doubled in the last decade. This increase has been associated with a significant burden of morbidity amongst ECLS survivors. Our objective was to identify demographic, clinical, and ECLS-related variables associated with favorable neurologic and functional outcomes in pediatric survivors of ECLS. Methods: Multicenter retrospective cohort study utilizing the Pediatric ECMO Outcomes Registry (PEDECOR). Survivors of ECLS aged 30 days to 18 years across 10 years (2015-2024) were included. Neonates and those who received cardiopulmonary bypass were excluded. Favorable neurologic and functional outcomes were defined as a change in Pediatric Cerebral Performance Category (PCPC) score or Functional Status Score (FSS) of ≤2 or unchanged from baseline, respectively. Logistic regression models were used to assess the association between study variables and outcomes. Results: Of 139 included patients, 94% had a favorable neurologic outcome and 66% had a favorable functional outcome. ECLS type was a nearly even distribution between Veno-arterial and Veno-venous (48% vs. 52%). Patients with longer median time to cannulation from intubation, primary diagnosis of infection, autoimmune, or multisystem disorder, age ≤ 2 years, and longer median time in the PICU after decannulation had significantly lower odds of favorable functional outcome in the unadjusted analysis (p< 0.05 for all). In the adjusted models, each additional day of ECLS was associated with 30% lower odds of a favorable functional outcome (p< 0.001). Patients who received ECLS for an infectious or autoimmune indication had 96% lower odds of a favorable functional outcome compared to those who received ECLS for a cardiovascular indication (p=0.012). The effect of ECLS duration on functional outcome was modified by age and history of a neurologic disorder. ECLS type was not significantly associated with functional outcome. No study variables were associated with a favorable neurologic outcome. Conclusions: Among pediatric survivors of ECLS, we observed high rates of favorable neurologic and functional outcomes. Factors independently associated with a worse functional outcome were younger age and indications for ECLS due to infectious or autoimmune conditions.