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.

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.

BackgroundThere 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.ObjectiveDevelop a nomogram incorporating 31-GEP with relevant clinical factors to improve prognostic accuracy.MethodsIn 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.ResultsLogistic 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.LimitationsThe 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.ConclusionsIntegration of 31-GEP and T stage can gain clinically useful prognostic information from data obtained noninvasively. 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. Develop a nomogram incorporating 31-GEP with relevant clinical factors to improve prognostic accuracy. 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. 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. 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. 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.

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.