A Knowledge Graph to Understand Nursing Big Data: Case Example for Guidance.

PURPOSE: To provide a summary of research on ontology development in the Centre of eIntegrated Care at Dublin City University, Ireland. DESIGN: Design science methods using Open Innovation 2.0. METHODS: This was a co-participatory study focusing on adoption of health informatics standards and translation of nursing knowledge to advance nursing theory through a nursing knowledge graph (NKG). In this article we outline groundwork research conducted through a focused analysis to advance structural interoperability and to inform integrated care in Ireland. We provide illustrated details on a simple example of initial research available through open access. FINDINGS: For this phase of development, the initial completed research is presented and discussed. CONCLUSIONS: We conclude by promoting the use of knowledge graphs for visualization of diverse knowledge translation, which can be used as a primer to gain valuable insights into nursing interventions to inform big data science in the future. CLINICAL RELEVANCE: In line with stated global policy, the uptake and use of health informatics standards in design science within the profession of nursing is a priority. Nursing leaders should initially focus on health informatics standards relating to structural interoperability to inform development of NKGs. This will provide a robust foundation to gain valuable insights into articulating the nursing contribution in relation to the design of digital health and progress the nursing contribution to targeted data sources for the advancement of United Nations Sustainable Development Goal Three.

Safe Transportation in-Spica Following Surgical Treatment of Infantile DDH: Solutions and Threats.

BACKGROUND: Government regulations mandate appropriate vehicular restraints for children under 4 years of age. Patients treated for infantile developmental dysplasia of the hip (DDH) with spica casts often require special accommodations. Previous work suggests that car seat loaner programs may help achieve these goals while avoiding the need for costly ambulance transportation. The purpose of this study was to evaluate our center's experience with postdischarge transportation in a large population of DDH infants and identify future threats to our program. METHODS: We performed a retrospective review of patients 4 years or younger of age who underwent closed or open reduction for DDH at our center between 2011 and 2018. Only the initial surgery of staged procedures was included. Patient demographic factors were recorded, as were procedure type, final restraint used for postdischarge transportation, and any potential discharge delays secondary to transportation issues. Costs were compared amongst transportation options. RESULTS: Our cohort consisted of 130 patients (mean age, 1.4±0.9 y; 98 females) treated for DDH. In total 41 children (31.5%) underwent closed reduction procedures, whereas 89 patients (68.5%) underwent open reductions. After reduction, 62 (47.7%) received 2-legged spica casts and 68 (52.3%) received 1.5-legged casts. The most common restraint was a hospital-loaned Hippo car seat (73, 55.8%) followed by family-owned car seats (27, 20.8%). Eight patients (6.2%) experienced delays in discharge while waiting for adequate restraints, 6 patients (4.6%) were transported by ambulance, and 4 patients (3.1%) left against medical advice with inadequate restraints. CONCLUSIONS: Following surgical treatment of DDH, over 50% of patients with a spica cast were discharged using our center's car seat loaner program. However, availability and cost can present barriers for patients, with 4.6% of patients still being transported home by ambulance and 3.1% with inadequate restraints against medical advice. Costs of car seats are significant both for patients' families intending to purchase them, as well as for hospitals maintaining loaner programs and replacing used/lost seats. Moving forward, the recent cessation of production of the most common "spica car seat" threatens the longevity of existing loaner programs and calls renewed attention to the issue of safe transportation in-spica from providers and car-seat manufacturers alike. LEVEL OF EVIDENCE: Level III.

Alternative method to determine the hematocrit of red blood cell units: a potential use in the apheresis unit.

BACKGROUND: In automated erythrocytapheresis procedures, achieving the desired-end hematocrit (Hct) requires that the COBE Spectra (CaridianBCT) machine be programmed with the mean Hct of the replacement red blood cell (RBC) units. To determine unit Hct, data derived from quality control (QC) Hct data were utilized. However, if a unit volume is outside the quality control (QC) volume parameters, the unit is accessed to measure its Hct. In this study, 21 percent of all RBC units need to be accessed to determine the Hct, which affects 47.5 percent of patient's erythrocytapheresis procedures. Spiking the unit compromises its integrity and hastens the expiration time of the unit. Nurses must wait until the patient arrives to check units outside QC parameters, thereby delaying the start time of procedures. Even if sampled units are kept refrigerated, they cannot be returned to the blood bank inventory once spiked. The goal of this study was to determine if accurate Hct levels from RBC units could be obtained from a unique segment. STUDY DESIGN AND METHODS: To determine the centrifuged Hct, samples were prepared from the RBC units and compared to that of the unique segment. RESULTS: The Hct of the unique segment exceeded that of the RBC unit by a small (1.2% in AS-1 units, 0.92% in AS-3 units), but statistically significant amount. CONCLUSION: The Hct from unique RBC segments closely approximates that of the original RBC unit. Unique segments can be made that will maintain the integrity and shelf life of RBC units.

Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis.

BACKGROUND: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is associated with significant pain and prolonged hospitalization. There is evidence that early mobilization and multimodal analgesia can accelerate functional recovery and reduced length of stay (LOS). Using these principles, we implemented a quality improvement initiative to enable earlier functional recovery in our AIS-PSF population. METHODS: We designed and implemented a standardized rapid recovery pathway (RRP) with evidence-based management recommendations for children aged 10 to 21 years undergoing PSF for AIS. Our primary outcome, functional recovery, was assessed using statistical process control charts for LOS and average daily pain scores. Our process measures were medication adherence and order set utilization. The balancing measure was 30-day readmission rate. RESULTS: We included 322 patients from January 1, 2011 to June 30, 2015 with 134 (42%) serving as historical controls, 104 (32%) representing our transition population, and 84 (26%) serving as our RRP population. Baseline average LOS was 5.7 days and decreased to 4 days after RRP implementation. Average daily pain scores remained stable with improvement on postoperative day 0 (3.8 vs 4.9 days) and 1 (3.8 vs 5 days) after RRP implementation. In the second quarter of 2015, gabapentin (91%) and ketorolac (95%) use became routine and order set utilization was 100%. Readmission rates did not increase as a result of this pathway. CONCLUSIONS: Implementation of a standardized RRP with multimodal pain management and early mobilization strategies resulted in reduced LOS without an increase in reported pain scores or readmissions.

'Now nobody falls through the net': practitioners' perspectives on the Gold Standards Framework for community palliative care.

The Gold Standards Framework (GSF) seeks to facilitate consistent and high quality community palliative care through a set of guidelines, mechanisms and assessment tools. The present study set out to examine practitioners' perspectives on the GSF during its first national roll-out. Two general practices that had adopted the GSF were recruited in each of four geographical areas, and each matched as closely as possible with a non-GSF practice. Sixty-eight semi-structured telephone interviews were carried out with general practitioners and district nurses in 16 selected practices, along with the GSF facilitator and up to four other 'stakeholders' in each area. Analysis revealed that the majority of GSF participants felt that the framework had strengthened their provision of community palliative care. In particular, communication within primary health care teams and co-ordination of services improved, aspects which were better in the GSF practices than in the matched non-GSF practices. Practitioners felt there was more consistency of care, with a reduced likelihood that individual patients would 'slip through the net'. The most common areas of concern were in relation to the workload associated with the role of the GSF co-ordinator. Implications for the development and effective implementation of the framework and for further research are discussed.