Standardized mapping of nursing assessments across 59 U.S. military treatment facilities.

OBJECTIVE: Create an interoperable set of nursing flowsheet assessment measures within military treatment facility electronic health records using the 3M Healthcare Data Dictionary (HDD). DESIGN: The project comprised three phases: 1) discovery included an in-depth analysis of the Essentris data to be mapped in the HDD; 2) mapping encompassed the creation of standard operating procedures, mapping heuristics, and the development of mapping tools; and 3) quality assurance incorporated validation of mappings using inter-rater agreement. RESULTS: Of 569,073 flowsheet concepts, 92% were mapped to the HDD. Of these, 31.5% represented LOINC concepts, 15% represented SNOMED CT and 1% represented both. 52.5% were mapped to HDD concepts with no standardized terminology representations. CONCLUSIONS: Nursing flowsheet data can be mapped to standard terminologies but there is not the breadth of coverage necessary to represent nursing assessments. Future work is necessary to develop a standard information model for the nursing process.

Achieving "meaningful use" of electronic health records through the integration of the Nursing Management Minimum Data Set.

OBJECTIVE: To update the definitions and measures for the Nursing Management Minimum Data Set (NMMDS). BACKGROUND: Meaningful use of electronic health records includes reuse of the data for quality improvement. Nursing management data are essential to explain variances in outcomes. The NMMDS is a research-based minimum set of essential standardized management data useful to support nursing management and administrative decisions for quality improvement. METHODS: The NMMDS data elements, definitions, and measures were updated and normalized to current national standards and mapped to LOINC (Logical Observation Identifier Names and Codes), a federally recognized standardized data set for public dissemination. RESULTS: The first 3 NMMDS data elements were updated, mapped to LOINC, and publicly disseminated. CONCLUSIONS: Widespread use of the NMMDS could reduce administrative burden and enhance the meaningful use of healthcare data by ensuring that nursing relevant contextual data are available to improve outcomes and safety measurement for research and quality improvement in and across healthcare organizations.

Integrating the nursing management minimum data set into the logical observation identifier names and codes system.

This poster describes the process used to integrate the Nursing Management Minimum Data Set (NMMDS), an instrument to measure the nursing context of care, into the Logical Observation Identifier Names and Codes (LOINC) system to facilitate contextualization of quality measures. Integration of the first three of 18 elements resulted in 48 new codes including five panels. The LOINC Clinical Committee has approved the presented mapping for their next release.

Endothelial cell recovery between comparator polymer-based drug-eluting stents.

OBJECTIVES: The purpose of this study was to assess trends in endothelial coverage and recovery among leading polymer-based drug-eluting stents (DES). BACKGROUND: Autopsy studies of human U.S. Food and Drug Administration (FDA)-approved DES implanted coronary arteries suggest that complications of late stent thrombosis are associated with incomplete endothelial coverage of struts. METHODS: Rabbits received sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES), zotarolimus-eluting stents (ZES), and everolimus-eluting stents (EES) for 14 or 28 days along with MULTI-LINK (ML) Vision control stents. Endothelial coverage above and between struts was measured by morphometric analysis of images acquired through en face scanning electron microscopy. Dual fluorescent immunolabeling was performed for platelet-endothelial cell adhesion molecule (PECAM)-1 and thrombomodulin (TM), factors involved in cell-to-cell contact and thrombogenicity, respectively. In a separate analysis, the endothelial mitogen, vascular endothelial growth factor (VEGF), was also assessed. RESULTS: Varying rates of endothelialization among comparator DES were most notable at 14 days, where coverage above struts remained poor in SES, PES, and ZES (or=70%), whereas no significant differences were observed at 28 days. Select DES with poor endothelialization showed a further reduced expression of PECAM-1. All DES showed an absence or weak expression of the antithrombotic cofactor TM. Incomplete endothelialization in select DES was further associated with increased VEGF secretion and messenger ribonucleic acid levels at 14 days, providing evidence of a transitional healing surface. CONCLUSIONS: The present study marks the first comparator analysis of endothelial coverage in leading polymeric DES, supporting disparities in arterial healing based on endothelial regrowth and recovery, favoring newer designs over the current generation of FDA-approved stents.

Sustained reduction of in-stent neointimal growth with the use of a novel systemic nanoparticle paclitaxel.

BACKGROUND: Paclitaxel (PXL)-eluting stents in animals cause incomplete healing and, in some instances, a lack of sustained suppression of neointimal growth. The present study tested the efficacy of a novel systemic delivery nanoparticle PXL for reducing in-stent restenosis. METHODS AND RESULTS: A saline-reconstituted formulation of PXL stabilized by albumin nanoparticles (nPXL) was tested in 38 New Zealand White rabbits receiving bilateral iliac artery stents. Doses of nPXL (1.0 to 5.0 mg/kg) were administered as a 10-minute intra-arterial infusion; control animals received vehicle (0.9% normal saline). In a follow-up chronic experiment, nPXL 5.0 mg/kg was given at stenting with or without an intravenous 3.5-mg/kg repeat nPXL dose at 28 days; these studies were terminated at 3 months. At 28 days, mean neointimal thickness was reduced (P< or =0.02) by doses of nPXL > or =2.5 mg/kg with evidence of delayed healing. The efficacy of a single dose of nPXL 5.0 mg/kg, however, was lost by 90 days. In contrast, a second repeat dose of nPXL 3.5 mg/kg given 28 days after stenting resulted in sustained suppression of neointimal thickness at 90 days (P< or =0.009 versus single dose nPXL 5.0 mg/kg and controls) with nearly complete neointimal healing. CONCLUSIONS: Although systemic nPXL reduces neointimal growth at 28 days, a single repeat dose was required for sustained neointimal suppression. Thus, this novel systemic formulation of PXL may allow adjustment of dose at the stent treatment site and prove to be a useful adjunct for the clinical prevention of in-stent restenosis.