The Minnesota Critical Care Working Group 1: Monitoring and coordinating statewide critical care surge response in the COVID-19 pandemic, March 2020 through July 1, 2021.

Background: In response to the COVID-19 pandemic and as part of the statewide healthcare coalition response the Minnesota Critical Care Working Group (CCWG), composed of Interprofessional leaders from the state's nine largest health systems was established and entrusted to plan and coordinate critical care support for Minnesota from March 2020 through July1, 2021.

Research Question: Can a statewide Critical Care Working Group develop contingency and crisis level surge strategies and indicators in response to the COVID-19 pandemic while evolving into a highly collaborative team?

Study Design And Methods: CCWG members (Intensivists, ethicists, nurses, MDH and MHA leaders) met by audio video conferencing as often as daily assessing COVID and non-COVID hospitalization data, developed surge indicators reflecting contingency versus crisis conditions, and planned responses collaboratively. A foundation of collaboration and teamwork developed which facilitated an effective statewide response.

The Minnesota Critical Care Working Group 2: Crisis Conditions During the COVID-19 Pandemic, July 2021 through March 2022.

Background: The Minnesota Statewide Healthcare Coordination Center requested that the Minnesota Critical Care Working Group (CCWG) and Ethics Working Group (EWG), comprising interprofessional leaders from Minnesota's 9 largest health systems, plan and coordinate critical care operations during the COVID-19 pandemic, including the fall 2021 surge.

Research Question: Can a statewide working group collaboratively analyze real-time evidence to identify crisis conditions and to engage state leadership to implement care processes?

Study Design And Methods: The CCWG and EWG met via videoconferencing during the severe surge of fall 2021 to analyze evidence and plan for potential crisis care conditions. Five sources of evidence informed their actions: group consensus on operating conditions, federal teletracking data, the Medical Operations Coordination Center (MOCC) patient placement data, and 2 surveys created and distributed to hospitals and health care professionals.

Developing LHS scholars' competency around reducing burnout and moral injury.

Unlabelled: Despite the known benefits of supportive work environments for promoting patient quality and safety and healthcare worker retention, there is no clear mandate for improving work environments within Learning Health Systems (LHS) nor an LHS wellness competency. Striking rises in burnout levels among healthcare workers provide urgency for this topic.

Methods: We brought three experts on moral injury, burnout prevention, and ethics to a recurring, interactive LHS training program "Design Shop" session, harnessing scholars' ideas prior to the meeting.

Compromised Integrity, Burnout, and Intent to Leave the Job in Critical Care Nurses and Physicians.

Unlabelled: To describe relationships between compromised integrity (CI), burnout, and intent-to-leave (ITL) practice in critical care (CC) and noncritical care (non-CC) nurses and physicians.

Design: CC nurses (RNs) and physicians (MDs) from the American Medical Association Coping with COVID survey were matched by gender, race, years in practice, and role with non-CC clinicians to determine likelihood of ITL in relation to burnout and CI.

Setting: U.

Low ICU burnout in a safety net hospital.

Objective: Burnout tends to be high in Intensive Care Unit (ICU) settings. Stressors include serious patient illness, round-the-clock acute events, and end of life (non-beneficial) care. We report on an ICU with very low burnout scores.

Associations and outcomes of septic pulmonary embolism.

Background: Septic pulmonary embolism is a serious but uncommon syndrome posing diagnostic challenges because of its broad range of clinical presentation and etiologies.

Objective: To understand the clinical and radiographic associations of septic pulmonary embolism in patients presenting to an acute care safety net hospital.

Methods: We conducted a retrospective analysis of imaging and electronic health records of all patients diagnosed with septic pulmonary embolism in our hospital between January 2000 and January 2013.

Heparin-induced hyperkalemia in a patient diagnosed with thyroid storm.

Objective: To describe a case of heparin-induced hyperkalemia and the role for transtubular potassium gradient (TTKG) to guide fludrocortisone therapy.

Case Summary: A 52-year-old white male developed hyperkalemia after receiving intravenous unfractionated heparin (UFH) for atrial fibrillation during thyroid storm. Admission laboratory results were noteworthy for normal potassium levels, undetectable thyroid-stimulating hormone, and mild transaminitis.

Assessment of the safety, tolerance, and protective effect against diarrhea of infant formulas containing mixtures of probiotics or probiotics and prebiotics in a randomized controlled trial.

Background: Probiotics and prebiotics are considered to be beneficial to the gastrointestinal health of infants.

Objective: The objective was to evaluate infant formulas containing probiotics and synbiotics (combinations of probiotics and prebiotics) for safety and tolerance.

Design: In a prospective, controlled, double-blind, randomized trial, healthy full-term infants were exclusively fed a control formula or study formulas containing Bifidobacterium longum BL999 (BL999) + Lactobacillus rhamnosus LPR (LPR), BL999 + LPR + 4 g/L of 90% galactooligosaccharide/10% short-chain fructooligosaccharide (GOS/SCFOS), or BL999 + Lactobacillus paracasei ST11 (ST11) + 4 g/L GOS/SCFOS from < or = 2 to 16 wk of age (treatment period).

[The worrying rise in the frequency of cesarean section].

The rise in the incidence of Cesarean section over the last thirty years is due to several factors. In particular, maternal age is increasing, parity is declining, and situations potentially requiring Cesarean section are more frequently encountered than before (prematurity, medically assisted procreation, antenatal diagnosis, previous Cesarean section, etc.).

Communication of prognostic information for critically ill patients.

Study Objectives: The purpose of this study was to determine whether the timing of prognostic information delivery by physicians is associated with caregiver satisfaction with communication or decision making in the ICU.

Design: Multicenter, prospective, longitudinal observational study.

Setting: Medical and surgical ICUs in a community and university hospital.