96 Impact and Feasibility of a Pediatric Social Determinants of Health Questionnaire: A Pilot Mixed-Methods Study

Background

Social determinants of health (SDoH)—which are factors such as socioeconomic status (SES), access to transportation, food and housing security, disability and social supports—have been shown to influence up to 50% of health in patients. The project team developed a SDoH Questionnaire which evolved into what is now referred to as BEARS (Barriers to Care, Economic Factors, Adversity, Resiliency, Social Capital). Part of the BEARS Questionnaire includes an optional section for inquiring about Adverse Childhood Experiences (ACEs).

Objectives

The primary purpose of this study was to evaluate the impact and feasibility of the BEARS Questionnaire. Additional objectives were to assess the utility and functionality of the BEARS Questionnaire as a social history-taking tool, including the cumulative ACEs questions, and obtain suggestions for improvement of the tool.

Design/Methods

This was a mixed methods pilot study that consisted of quantitative surveys and qualitative structured interviews with clinicians who had experience using the BEARS Questionnaire. Descriptive statistics were performed on all survey results. Thematic analysis was performed on clinician interviews with recurrent themes being identified through iterative analysis and tagged quotations.

Results

15 clinicians completed the quantitative survey and five took part in a qualitative interview. Study participants included surgeons, pediatricians, speech language pathologists, social workers and nurse clinicians. The BEARS Questionnaire changed clinician practice by increasing the frequency and breadth of social screening in their patients and optimizing care to fit their patients’ social context. Participants described the BEARS as an effective screening tool for SDoH and ACEs that was feasible to implement into their clinic workflow.

Three themes emerged from our interviews: (1) Thorough social history taking highlights family resiliency and improves clinician-patient rapport, (2) Screening for ACEs is acceptable and feasible in a safe clinical environment, and (3) Social screening is feasible in a busy clinical environment and there is room for improvement.

Conclusion

This study highlights the importance of social screening in pediatric patients and their families, and how using a social screening tool allows providers to tailor care for a patients’ social context. The BEARS Questionnaire is feasible to implement within the context of a busy clinic. Finally, despite being a sensitive topic, an ACEs questionnaire can be incorporated when done in a trauma-informed way, and in the context of a longitudinal therapeutic relationship.

P423 REACTION TIME IS CARE TIME: HOW TO ENSURE TO QUALITY AND SAFETY IN HEALTH CARE

Background

Caring cardiac and / or cardiac surgery patient requires specific and specialized skills. Interprofessional collaboration is needed along integrated care pathway. To improve innovation and quality of care services are important the multidisciplinary teamwork, customized patient interventions, continuing nursing training and the use of validated clinical tools shared between Healthcare Team. Nurses have a central role in terms of prevention: Patient monitoring system and multidimensional assessment allow to care and to identify ward patients who are in danger of clinical deterioration. That is important to ensure an appropriate management at an early stage.

Clinical Case

On admission the patient is bright and alert and does not appear to be in distress. His vital signs are normal (MEWS 0). The patient is on therapy with Tirofiban and Furosemide in drips The diagnosis at admission is sub–occlusion of the Common Trunk of the Coronary Artery. After a few hours, the patient report retrosternal heartburn and dyspnoea with spontaneous regression. There aren’t any significant alterations of clinical signs during the symptomatic phase (MEWS 0). However, the nurse decides to continue to monitor the person more frequently compared to the timing of MEWS Protocol. In a short time the nurse finds a progressive clinical instability of the patient, confirmed by an increase in MEWS score.

Treatment

The patient monitoring system and the nursing process of Problem Solving and Decision Making allow to identify patient clinical deterioration at an early stage. For this reason, physicians and the critical care Team discuss about the management plan to guarantee of an appropriate care is provided. They decide to transfer the patient to the Intensive Care Unite, already intubated and ventilated.

Conclusions

The reaction time is important to ensure quality and appropriateness of care, to minimize possible complications and to generate a positive impact on health outcomes, especially in the treatment of time–dependent disease. The experience is also important to promote the development of nurses’ critical–thinking skills, competence and the ability to associate the use of clinical tools to the overall assessment of the person (medical history, clinical pathway and manifestations of the disease).

Volcanic Vortex Rings: Axial Dynamics, Acoustic Features, and Their Link to Vent Diameter and Supersonic Jet Flow

By injecting a mixture of gas and pyroclasts into the atmosphere, explosive volcanic eruptions frequently generate vortex rings, which are toroidal vortices formed by the jet's initial momentum. Here, we report high-speed imaging and acoustic measurements of vortex rings sourcing from gas-rich eruptive jets at Stromboli volcano (Italy). Volcanic vortex rings (VVRs) form at the vent together with an initial compression acoustic wave, VVRs maximum rise velocity being directly proportional to the amplitude and inversely proportional to the duration of the compression wave. The axial rise and acoustic signature of VVRs match well those predicted by recent fluid-dynamic experiments. This good match allows using the high-frequency (80-1,000 Hz) component of the jet sound and the time-dependent rise of VVRs to retrieve two key eruption parameters: the Mach number of the eruptive jets (<1.5) and vent diameter (∼0.7 m), respectively, the latter being confirmed independently by direct Uncrewed Aerial Vehicle observations.

Surface ruptures database related to the 26 December 2018, MW 4.9 Mt. Etna earthquake, southern Italy

We provide a database of the surface ruptures produced by the 26 December 2018 Mw 4.9 earthquake that struck the eastern flank of Mt. Etna volcano in Sicily (southern Italy). Despite its relatively small magnitude, this shallow earthquake caused about 8 km of surface faulting, along the trace of the NNW-trending active Fiandaca Fault. Detailed field surveys have been performed in the epicentral area to map the ruptures and to characterize their kinematics. The surface ruptures show a dominant right-oblique sense of displacement with an average slip of about 0.09 m and a maximum value of 0.35 m. We have parsed and organized all observations in a concise database, with 932 homogeneous georeferenced records. The Fiandaca Fault is part of the complex active Timpe faults system affecting the eastern flank of Etna, and its seismic history indicates a prominent surface-faulting potential. Therefore, this database is essential for unravelling the seismotectonics of shallow earthquakes in volcanic areas, and contributes updating empirical scaling regressions that relate magnitude and extent of surface faulting.

Anomalous Discharge of Endogenous Gas at Lavinio (Rome, Italy) and the Lethal Accident of 5 September 2011

The Rome region contains several sites where endogenous gas is brought to the surface through deep reaching faults, creating locally hazardous conditions for people and animals. Lavinio is a touristic borough of Anzio (Rome Capital Metropolitan City) that hosts a country club with a swimming pool and an adjacent basement balance tank. In early September 2011, the pool and the tank had been emptied for cleaning. On 5 September, four men descended into the tank and immediately lost consciousness. On 12 August 2012, after a long coma the first person died, the second one reported permanent damage to his central nervous system, and the other two men recovered completely. Detailed geochemical investigations show that the site is affected by a huge release of endogenous gas (CO2 ≈ 96 vol.% and H2S ≈ 4 vol.%). High soil CO2 and H2S flux values were measured near the pool (up to 898 and 7.155 g·m-2·day-1, respectively), and a high CO2 concentration (23-25 vol.%) was found at 50-70 cm depth in the soil. We were able to demonstrate that gas had been transported into the balance tank from the swimming pool through two hubs connected to the lateral overflow channels of the pool. We show also that the time before the accident (60 hr), during which the balance tank had remained closed to external air, had been largely sufficient to reach indoor nearly lethal conditions (oxygen deficiency and high concentration of both CO2 and H2S).

Quality of local school wellness policies for physical activity and resultant implementation in Pennsylvania schools

Background

In 2006, United States public schools participating in federal school meal programs were required to adopt school wellness policies. The effect of these policies on school nutrition environments is well documented; however, evaluation of physical activity policies has received less investigation. We aimed to evaluate how district wellness policies aligned to practice for physical activity implementation in 40 schools with high obesity rates (>24%).

Methods

Wellness policies were evaluated using the validated Wellness School Assessment Tool (WellSAT). Concurrently, schools completed the validated Alliance for a Healthier Generation's Healthy Schools Program (HSP) self-assessment to evaluate physical activity practices. Overall, 13 of 20 physical activity measures from WellSAT and 12 of 13 physical activity measures from HSP were aligned to match policy with practice.

Results

Most policy items scored 0 or 1, indicating either 'no mention in the policy' or 'containing weak or vague language'. Corresponding HSP results indicated that school physical activity practices are 'not in place' or 'under development'. A strong, positive, correlation (r = 0.92, P < 0.001) indicated that a significant relationship exists between policy and implementation.

Conclusions

Results indicate that most districts currently have weak policies regarding physical activity, limiting the potential to positively influence school-based physical activity.

Acute oxygen supplementation does not relieve the impairment of respiratory muscle strength in hypoxemic COPD

STUDY OBJECTIVES

To verify whether hypoxemia affects respiratory muscle strength in the absence of malnutrition and whether such effect, if present, is reversible with an acute oxygen supplementation.

DESIGN

Case series analysis, before-after trial.

SETTING

Outpatient pneumology departments of two university hospitals.

PATIENTS

One hundred twenty patients affected by COPD in stable conditions having actual to ideal body weight ratio of > or =90%.

MEASUREMENTS AND RESULTS

Maximal inspiratory pressure (MIP) was measured at functional residual capacity level in the whole sample of subjects and during oxygen supplementation in 58 patients having a PaO2< or =60 mm Hg when breathing in room air. Predictors of MIP were assessed by a multivariate analysis. MIP values before and after oxygen supplementation were compared by a paired t test. MIP was independently correlated with FVC (p<0.001), PaO2 (p<0.01), and age (p<0.01). In the subgroup of hypoxemic patients, MIP values did not change significantly after oxygen supplementation (3.08+/-1.74 vs 3.03+/-1.91 kPa, t=0.43, not significant).

CONCLUSIONS

Hypoxemia is an important negative correlate of MIP even in well-nourished COPD patients. Its effect is not reversible with an acute oxygen supplementation.

A case of pediatric systemic lupus erythematosus with early onset and unusual serologic and clinical findings

The authors report on a case of Pediatric Systemic Lupus Erythematosus (SLE) in a female child aged 3 1/2 with a set of peculiar clinical and serologic characteristics; early onset of the disease, non-specific clinical signs, high serum levels of IgG and a clinical course characterized by the absence of renal neurological and articular involvement.

Endothelium-dependent vasorelaxation caused by various plant extracts

In a previous study (Am J Physiol 1993;265: H774-8), we found that certain red wines and other grape products caused endothelium-dependent vasorelaxation. In the present study, aqueous extracts of a variety of vegetables, fruits, teas, nuts, herbs, and spices were tested for their endothelium-dependent relaxing ability in vitro. Rings of rat aorta, with or without an intact endothelium, were mounted in tissue baths, contracted with phenylephrine, and then exposed to diluted plant extracts. Many, but not all, extracts exhibited endothelium-dependent relaxations that were reversed by NG-monomethyl-L-arginine, a nitric oxide synthase inhibitor, which suggested involvement of nitric oxide, the endothelium-derived relaxing factor in the response. Furthermore, extracts that caused relaxation also increased tissue levels of cyclic GMP, the mediator of nitric oxide-induced vascular smooth-muscle relaxation. These results may lend further support to mounting evidence that plant foods contain compounds that, if absorbed intact and in sufficient quantities, could conceivably be beneficial in prevention of cardiovascular disease.

Experimental investigation of temperature gradients in the inner ear following argon laser exposure

In microsurgery of the middle ear using argon laser, heat is produced on the sensorineural structures adjacent to the irradiated bones. Thermal gradients following laser applications have been measured by means of special thermocouples. The footplate was perforated by a 50 msec. ray applied both at 380 mWatt and at 460 mWatt. The maximum temperature increase registered in the labyrinthine spaces was respectively 2 degrees C. and 3.5 degrees C. Coagulation of the promontory mucosa was performed using 100 msec. impulses at 200 mWatt. At the end of a series of 12 applications the temperature increase at the level of the basal coil was 1.4 degrees C. From the above results the authors conclude that no damage is induced during laser microsurgery and that, considering the power and time values relative to impulses, the use of laser in routine clinical practice should be relatively safe.